Instruction: Generate impression based on findings.

Input: Left-sided ulcerative colitis. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Mild inflammatory changes of the rectum. The bowel is otherwise normal in appearance. Specifically, the terminal ileum is normal in caliber and without inflammatory changes. There is no abscess, fistula or perforation.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Mild inflammatory changes of the rectum. The bowel is otherwise normal in appearance. Specifically, the terminal ileum is normal in caliber and without inflammatory changes. There is no abscess, fistula or perforation.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Mild inflammatory changes of the rectum. No other abnormality identified.


Instruction: Generate impression based on findings.

Input: Cirrhosis of the liver without mention of alcohol, assess for HCC ABDOMEN:LIVER, BILIARY TRACT: Cirrhosis and perihepatic ascites. Scattered T2 hyperintense foci but no arterially enhancing lesion. Portal vein is patent.SPLEEN: Splenomegaly.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral simple renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Side to side bowel anastomosis in the right lower quadrant.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Upper abdominal varices.

Output: Cirrhosis without evidence to suggest HCC.


Instruction: Generate impression based on findings.

Input: Ms. Diaz is a 35 year old female with a strong family history of breast cancer (mother diagnosed at the age of 32, three maternal aunts and a paternal aunt). Personal history of benign right breast MR guided biopsy in 2010 for papilloma. There is scattered fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. Artifact from the right central breast biopsy clip is again noted.No abnormal axillary lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: assess sinuses, aspergillus: sinusitis. There are postoperative findings related to prior sinonasal debridement. However, there is diffuse pansinus mucosal enhancement and debris that displays low T2 and intermediate T1 signal. The enhancement along the walls of the sphenoid sinuses extend to the planum sphenoidale and anterior sella, where there are corresponding bony dehiscences that are more clearly depicted on CT. There are also dehiscences in the bilateral lamina papyracea and nasolacrimal ducts, with persistent enlargement of the left lacrimal sac, but no gross intraorbital extension, although the images are not optimized for the evaluation of the orbits. However, the left optic nerve canal is narrowed secondary to reactive thickening of the adjacent bone, which is also more clearly depicted on the prior CT. There is no evidence of intracranial abscess. There is no midline shift or herniation.

Output: 1. Postoperative findings related to prior sinonasal debridement with persistent extensive diffuse pansinus fungal disease.2. Inflammation along the walls of the sphenoid sinuses extend through bony dehiscences at the planum sphenoidale and anterior sella, which are more clearly depicted on CT. 3. Dehiscences in the bilateral lamina papyracea and nasolacrimal ducts, with persistent enlargement of the left lacrimal sac, but no gross intraorbital extension, although the images are not optimized for the evaluation of the orbits.4. The left optic nerve canal is significantly narrowed due to what appears to be reactive thickening of the adjacent bone. This is also more clearly depicted on the prior CT.


Instruction: Generate impression based on findings.

Input: Anesthesia of skin [R20.0], Reason for Study: ^Reason: patient has sensory abn from Level C8 down. rule out myelitis and MS. NL GFR 1/5/2016 History: sensory abn from L C8 down with brisk DTRs Brain MRIThere is no evidence of acute ischemic or hemorrhagic lesion.There is no abnormal enhancement.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.C spine MRIThere is normal cervical lordosis. The cranial-cervical junction is normal. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The cord signal is normal. The epidural space, thecal sac, and spinal cord are preserved with no evidence of spinal canal/neural foraminal stenosis, cord compression or myelopathy. There is no evidence of abnormal enhancement.

Output: 1. Normal brain MRI2. Normal cervical spine MRI


Instruction: Generate impression based on findings.

Input: Limited images the brain were acquired per the Stealth protocol. There is no evidence of intracranial mass. There are no areas of abnormal parenchyma signal or enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The sella is again partially empty. There is protrusion of the bilateral optic nerve discs as well as mild posterior flattening of the globes. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable.

Output: Examination for treatment planning. No intracranial mass or abnormal lesions along the expected tract of the ventriculostomy catheter. Findings suggestive of pseudotumor cerebri.


Instruction: Generate impression based on findings.

Input: Dizziness and giddiness [R42], Reason for Study: ^Reason: stroke, embolus History: dizziness, gait unsteadiness, blurred vision79 years Female (DOB:8/28/1937)Reason: see mra neck History: see mra neckPROVIDER/ATTENDING NAME: MICHAEL ANDREW WARD DAVID G. BEISER Brain MRINo evidence of acute ischemic or hemorrhagic lesion.Multifocal scattered FLAIR/T2 high signal intensity lesions on bilateral periventricular white matter and centrum semiovale indicate non specific small vessel ischemic disease.The ventricles, sulci and cisterns are unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal.Neck MRA3D MRA neck non contrast TOF images with maximum intensity projections of the cervical vasculature demonstrate limited view especially aortic arch level, however, no evidence of significant luminal stenosis or occlusion. The vertebral artery origins cannot be evaluated. There is no definitive evidence of abnormal finding on bilateral common carotid, carotid bifurcations, internal/external carotid.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. Non specific small vessel ischemic disease.3. Normal brain MRA.4. Limited examination for neck MRA but no definitive evidence of abnormality. This is due to technical limitation of non contrast MRA of neck, thus if clinically indicated, neck CTA or contrast enhanced MRA can be considered.


Instruction: Generate impression based on findings.

Input: 23-year-old male with right knee pain and swelling for 3 weeks s/p twisting injury. History of ACL and lateral meniscus tears repaired in 2012. MENISCI: There is loss of the expected configuration of the posterior horn of the lateral meniscus, which is replaced by meniscal fragments and fluid. Findings are suspicious for re-tear. The medial meniscus and the anterior horn of the lateral meniscus are unremarkable.ARTICULAR CARTILAGE AND BONE: Loss of lateral compartment articular cartilage overlying the torn posterior horn of the lateral meniscus. The remaining articular cartilage within the knee joint is unremarkable. Mild bone marrow edema is noted in the lateral femoral condyle.LIGAMENTS: Postsurgical changes status post ACL reconstruction with intact graft. The PCL and collateral ligaments are intact.EXTENSOR MECHANISM: The extensor tendons are intact.ADDITIONAL

Output: Findings compatible with re-tear of the posterior horn of the lateral meniscus, with loss of overlying articular cartilage and mild associated bone marrow edema.


Instruction: Generate impression based on findings.

Input: Shoulder mass ROTATOR CUFF: There is minimal increased signal within the distal fibers of the supraspinatus indicating minimal tendinosis. Otherwise rotator cuff is intact.SUPRASPINATUS OUTLET: Minimal osteoarthritis affects the acromioclavicular joint. There is no significant subacromial subdeltoid fluid .GLENOHUMERAL JOINT AND GLENOID LABRUM: No significant abnormality noted.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: Lobulated predominantly fatty mass within the subcutaneous tissues of the shoulder demonstrate some heterogeneous T2 signal and enhancement and as a result, the possibility of an underlying low-grade malignancy cannot be excluded. The location and appearance is amenable to ultrasound-guided biopsy but referral to orthopedic surgery (Dr. R. Haydon) is recommended. These findings were discussed directly with the ordering physician Dr. A. Beckerly at the time of interpretation.


Instruction: Generate impression based on findings.

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

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


Instruction: Generate impression based on findings.

Input: History of renal cancer. Evaluate for metastatic disease. ABDOMEN:LIVER, BILIARY TRACT: Normal hepatic morphology without focal suspicious lesion. Cholelithiasis within a normally distended gallbladder. No biliary ductal dilatation. Segment VI septated 1 cm cyst.SPLEEN: No significant abnormality noted.PANCREAS: Mild fatty atrophy.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Status post right nephrectomy. Postsurgical changes of a partial left nephrectomy of the lateral interpolar region. No evidence of tumor recurrence in the surgery. No regional lymphadenopathy. Several simple left renal cysts are present, unchanged.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: Postsurgical changes without evidence of metastases or suspicious lesions.


Instruction: Generate impression based on findings.

Input: Female 44 years old; Reason: evaluate for sacral osteo History: sacral decubitus ulcers, infected, deep to bone BONE MARROW: Abnormal T1 and T2 prolongation involving the left ischium compatible with osteomyelitis which is slightly increased from prior. There is also cortical irregularity in the area. There is gas and fluid that extends up to the cortical surface.There is a new deep ulcer involving the right ischium with mild edematous changes in the right ischium without definite T1 changes or definite cortical erosion.SOFT TISSUES: Severe body wall anasarca. Deep ulcers adjacent to the ischium bilaterally (left larger than right). Perirectal soft tissue edema and possible ulcer.Percutaneous bladder catheter. There is severe muscle atrophy of the gluteal muscles. There is severe body wall anasarcaJOINTS: Bilateral chronic hip dysplastic changes with osteoarthritis.ADDITIONAL

Output: Findings compatible with osteomyelitis of the left ischium with marrow changes.New right deep ulcer with marrow edema of the ischium but no T1 changes overall findings are suggestive of reactive osteitis.


Instruction: Generate impression based on findings.

Input: 18-year-old female with locked left knee. Several sequences are limited by patient motion artifact.MENISCI: We see no bucket handle tear. The anterior horn of the medial meniscus divides into two separate structures at its root, which could conceivably represent a chronic vertical tear, although we suspect this represents normal variant anatomy for this patient. ARTICULAR CARTILAGE AND BONE: We see no fluid-filled articular cartilage defects. There is moderate synovitis of the knee, particularly posteriorly with a joint effusion concentrated anteriorly in the knee. Multiple foci of rounded and bandlike low signal intensity in the suprapatellar pouch and also in the posterior knee may represent a combination of thickened synovial folds and debris, although we see no discrete articular cartilage defect. There is mild irregularity of the posterolateral surface of the lateral femoral condyle, which may represent early erosion. There also appear to be small erosions around the margin of the tibial plateau. There is mild marrow edema underlying these suspected erosions. LIGAMENTS: Cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: Extensor mechanism is intact.ADDITIONAL

Output: 1.Surgical changes of prior arthroscopy.2.Synovitis of the knee with what appear to be small erosions. This may represent an inflammatory arthritis or less likely synovial chondromatosis. Conventional radiographs are recommended for further evaluation.3.No bucket handle tear is evident. Other findings as above.


Instruction: Generate impression based on findings.

Input: Clinical question: Preop for brain biopsy. Signs and symptoms: Preop for brain biopsy. Pre-and post-enhanced fusion brain MRI:Examination is performed as a surgical guidance and is not a complete diagnostic test.Examination demonstrate extensive patchy foci of T2 hyperintensity in the subcortical and periventricular white matter as well as bilateral basal ganglia, thalami, midbrain and pons without change since prior exam from 3 -- 7 -- 15. There is no detectable abnormal parenchymal or leptomeningeal enhancement. This is a similar observation is prior to study. Mild prominence of lateral ventricles with maintained midline also remains similar to prior exam. The signal void of major intracranial arterial branches are identified.The signal intensity and pattern of enhancement of the intracranial venous sinuses are within normal.There is a tiny subcutaneous nodule of increased T2 signal intensity measuring approximately 8mm in size in the right temporal scalp similar to prior study.

Output: Surgical planning exam as detailed above and without evidence of any change since prior diagnostic pre and post enhanced brain MRI from 3 -- 7 -- 50


Instruction: Generate impression based on findings.

Input: Questioning abnormal findings on CT-scan: new daily persistent headache. There is a punctate focus of susceptibility effect in the right frontal lobe anterior periventricular white matter. There are also a few scattered punctate foci of high T2 signal predominantly in the white matter of the bilateral frontal lobes. There is no evidence of acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: A punctate focus of susceptibility effect in the right frontal lobe anterior periventricular white matter corresponds to the nonspecific calcification demonstrated on the prior CT and may represent a cavernous malformation, for example. A few scattered punctate foci of high T2 signal predominantly in the white matter of the bilateral frontal lobes are also nonspecific.


Instruction: Generate impression based on findings.

Input: Diagnosis: Secondary malignant neoplasm of brain and spinal cordClinical question: history of head and neck SCCa with single brain metastasis s/p resection and adjuvant SRS; surveillance MRISigns and Symptoms: brain metastases The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a punctate focus of diffusion restriction present at the right caudate nucleus new since prior exam. There is no associated contrast enhancement.Patient is status post left temporal craniotomy. There is some minor signal change present in the inferior aspect of the left temporal lobe measuring 8 x 10 mm axial dimensions which is associated with a low but of the susceptibility effect but no enhancement following gadolinium administration.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. These are stable compared to the previous exam.There is a periventricular punctate focus of signal hypointensity in the right centrum semiovale on susceptibility weighted imaging which was also present on the prior exam and is unchanged.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. There is a developmental venous anomaly present in the left centrum semiovaleThe visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.A small punctate lesion in the right caudate nucleus is suspected to most likely represent a microinfarct. A follow-up exam may be helpful to further evaluate this.2.Status post left temporal lobe surgery.3.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. They are stable compared to the prior exam.


Instruction: Generate impression based on findings.

Input: A 42 year old female with cardiac arrest and deep brain damage referred to cardiac MRI to evaluate cardiac etiology Left VentricleThe left ventricle is normal in size with hyperdynamic systolic function. There is mild global hypertrophy (LV wall thickness 12-13 mm). The overall LV ejection fraction is 71%, the LV end diastolic volume index is 37 ml/m2 (normal range: 65+/-11), the LVEDV is 124 ml (normal range 109+/-23), the LV end systolic volume index is 10 ml/m2 (normal range 18+/-5), the LVESV is 35 ml (normal range 31+/-10). 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 normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 61%, the RV end diastolic volume index is 44 ml/m2 (normal range 69+/-14), the RVEDV is 151 ml (normal range 110+/-24), the RV end systolic volume index is 18 ml/m2 (normal range 22+/-8), and the RVESV is 59 ml (normal range 35+/-13). No RV wall motion abnormalities are noted.Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThere are small BL pleural effusions. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with hyperdynamic systolic function. There is mild global hypertrophy. The LVEF is 71%. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.2. The right ventricle is normal in size with normal systolic function. The RVEF is 61%. No RV wall motion abnormalities.3. No MRI evidence for RV dysplasia or HCM.


Instruction: Generate impression based on findings.

Input: Sarcoid versus inflammatory muscle disease. Cervical:Examination is mildly motion degraded which limits evaluation for subtle cord signal abnormalities. No definite signal abnormality within the cervical cord is however appreciated. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained. Bone marrow signal is benign. Mild degenerative changes are seen throughout the cervical spine with small disc osteophyte complexes and mild bilateral facet arthropathy. Individual levels as below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: No significant compromise to the spinal canal or neural foramina.C4-5: No significant compromise to the spinal canal or neural foramina.C5-6: No significant compromise to the spinal canal or neural foramina.C6-7: No significant compromise to the spinal canal or neural foramina.C7-T1: No significant compromise to the spinal canal or neural foramina. Small bilateral perineural cysts incidentally noted in the neural foramina.Paraspinous soft tissues are unremarkable.Lumbar:Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign. T1 hyperintense lesion involving the L5 vertebral body is consistent with a hemangioma. The conus medullaris is normal in position. Perineural cyst at the right S2 level is incidentally noted.Individual levels as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: No significant disc disease. No spinal canal or neural foraminal stenosis.L4-L5: No significant disc disease. No spinal canal or neural foraminal stenosis.L5-S1: No significant disc disease. No spinal canal or neural foraminal stenosis.There is asymmetrically increased edema involving the paraspinous musculature on the left, best seen on the sagittal STIR sequence.

Output: 1. No evidence of cervical cord signal abnormality. There are mild degenerative changes throughout the cervical spine without significant spinal canal or neural foraminal stenosis at any level. 2. No spinal canal or neural foraminal stenosis in the lumbar spine.3. If there is high concern for leptomeningeal disease in the spine related to an inflammatory process, post gadolinium sequences may be considered. 4. There is edema involving the lumbar paraspinous musculature on the left.


Instruction: Generate impression based on findings.

Input: Headache. Rule out bleed/mass. Areas of high-density line the ependyma of the frontal horns of the lateral ventricles bilaterally with associated edema that crosses the corpus callosum. The lateral ventricles appear enlarged while the third and fourth ventricle are normal in appearance indicating mass effect at the level of the foramen of Monro. There is prominence of the pineal gland. These findings are highly suspicious for lymphoma. A germ cell tumor is in the differential but less likely. An MRI is recommended for further evaluation.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.These findings were discussed with Dr. Glickman at the time of interpretation.

Output: Lateral ventricular enlargement with high density lining the ependyma and edema crossing the corpus callosum is highly suggestive of lymphoma, with a germ cell tumor also in the differential. An MRI is recommended for further evaluation.


Instruction: Generate impression based on findings.

Input: 50 year-old female with history of pharynx cancer, melanoma. Evaluate for recurrence. Rule out long metastases CT of soft tissues of the neck with infusion:Images through the skull base and including cavernous sinuses remain within normal limits. Mastoid air cells and paranasal sinuses are unremarkable.Images through the neck demonstrate extensive posttherapy and surgical changes on the left side of the neck.Postoperative changes at the level of the left hypopharyngeal wall, left submandibular region and extending to the floor of the mouth and region of the left piriform sinus is associated with some soft tissue fullness in these regions. In comparison with the prior examination there is suggestion of possible slight reduction in the amount of soft tissue fullness in history area. I detect no definitive tumor in this location. Significant distortion of the anatomical landmarks and soft tissue adhesion in the surgical site makes precise evaluation difficult with however as mentioned above no definitive evidence of tumor is detected. This recurrence of tumor is concerned follow up with PET scan or an MRI is recommended. A submental node in the midline is again identified and measures 12.2 x 13.4-mm which is identical to prior examination.No evidence of any pathologic adenopathy in the neck is detected. The bony structures of the area of exam are unremarkable.Limited images of the apices of the lungs demonstrate minimal apical scarring.Limited view of mediastinum is negative. Please review the dictated report of CT of chest performed the same date.CT of brain with infusion:Examination demonstrate no abnormal enhancement of the brain parenchyma or leptomeninges. Cortical sulci, ventricular system and all CSF cisterns remain within normal. Calvarium is intact. No definitive evidence of any abnormality of the soft tissues of the scalp is identified60 CT of Omnipaque 350 was utilized for the above studies.

Output: 1.No detectable tumor or or pathologic adenopathy in the neck.2.Stable prominent submental node as detailed.3.Negative CT of brain and calvarium with infusion.


Instruction: Generate impression based on findings.

Input: History of arachnoid cyst. Yearly follow up to evaluate change in size. There is redemonstration of a cystic lesion centered on the right aspect of the quadrigeminal plate cistern measuring 3.2 x 2.4 cm, which is unchanged in size. The lesion follows CSF signal characteristics on all sequences. There is no nodularity within the lesion. There is associated significant flattening of the right posterolateral midbrain and the right cerebellar vermis to a similar degree as prior exams. The cerebral aqueduct remains effaced, however, the ventricles are unchanged in size and configuration.There is no evidence of intracranial hemorrhage or acute infarct. The brain parenchyma appears unremarkable. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable. There is left maxillary sinus mucosal thickening and some fluid within the left mastoid air cells. There is prominence of the adenoid tonsillar tissue which can be normal in this age group.

Output: No significant change in size or appearance of a cystic lesion occupying the right aspect of the quadrigeminal plate cistern, most compatible with an arachnoid cyst.


Instruction: Generate impression based on findings.

Input: 69-year-old male with acute hip pain and leukocytosis, evaluate for septic hip There is enhancing reticulation along the anterolateral subcutaneous fat of the pelvis, hip and upper thigh indicating inflammation. There is edema and heterogeneous enhancement of the gluteus medius muscle containing branching nonenhancing foci seen on the small field of view post contrast images of the right hip. This process extends superiorly off the field of view on these images, but the edema seen within the muscle on the large field-of-view images extends to the muscle origin. The posterior fibers of the gluteus medius muscle are relatively spared. As seen on the prior CT, there is crescentic edema/fluid deep to the tensor fascia lata and iliotibial band and superficial to the vastus lateralis muscle which extends inferiorly off the field-of-view of this study. This edema/fluid extends posteriorly along the greater trochanter and deep to the gluteus maximus muscle. There is also edema and mild enhancement of the adductor musculature of the hip and perhaps a tiny focal collection without rim enhancement along the posterior aspect of the adductor brevis, which may represent confluent edema. There is also minimal edema of the contralateral adductor musculature at the pubic origin. Bone marrow signal intensity is within normal limits without findings to suggest osteomyelitis. Facet arthropathy affects the lower lumbar spine. There is no joint effusion or findings to suggest synovitis of the hips or sacroiliac joints.

Output: Edema and heterogeneous enhancement of the gluteus medius muscle is nonspecific but could represent pyomyositis. There is also confluent edema/fluid seen on the large field-of-view images extending inferiorly down the lateral aspect of the thigh, deep to the iliotibial band with additional inflammatory changes as described above. No discrete drainable fluid collections are present. The possibility of infection, including necrotizing fasciitis, cannot be excluded on the basis of this study. Please note that the postcontrast images of this exam are limited to a small field-of-view centered at the hip and if further imaging is clinically warranted, the patient may return for additional postcontrast images with extended coverage (we attempted to have the patient called back for further imaging, but we were notified that the patient was on his way to surgery).


Instruction: Generate impression based on findings.

Input: Finger swelling and pain Just volar to the PIP joint of the middle finger is a well-defined cystic lesion measuring 1.2 x 1.3 x 0.7 cm in the greatest craniocaudal, transverse, and AP dimensions. This lesion is hyperintense on T2 sequences, hypointense on T1 sequences, and demonstrates no significant central or solid enhancement. There is a large amount of immediate surrounding soft tissue edema largely overlying the volar tissues of the middle finger. There is mildly increased signal and thickening of the flexor digitorum tendons of the middle finger and a small amount of fluid also surrounds the tendon with fibers that are otherwise intact. A trace amount of fluid also surrounds the flexor tendons of the ring finger.The marrow signal of the hand is normal without abnormality, specifically no evidence of fracture or bony destruction.

Output: 1. Tenosynovitis of the flexor digitorum tendons of the middle finger.2. Cystic lesion volar to the PIP joint of the middle finger most likely represents a small ganglion cyst.


Instruction: Generate impression based on findings.

Input: History of Crohn's disease with headache and suspected infliximab-induced lupus like reaction. There are scattered areas of fine leptomeningeal enhancement and T2 hyperintensity, which appears to be vascular in nature, predominantly in the posterior bilateral cerebral hemispheres. There is no evidence of intracranial hemorrhage, mass, abscess, or acute infarct. The brain, brainstem, cerebellum, and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Scattered leptomeningeal abnormality vasculature, predominantly in the posterior bilateral cerebral hemispheres, may represent a drug-induced vasculitis, without evidence of acute infarction. A brain MRA may be useful for further evaluation, nevertheless.


Instruction: Generate impression based on findings.

Input: Reason: L hand swelling and pain, r/o abscess History: see above. Lobulated and septated collection of near-fluid to fluid signal intensity within the soft tissue surrounding the metacarpophalangeal joint of the index finger. Overall, the collection is approximately 5 cm in longitudinal dimension extending from the neck of the second metacarpal to the level of the mid diaphysis of the proximal phalanx of the index finger. Proximally, the collection extends along the radial aspect of the first dorsal interosseous muscle and extends volar to the first lumbrical muscle, but remains distal to the thenar musculature. Fluid also extends into the web space between the bases of the proximal phalanges of the index and middle fingers. The collection does not appear to involve the flexor tendon apparatus, and there is only minimal fluid within the flexor tendon sheath of the index finger. The collection abuts the extensor tendon, joint capsule and perhaps the adjacent bone, but we see no joint effusion or evidence of osteomyelitis. Generalized subcutaneous edema involves the hand and fingers, particularly dorsally. There is also nonspecific edema within the thenar musculature of the hand. Mild degenerative arthritic changes affect the wrist.

Output: Lobulated collection of fluid signal intensity within the soft tissue surrounding the second metacarpophalangeal joint is compatible with an abscess, with additional soft tissue inflammation as described above. We see no evidence of osteomyelitis.


Instruction: Generate impression based on findings.

Input: Male, 13 years old. Reason: follow up structural abnormalities History: hyperintense T2 focus. The previously seen focus of susceptibility artifact in the right corona radiata appears unchanged. A lesion with edema. The previously described subcentimeter T2 hyperintense subcortical focus in the inferior right temporal lobe is unchanged. As before, this lesion does not appear to suppress readily with FLAIR technique. There is no abnormal associated enhancement. There is no mass effect or edema. The ventricles and basal cisterns are normal in size and configuration. No abnormal extra-axial fluid collection is identified. The midline structures and craniocervical junction are within normal limits. There is no diffusion abnormality. Normal flow-voids are demonstrated in the major intracranial vascular structures. The paranasal sinuses, mastoid air cells, and orbits are unremarkable.

Output: 1.A subcentimeter right temporal lobe T2 hyperintense focus is stable although as before does not suppress with FLAIR technique. The differential is unchanged, most likely representing a neuroglial cyst or prominent perivascular space. Repeat imaging in 1 year to assess for stability is recommended.2.A stable nonspecific focus of susceptibility in the right corona radiata may represent sequelae of prior microhemorrhage or may represent a small cavernoma.


Instruction: Generate impression based on findings.

Input: Status post hypertensive stroke on xarelto. Examination is motion degraded. There is restricted diffusion involving the right posterior corona radiata extending into the posterior aspect of the right caudate body. There is corresponding hypodensity on CT from 1/24/2015 and minimal in this location on CT from 1/20/2015.Again seen is intraparenchymal hemorrhage involving the right caudate tail, adjacent periventricular white matter, and with intraventricular extension. Unchanged caliber of the ventricular system with right lateral ventricles larger than the left without evidence of hydrocephalus.Tiny focus of susceptibility is seen in the dorsal pons suspected to represent a chronic microhemorrhage, less likely vessel. Few scattered foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild chronic small vessel ischemic changes. Brain parenchyma is otherwise unremarkable for age. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: 1. Acute infarct involving the right posterior caudate and corona radiata/periventricular white matter. Serial CT demonstrates developing hypodensity in this location between CT 1/20 and 1/24/2015.2. Unchanged adjacent intraparenchymal hemorrhage with intraventricular extension.3. Examination is motion degraded. There is a probable chronic microhemorrhage focus in the pons. No other foci of chronic hemorrhage or intracranial masses are appreciated. 4. Mild chronic small vessel ischemic changes.


Instruction: Generate impression based on findings.

Input: 44-year-old female with diffuse large B-cell non-Hodgkin's lymphoma. Completed 4 cycles cycles of CHOP/R chemotherapy on 10/17/07. Restaging. CHEST: LUNGS AND PLEURA: Probable intrapulmonary lymph node (image 53; series 5) stable.MEDIASTINUM AND HILA: No significant abnormality noted. CHEST WALL: No significant abnormality noted. ABDOMEN: LIVER, BILIARY TRACT: Multiple enhancing lesions scattered throughout all lobes liver which have been discussed at length previously appear stable in size. Again these were thought to represent multiple FNHs verses hepatic adenomas. These could be further differentiated using MRI as clinically indicated. No intrahepatic biliary ductal dilatation. Hepatic vessels appear to be patent.SPLEEN: No significant abnormality noted. PANCREAS: No significant abnormality noted. ADRENAL GLANDS: No significant abnormality noted. KIDNEYS, URETERS: No significant abnormality noted. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted. BOWEL, MESENTERY: No significant abnormality noted. BONES, SOFT TISSUES: No significant abnormality noted. OTHER: No significant abnormality noted. PELVIS: UTERUS, ADNEXAE: No significant abnormality noted. BLADDER: No significant abnormality noted. LYMPH NODES: Slight interval decrease in size of previously noted pelvic adenopathy. Reference left external iliac node (image 168; series 4) difficult to measure on the current examination. An approximate measurement is 1.8 x 1.1 cm, decreased in size compared to prior. BOWEL, MESENTERY: No significant abnormality noted. BONES, SOFT TISSUES: No significant abnormality noted. OTHER: No significant abnormality noted.

Output: Slight interval regression in size of pelvic adenopathy. No new adenopathy appreciated. Stable enhancing liver lesions as noted above.


Instruction: Generate impression based on findings.

Input: History of testicular cancer. Right testicular seminoma. ABDOMEN:LIVER, BILIARY TRACT: Punctate too small to characterize hyperintensities, likely cysts. No suspicious lesion, biliary ductal abnormality or vascular abnormality.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Simple appearing bilateral cysts and too small to characterize hyperintensities. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No enlarged retroperitoneal lymphadenopathy. Very small sub-5mm short-axis left periaortic lymph nodes are nonspecific, stable and of doubtful significance.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Small inguinal lymph nodes are unchanged. BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No evidence of metastatic disease.


Instruction: Generate impression based on findings.

Input: 82 years, Female, NSCLC with brain metastasis, status post SRS. Surveillance. Compared to 6/16/2016, there has been mild interval enlargement of enhancing lesion in the left frontal lobe which measures 16 x 17 x 14 mm in the AP, transverse, and craniocaudal dimensions, previously 15 x 13 x 11 mm measured similarly. There is increase in thickness of the peripherally enhancing tissue with central area of necrosis appearing relatively smaller. There is also increase in surrounding vasogenic edema and minimal associated mass effect on the left frontal horn. No significant midline shift or herniation.No new enhancing lesions are definitively appreciated within the limits of mild motion degradation. There is a 4 mm focus of enhancement in the left parietal lobe along the cortical surface adjacent to the intraparietal sulcus, series 1102 image 140, which appears to be present on prior studies although obscured due to motion artifact on multiple prior studies. No evidence of acute ischemia. No large hemorrhage. There are minimal foci of susceptibility associated with the left frontal lobe lesion compatible with microhemorrhage. Again seen are patchy foci of T2/FLAIR hyperintensity in the bilateral periventricular and subcortical white matter which are nonspecific but compatible with posttreatment-related changes and/or chronic small vessel ischemic disease. Ventricles are normal in size. Calvarium and extracranial soft tissues are grossly unremarkable.

Output: 1. Compared to 6/16/2016, there has been mild increase in size of left frontal lobe enhancing lesion. Given history of recent radiation therapy, post treatment change remains a possibility. Tumor progression however cannot be excluded. Consider short-term follow-up with perfusion imaging.2. 4 mm focus of enhancement in the left parietal lobe along the cortical surface adjacent to the intraparietal sulcus is suspicious for an additional punctate metastatic focus. This lesion appears to be present on prior recent studies although not well imaged due to motion degradation.


Instruction: Generate impression based on findings.

Input: 57-year-old male with smoldering multiple myeloma. Rule out bone lesions. BONE MARROW: Heterogeneous bone marrow, particularly within the proximal femoral metadiaphysis bilaterally, which appears most consistent with residual islands of red marrow. No definite discrete myelomatous deposits are identified.SOFT TISSUES: No focal mass lesions are identified. JOINTS: No significant abnormality noted. Please refer to the dedicated MRI of lumbar spine examination report for additional details.ADDITIONAL

Output: No definite discrete myelomatous deposits are identified.


Instruction: Generate impression based on findings.

Input: HCC status post TACE/RFA, evaluate for recurrence ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver. Postablation zones appear similar to the prior exam measuring 3.6 x 2.5 cm in segment 5 (series 12, image 29; previously 3.6 x 2.5 cm) and 5.8 x 4.8 cm in segment 6 (series 12, image 29; previously 5.8 x 4.8 cm). Internal T1 hyperintensity is compatible with deposition of blood products. No new arterially enhancing lesions. The hepatic vasculature is patent. Cholelithiasis.SPLEEN: Spleen is top normal in size.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Right Spigelian hernia containing fat and small bowel without evidence of complication.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1.Cirrhotic liver with stable appearance of postablation zones.2.No arterially enhancing lesions to suggest recurrent tumor.


Instruction: Generate impression based on findings.

Input: 50 years, Female, worsening gait and depression, history of untreated multiple sclerosis. Examination is obtained per multiple sclerosis protocol. Comparison study from 2014 was obtained with thicker slices, limiting comparison of small lesions. Again seen are extensive patchy confluent areas and scattered foci of T2/FLAIR hyperintensity throughout the periventricular and subcortical white matter with morphology and distribution compatible with known demyelinating disease. Few infratentorial lesions are also evident involving the right cerebellar hemisphere and middle cerebellar peduncles. Allowing for the differences in technique, there is no clear evidence of progression. There is mild parenchymal volume loss as before. There is also a mild to moderate burden of T1 hypointense lesions. No abnormal enhancement. No intracranial mass or mass effect. No hydrocephalus. No midline shift or herniation. Calvarium and extracranial soft tissues are grossly unremarkable.

Output: Allowing for differences in technique, there is no evidence of progression of chronic demyelinating disease when compared to prior MRI from 5/16/2014. No abnormal enhancement.


Instruction: Generate impression based on findings.

Input: 54 year old female with hypertension, headaches, altered mental status. Please evaluate for evidence of acute bleed. There is a subcortical hypodense region in the right frontal lobe which likely represent ischemic changes of indeterminate age. MRI is recommended for further evaluation.Diffuse subcortical white matter hypodensities likely represent small vessel skin disease of indeterminate age.The ventricles and basal cisterns are normal in size and configuration.An old left zygomatic arch buckle fracture is noted. An old right zygomatic arch nonhealed fracture is noted. Additional fracture in the lateral wall of the orbits and bilateral surgical wires in the zygomatic arches are noted. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Right frontal lobe hypodensity may represent ischemic changes of indeterminate age with additional diffuse white matter hypodensities that may represent small vessel skin disease. MRI is recommended for further evaluation. No evidence of intracranial hemorrhage.


Instruction: Generate impression based on findings.

Input: 35-year-old woman status post liver transplant in 1999 for cryptogenic cirrhosis, now with abnormalities in liver function tests. ABDOMEN:LIVER, BILIARY TRACT: The patient is status post liver transplant. The transplant liver is normal in signal and morphology and no focal lesion is identified. The biliary enteric anastomosis is patent and the extrahepatic bile duct appears normal in caliber (series 5, image 70). There is, however, mild intrahepatic biliary ductal dilatation seen throughout both lobes of the liver. The left and right bile ducts are not definitely seen communicating (series 5, image 70), however no intraductal or extrinsic lesion is identified.The portal vasculature is patent.SPLEEN: The spleen is mildly enlarged but otherwise normal.PANCREAS: The pancreas is normal.ADRENAL GLANDS: The adrenal glands are normal.KIDNEYS, URETERS: The kidneys are normal and enhance symmetrically.RETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: Partially visualized small bowel and colon are normal.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Intrahepatic bile duct dilatation with intrahepatic strictures. No intraductal or extrinsic lesion seen.


Instruction: Generate impression based on findings.

Input: Rectal pain/bleeding. Newly diagnosed rectal cancer. Staging exam. Overall image quality: GoodPELVIS:UTERUS, ADNEXA: No significant abnormality noted. BLADDER: No significant abnormality noted. LYMPH NODES: Lymph nodes in the perirectal space, within the mesorectal fascia: Few bilateral nodes measuring up to 8 mm. Lymph nodes outside the mesorectal fascia: A large lymph node mass extends beyond the mesorectal fascia on the left, measuring 3.0 x 2.2 cm (series 601, image 42).BOWEL, MESENTERY: Rectal Tumor:Size: 2.1 x 1.8 x 3.8 cm (image 35/series 601)Tumor appearance on T2-weighted images: Hypointense nodular lesion with central hyperintensity.Tumor location: Left rectum (3:00 position) approximately 3.5 cm from the anus.(For lower rectal tumors):Distance of the lower edge of the tumor to the anal verge (lower edge of the anal canal): 3.5 cm (image 29, series 801).Distance of the lower edge of the tumor to the pelvic floor (relationship of the tumor to the anal sphincter complex): 2.0 cm (image 30, series 801.Circumference of the rectum involved: Approximately 50%.Relationship and proximity of the tumor to adjacent structures (uterus, cervix, vagina): Tumor does not abut the uterus, cervix, or vagina.MRI T-stage: T3c - Tumor invades >1cm into perirectal fat or extramuralTumor Distance to Mesorectal Fascia: Abuts the mesial rectal fascia posterolaterally (image 36/series 601).BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Left rectal mass likely invading through the mesorectal fascia with pelvic adenopathy suspicious for locoregional nodal metastases, as above.


Instruction: Generate impression based on findings.

Input: Reason: 17 y/o M with R leg osteosarcoma; pre-surgical evaluation History: R leg osteosarcoma There is large soft tissue mass with osteolysis of the proximal right fibula measuring approximately 11.8 x 8.5 x 12.1 cm. This mass abuts the right tibia but does not appear to invade the cortex. There is heterogenous enhancement of this mass with regions of nonenhancement compatible with necrosis. There is extensive involvement of the surrounding muscles.

Output: Large heterogeneously enhancing mass with destruction of proximal right fibula, compatible with history of osteosarcoma.


Instruction: Generate impression based on findings.

Input: Low back pain for months and right hip pain Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits aside from straightening of lumbar lordosis, which may be in part positional. Bone marrow signal is benign. The conus medullaris is normal in position.Mild degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: No significant disc disease. No spinal canal or neural foraminal stenosis.L4-L5: No significant disc disease. No spinal canal or neural foraminal stenosis.L5-S1: There is disc desiccation and bulge, with small right foraminal/extraforaminal protrusion. There is contact of the exiting right L5 nerve root. There is mild right and minimal left neural foraminal narrowing. Spinal canal is patent.Paraspinous soft tissues are within normal limits.

Output: Small disc protrusion at the right L5-S1 level with contact of the right L5 nerve root in the foramen and extraforaminally. No definite evidence of impingement but can be correlated with clinical findings. Spinal canal and neural foramina at the remainder of the lumbar levels are patent.


Instruction: Generate impression based on findings.

Input: There is interval decrease in size of the infiltrative mass centered in the right oral tongue. The mass now measures up to approximately 40 mm. There is a persistently partially cystic right level 2A lymph node that measures 11 x 17 mm in axial cross-section. There is also a heterogeneous appearing smaller right level 2 lymph node. There is no evidence of significant left cervical lymphadenopathy. There is a heterogeneous left thyroid nodule that measures up to 45 mm. The salivary glands are unremarkable. There is a fluid level in the right maxillary sinus. There is multilevel degenerative spondylosis. The orbits are unremarkable.

Output: 1. Interval decrease in size of the right tongue squamous cell carcinoma, but persistent right level 2 lymphadenopathy. Assessment is limited by the lack of contrast, however.2. Nonspecific heterogeneous left thyroid nodule that measures up to 45 mm. Thyroid ultrasound may be useful for further evaluation.


Instruction: Generate impression based on findings.

Input: Female, 11 years old, history of medulloblastoma status post craniotomy, radiation therapy and chemotherapy. Off therapy evaluation 33 months following completion of therapy. Brain:Findings related to prior surgery and treatment within the posterior fossa are again seen. The tumor resection bed, and associated encephalomalacia of the cerebellar hemispheres, are stable in appearance. A small area of enhancement measuring 6 x 4 mm along the right margin of the fourth ventricle is unchanged. No new suspicious enhancement is seen.Elsewhere in the brain, encephalomalacia affecting the right occipital lobe is stable. No new areas of signal abnormality or pathologic enhancement is detected. There are numerous foci of susceptibility artifact within the brain parenchyma and along the ventricular margins which are unchanged. Ventricles remain prominent but caliber and morphology are similar to that seen on the prior exam.Spine:Spinal cord morphology and signal characteristics are within normal limits. No evidence of pathologic intrathecal enhancement is seen.Fatty marrow replacement seen at some levels of the spine is compatible with prior radiation therapy. Otherwise, no concerning marrow signal abnormality or pathologic marrow enhancement is detected.Spinal alignment is anatomic. Vertebral body heights and morphology are within normal limits. No spinal canal or neuroforaminal stenosis is suspected.

Output: 1. Stable appearance of the posterior fossa treatment bed. This includes a small area of enhancement along the right margin of the fourth ventricle. No new lesions are detected.2. Evidence of prior radiation therapy is seen in the spine. No findings are evident to suggest metastatic disease.


Instruction: Generate impression based on findings.

Input: Altered mental status: recently diagnosed lung adenocarcinoma with brain mets s/p radiation and steroids. MRI: There are new areas of restricted diffusion and high T2 signal in the left insula, perirolandic region, parietal lobe, and medial occipital lobe superimposed upon pre-existing areas of restricted diffusion in the left basal ganglia and lateral occipital lobe. There are multiple areas of peripheral and gyriform enhancement in the left cerebral hemisphere with an overall background of decreased perfusion. The largest peripherally enhancing lesion of the left cerebral hemisphere is located in the paracentral lobe, measuring up to 15 mm. Some of the lesions demonstrate susceptibility effect and intrinsic T1 hyperintensity, particularly in the left basal ganglia and occipital lobe. There are also ring-enhancing lesions in the left cerebral hemisphere, which measure up to 5 mm. There are scattered nonspecific foci of T2 hyperintensity without restricted diffuse in the cerebral white matter. There is an enhancing pituitary mass with suprasellar extension and mass effect upon the optic apparatus that measures up to 3 cm. 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.MRA: There is a new abrupt cut-off of flow-related enhancement in a left M2 branch proximally. There is also a persistent abrupt cut-off of flow-related enhancement in a left P2 segment. The rest of the major cerebral arteries appear to be intact otherwise.

Output: 1. Acute upon subacute infarcts in the left middle and posterior cerebral artery territories associated with areas of microhemorrhage and enhancement. However, a portion of the enhancing lesions in the bilateral cerebral hemispheres likely represent underlying metastases.2. Abrupt cut-off of left M2 and P2 branches may be due to thromboembolic disease. Vascular imaging of the neck may be useful.3. A pituitary mass likely represents a macroadenoma.Discussed with Dr. GAJEWSKI at 3:15 PM on 7/10/15.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for growth of astrocytoma. One month post RT/TMZ scan. Pre-and post-enhanced brain MRI:No diffusion weighted abnormalities.Examination demonstrates a flair/T2 hyperintense well demarcated mass centered at the left thalamus. It demonstrated regional mass effect and without detectable surrounding vasogenic edema or enhancement. On axial T2 series it measures 39 times 24-mm in transaxial dimensions which is nearly identical to prior exam. It also measures at 31.5 mm in venous axis and coronal T2-weighted images similar to prior study.The mass apply subtle mass effect on the third ventricle and trace midline shift to the right however without evidence of ventriculomegaly.Similar to prior exam there is a second small focus of T2/flair hyperintensity in the medial aspect of the left anterior temporal lobe without enhancement. This lesion is not in continuity with the mass within the left thalamus which is a similar observation is prior exam. This finding results in subtle increased volume and measures at 13 times 14-mm in transaxial dimensions on T2 flair series. This finding is also suspected of representing a neoplastic process. Additionally few small scattered foci of flair hyperintensity in the periventricular and subcortical white matter without enhancement or interval change since prior exam. Although nonspecific the findings could represent minimal chronic small vessel ischemic strokes.There is revisualization of a left anterior paramedian burr hole representing the site of prior surgical approach for biopsy. A linear susceptibility extends from the level of the burr hole to the anterior/superior aspect of left thalamic tumor and consistent with minimal hemorrhage along the course of biopsy approach.

Output: 1.No evidence of an acute or new finding since prior study.2.Stable size, signal intensity and morphology of a left thalamic nonenhancing mass since prior exam.3.Stable small focus of flair/T2 hyperintensity in the medial aspect of the left anterior temporal lobe which could also represent a focus of neoplasm.4.Stable few nonspecific foci of periventricular and subcortical flair hyperintensity.


Instruction: Generate impression based on findings.

Input: 62-year-old female with history of biliary pancreatitis, MRCP 8/3 showed normal pancreatic duct and biliary tree, assess pancreas and biliary tree ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesion. The hepatic vasculature is patent. No biliary ductal dilation. The common bile duct is normal in caliber and morphology measuring 6 mm in diameter. No evidence of choledocholithiasis. Status post cholecystectomy. SPLEEN: No significant abnormality noted.PANCREAS: The main pancreatic duct is normal in caliber and morphology. Interval resolution of peripancreatic edema.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Redemonstration of a focus of fat signal intensity with peripheral rim enhancement abutting the anterior margin of the left hepatic lobe most compatible with fat necrosis, not significantly changed. Incidentally seen distended stomach containing ingested material. BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1. Normal caliber of the common bile duct and main pancreatic duct without evidence of choledocholithiasis.2. Interval resolution of peripancreatic edema.3. Incidentally seen distended stomach containing ingested material, may reflect recent meal/ingested material.


Instruction: Generate impression based on findings.

Input: Pain Severe osteoarthritis affects the right hip with bone-on-bone apposition superiorly, appearing similar to that seen on the March 31, 2016 study. Moderate osteoarthritis affects the left hip, also appearing similar to that seen on the March 2016 study. Overall, the bones appear slightly demineralized suggesting osteopenia. There is a 2 cm ovoid lucent focus in the proximal left femoral diaphysis seen on the AP view of the left hip. This may simply represent a benign focus of cortical thinning; however if the patient has a known history of primary malignancy or pain referable to this site, then MRI or skeletal scintigraphy may be considered for further evaluation to exclude metastatic disease. Sclerosis along the left sacroiliac joint is likely degenerative in etiology. Degenerative arthritic changes also affect the visualized lower lumbar spine.

Output: Bilateral hip osteoarthritis, right greater than left. A lucency in the proximal left femur may simply represent a benign focus of cortical thinning; however, if the patient has a known history of primary malignancy or pain referable to this site, then MRI or skeletal scintigraphy may be considered for further evaluation to exclude metastatic disease.


Instruction: Generate impression based on findings.

Input: 51-year-old female with IVC filter placement and status post attempts unsuccessful retrieval of the IVC filter with placement of an additional IVC filter. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: An IVC filter is placed within the intrahepatic IVC. 15 x 15 mm hypodense lesion in the left lobe of the liver best seen image number 45 of series number 3 is nonspecific in appearance. If clinically indicated, dedicated liver MRI or CT may be helpful for further evaluation.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Left adrenal nodule measuring 14 mm in diameter. Its CT appearance is nonspecific on this single phase post contrast CT.KIDNEYS, URETERS: Subcentimeter hypodense lesions in both kidneys which are too small to characterize with atelectasis.RETROPERITONEUM, LYMPH NODES: Infrarenal IVC filter is tilted. Please refer to the interventional radiology procedure note on 12/10/2009 for better description.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Small fat containing periumbilical hernia. Nodular density in the anterior abdominal wall likely secondary to injections.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Two IVC filters are in place. Inferiorly placed IVC filter is tilted. Please refer to the interventional radiology procedure report on 12/10/2009.Indeterminant hypodensities in the liver. If clinically indicated further evaluation with dedicated liver MRI or CT is recommended.Indeterminant left adrenal nodule.


Instruction: Generate impression based on findings.

Input: 52 year-old male with a history of atrial fibrillation with three previous ablations and recent cardioversion with recurrence of atrial fibrillation. He is referred for cardiac MRI for further evaluation. Left VentricleThe left ventricle is normal in size with mildly reduced systolic function. The overall LV ejection fraction is 48%, the LV end diastolic volume index is 66 ml/m2 (normal range: 74+/-15), the LVEDV is 164 ml (normal range 142+/-34), the LV end systolic volume index is 36 ml/m2 (normal range 25+/-9), the LVESV is 86 ml (normal range 47+/-19), the LV mass index is 25 g/m2 (normal range 85+/-15), and the LV mass is 59 g (normal range 164+/-36). There is global hypokinesis. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is severely dilated (end-systolic volume 142 ml). Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 52%, the RV end diastolic volume index is 72 ml/m2 (normal range 82+/-16), the RVEDV is 174 ml (normal range 142+/-31), the RV end systolic volume index is 35 ml/m2 (normal range 31+/-9), and the RVESV is 84 ml (normal range 54+/-17).Right AtriumThe right atrium is severely dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium. The ostial measurements are as below. All of the pulmonary vein ostial had evidence of late gadolinium enhancement secondary to ablation; however, the left upper pulmonary vein appears to have the largest "ablation gaps."LUPV: 15x14mmLIPV: 14x9mmRUPV: 21x16mmRIPV: 17x13mmPulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with mildly reduced systolic function (LVEF 48%) without evidence of underlying myocardial fibrosis, inflammation, or infiltration.2. The right ventricle is normal in size and systolic function (RVEF 52%).3. The left and right atria are severely dilated. 4. The left inferior pulmonary vein diameter is somewhat small.5. The left upper pulmonary vein appears to have the largest "ablation gap."I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Brain: There is redemonstration of postoperative findings from multiple prior craniotomies with areas of bilateral frontal and cerebellar hemisphere encephalomalacia. There is an unc hanged meningioma along the planum sphenoidale. There is decreased enhancement associated with a cystic lesion with associated susceptibility effect in the left cerebellar hemisphere, which is otherwise unchanged in size. There is no evidence of acute ischemia. The shunted ventricular system appears slightly smaller. There is an unchanged enhancing intraconal lesion within the lateral left orbit. There is a partially-imaged upper cervical spinal cord ependymoma and upper cervical spinal canal schwannomas. There are unchanged enhancing left parietal and right occipital scalp lesions. There is scattered mild paranasal sinus mucosal thickening.Internal Auditory Canal: There are postoperative findings related to bilateral retrosigmoid craniotomies. The residual components of the left vestibular schwannoma have not significantly changed in size. Likewise, the residual right vestibular schwannoma has not significantly changed in size. There is persistent enhancement within the bilateral labyrinthine structures. There is also no significant interval change in the left facial nerve schwannoma involving the geniculate ganglion and internal auditory canal. There are also smaller facial nerve schwannomas centered in the right geniculate ganglion, as well as in the right mastoid segment, which is unchanged. A punctate left cerebellomedullary cistern schwannoma is unchanged. There are grossly unchanged bilateral trigeminal nerve schwannomas.

Output: 1. Unchanged planum sphenoidale meningioma.2. Unchanged residual bilateral vestibular schwannomas and bilateral facial nerve and trigeminal nerve schwannomas, as well as a left cerebellomedullary cistern schwannomas.3. Decreased enhancement associated with a cystic left cerebellar lesion, which is otherwise similar in size.4. Unchanged scalp additional schwannomas.5. Partially-imaged upper cervical spinal cord ependymoma and upper cervical spinal canal schwannomas. 6. The shunted ventricular system appears to have decreased slightly in size.


Instruction: Generate impression based on findings.

Input: Primary central sleep apnea. Evaluate hypothalamus. Brain parenchyma appears within normal limits. No lesions or masses associated with the hypothalamus are appreciated. There is no evidence of intracranial hemorrhage, mass or edema. No diffusion abnormality. The ventricles and basal cisterns are normal in size and configuration. The expected intracranial vascular flow voids are present. No abnormal parenchymal or meningeal enhancement.Mild mucosal thickening involving the left maxillary sinus and right anterior ethmoid air cells. Paranasal sinuses are otherwise clear. Calvarium and extracranial soft tissues are unremarkable.

Output: MRI of the brain appears within normal limits. Specifically, no hypothalamic abnormality is identified.


Instruction: Generate impression based on findings.

Input: Acute recurrent pancreatitis complicated by pseudocyst status post AXIOS stent placement for drainage. Reevaluate pseudocyst. ABDOMEN:LIVER, BILIARY TRACT: No focal lesion biliary ductal dilatation or vascular abnormality. Normally distended gallbladder.SPLEEN: No significant abnormality noted.PANCREAS: Compared to the CT dated 4/27/2016 there has been marked decrease in size of the intraparenchymal pancreatic fluid collection with the gastrocystostomy stent device in place. There appears to be a percutaneous drain as well extending through the left upper quadrant into the stomach and terminating near the catheter device. The proximal and distal main pancreatic duct is normal in caliber.There is significant atrophy of the pancreatic body which is replaced by inflammatory/necrotic tissue. The pancreatic duct is not visualized at this level without upstream dilatation.Normal intrinsic T1-weighted signal intensity of the pancreatic head and uncinate process. Moderately decreased intrinsic T1-weighted signal intensity of the body and tail of the pancreas. The residual parenchyma demonstrates postcontrast enhancement. No evidence of acute peripancreatic inflammatory changes.Moderate narrowing of the portal vein confluence with opacification of the portal vein. The splenic vein is attenuated but opacified.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral simple appearing cysts. No hydroureteronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Compared to the 4/27/2016 CT the fluid collection in the pancreatic body has essentially resolved. Significant atrophy of the pancreatic body which is replaced by inflammatory/necrotic tissue without visualization of the pancreatic duct at this level. No upstream pancreatic ductal dilatation.2.No new fluid collection or evidence of acute pancreatitis.


Instruction: Generate impression based on findings.

Input: Reason: rule out rotator cuff tear History: pain and weakness. ROTATOR CUFF: Moderate supraspinatus tendinosis. There is fatty atrophy of the supraspinatus tendon.The infraspinatus tendon and muscle are intact.There is a partial-thickness bursal surface tear of the insertional subscapularis tendon in a background of moderate tendinosis. There is fatty atrophy of the subscapularis tendon.The teres minor tendon and muscle are intact.SUPRASPINATUS OUTLET: Mild osteoarthritis affects the acromioclavicular joint. Small amount of fluid within the subacromial subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: The labrum is grossly intact within the limits of a non-arthrographic study. There are multiple subcortical cysts along the superior humeral head.BICEPS TENDON: The biceps tendon is intact. ADDITIONAL

Output: 1.Partial thickness bursal surface tear of the subscapularis tendon. No full thickness rotator cuff tear. Fatty muscle atrophy of the supraspinatus and subscapularis muscles.2.Mild AC joint osteoarthritis. Small amount of fluid within the subacromial subdeltoid bursa.


Instruction: Generate impression based on findings.

Input: Male, 37 years old, with history of grade 2 oligodendroglioma status post radiation therapy, now on PCV. Findings are redemonstrated compatible with prior left frontal biopsy. A region of T2 hyperintensity involving predominantly the left frontal lobe white matter, but with some evidence of cortical thickening as well, is again seen showing no significant interval change in size or morphology. As on the prior examination, the anterior central portion of this lesion demonstrates bubbly FLAIR suppressing signal characteristics which may reflect cystic change. On postcontrast images, there is no convincing pathologic enhancement apart from some subtle vascularity which enters the lesion.No significant mass effect is detected. No evidence of any new parenchymal signal abnormality or pathologic enhancement is seen. The ventricular system is stable and within normal limits for size.Again seen is thickening and enhancement of the right orbital roof which on prior CT demonstrates a morphology most suggestive of fibrous dysplasia.

Output: Stable lesion in the left frontal lobe with no findings to suggest progressive disease.


Instruction: Generate impression based on findings.

Input: Reason: Evaluate for degenerative vs. Inflammatory changes as source of back pain History: Low back pain. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The discs appear desiccated. Scattered foci of increased T1 and T2 signal within the bone marrow are compatible with benign hemangiomas and/or focal fat deposition. No suspicious bone marrow replacing lesions are identified. The spinal cord displays normal signal and morphology. The tip of the conus is located at L1-L2. No pathological enhancement is identified. The paravertebral soft tissues are unremarkable.T12-L1: No significant stenosis.L1-L2: Minimal disc bulge without significant stenosis.L2-L3: Minimal disc bulge without significant stenosis.L3-L4: Minimal disc bulge eccentric to the left without significant stenosis.L4-L5: Mild facet hypertrophy. No significant stenosis.L5-S1: Mild facet hypertrophy. No significant stenosis.

Output: Minimal to mild degenerative changes without significant central canal or foraminal stenosis.


Instruction: Generate impression based on findings.

Input: Clinical question: Stroke. Signs and symptoms: Stroke. Non-enhanced CT brain:Small left likely stroke is again identified. The corner infarct the left pons is again noted. Old likely hemorrhagic lacunar infarct of left basal ganglia is again identified. There is ex vacuo dilatation of left lateral ventricle secondary to this large stroke.There is no evidence of new hemorrhage, edema, mass-effect, midline shift or hydrocephalus. The study is essentially stable since prior exam. If concern for new strokes persist follow-up with an MRI is recommended.

Output: Multiple old strokes and no evidence of acute new intracranial findings. Stable exam.


Instruction: Generate impression based on findings.

Input: 72 year old female patient with severe hip pain, fungemia, elevated CRP/ESR, eosinophilia. Evaluate for PVNS. Please note patient could not tolerate the examination and only T1 weighted coronal and axial fat-suppressed T2-weighted images were obtained, both of which are markedly limited by motion artifact. Given this limitation, the following observations are made:There are erosions of the femoral head and acetabulum as seen on a recent CT scan. There is edema type signal within the femoral neck which may be secondary to the aforementioned erosions. Due to the aforementioned limitations, we cannot tell if there has been progression of erosions compared to the prior CT study. We see no frank fluid within the hip joint. Low signal intensity along the right femoral neck may represent pigmented villonodular synovitis, but could also be seen with amyloid deposition. There is edema within the adductor musculature within the hip, the musculature anterior to the right proximal femur, the right gluteus minimus muscle, and along the right iliopsoas muscle. Edema is noted within the subcutaneous fat. Mild osteoarthritis affects the left hip.

Output: Markedly limited study as described above showing erosive arthropathy of the right hip without frank fluid in the joint, which could represent pigmented villonodular synovitis, amyloidosis, or sequela of chronic inflammatory (including chronic fungal) arthritis. A repeat study following proper patient sedation can be considered.


Instruction: Generate impression based on findings.

Input: Clinical question: Baseline exam prior to starting new systemic therapy; please assess extent of known metastatic disease and compare to scan from 5/5/2015. Signs and Symptoms: History of glioblastoma multiforme Pre- and post enhanced brain MRI:Negative diffusion weighted images.Examination redemonstrate extensive focus of FLAIR hyperintensity in the pattern of vasogenic edema however without significant mass effect in the right parietal-temporal and extending into the right frontal similar to prior exam in extent. A cavity forming ring enhancing mass consistent with patient's known GBM is again identified.This finding measures approximately at 34 mm in AP axis which is smaller compared to prior study measurement of 40 mm. Thick irregular rim enhancement of this lesion demonstrate no significant change. A previously measured focus of enhancement along the anterior superior aspect of the tumor measures at 14 x 10 mm (sagittal post enhanced series) compared to prior study measurement of 13 x 21 mm. Decreased size of cavity and enhancement suggestive of interval improvement.Ventricular system remains within normal size and with maintained midline.Small focus of linear enhancement in the right frontal lobe under a small right frontal craniotomy representing resection cavity demonstrate no significant change since prior exam.No evidence of new focus of signal abnormality or abnormal enhancement since prior study.

Output: 1.Slight interval decreased size of rim-enhancing necrotic lesion since prior exam as detailed/measured above.2.Extensive surrounding FLAIR hyperintensity with mild associated mass effect however without the radiation of midline remains stable. 3.Linear focus of enhancement in the right frontal lobe stable since prior exam.


Instruction: Generate impression based on findings.

Input: Following a discussion of the procedure with the patient and/or family, including its risks, benefits, alternatives and steps to prevent infection, informed written consent was obtained and documented in the patient's chart. The time-out form was completed to confirm patient identity and side/type of procedure. All operators present for the case performed standard preprocedural prep including hand washing, sterile gloves, mask and cap. The patient was prepped and draped in the usual aseptic fashion. Local anesthesia over the target area was obtained by 1% lidocaine. Targeted ultrasound examination demonstrates a large heterogeneous mass along the medial aspect of the proximal right thigh corresponding to the findings seen on recent MRI and ultrasound examination. There is minimal, if any, peripheral vascularity on Doppler interrogation. There are multiple thin internal septations identified within the lesion. Using ultrasound guidance, a 16-gauge Achieve core biopsy needle was advanced into the lesion which appears to correspond to the area of enhancement on recent MRI examination. Five 16-gauge core biopsy specimens were obtained and placed in formalin. Approximately 10 cc's of gelatinous material were aspirated from the lesion and placed in a sterile cup.The core biopsy specimens and aspirate were hand carried to the Surgical Pathology labThe patient tolerated the procedure well without immediate complication. Routine post procedure instructions were communicated to the patient.ESTIMATED BLOOD LOSS: Less than 5cc. An adhesive bandage was placed on the patient’s skin.

Output: Ultrasound guided biopsy of right thigh mass.


Instruction: Generate impression based on findings.

Input: There is no acute infarct, suspicious intracranial enhancement, mass effect, or cerebral edema. There are nonspecific T2 signal abnormalities in the periventricular and subcortical white matter which may be vascular related. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There is trace high T2 signal in the left mastoid air cells. The skull and extracranial soft tissues are unremarkable.

Output: No intracranial metastases.


Instruction: Generate impression based on findings.

Input: There is no evidence of intracranial hemorrhage or acute infarct. There are scattered patchy foci of T2 hyperintensity throughout the supratentorial and infratentorial white matter that are most compatible with moderate chronic small vessel ischemic disease. 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 left parotid gland and adjacent soft tissues are slightly smaller than the right of uncertain clinical significance. The skull, paranasal sinuses, and scalp soft tissues are unremarkable. There are possible mild appearing degenerative changes of both temporomandibular joints.

Output: 1.No evidence of left mastoid abnormality, although, this exam is not designed to evaluate this region. 2.No evidence of intracranial hemorrhage or acute infarct.3.Moderate supratentorial and infratentorial presumed chronic small vessel ischemic disease.4.The left parotid gland and adjacent soft tissues are slightly smaller than the right of uncertain clinical significance.5.Possible mild appearing degenerative changes of both temporomandibular joints that is not well assessed on this exam.


Instruction: Generate impression based on findings.

Input: Clinical question: Chiari malformation, syrinx, evaluate for change, yearly follow-up, do CSF flow study. Signs and symptoms: Yearly follow-up. Nonenhanced brain MRI:Negative diffusion weighted images.Redemonstration of Chiari malformation with approximately 12 mm herniation of the tonsils and with flattening deformity of the inferior poles similar to prior exam.There is normal signal intensity of brain parenchyma on all MRI sequences. Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination.Signal void of major intracranial arterial branches are identified.Unremarkable calvarium and soft tissues of the scalp.Unremarkable images through the orbits, paranasal sinuses and mastoid air cells.CSF flow study is of very poor quality due to extensive motion artifact.Patient was also unable to continue and MRI of the spine was not performed. Patient requested to reschedule an return for completion of the study.

Output: 1.Nonenhanced brain MRI demonstrate stable Chiari malformation and unremarkable otherwise.2.CSF flow study is of severely degraded due to motion artifact and MRI of spine was not performed due to patient's inability to continue and requested to reschedule the exam for a later date.


Instruction: Generate impression based on findings.

Input: Medulloblastoma status post craniotomy, chemotherapy, and radiation therapy: off therapy evaluation. Brain: There are postoperative findings related to suboccipital craniotomy for resection of a cerebellar medulloblastoma. There is unchanged confluent T2 hyperintensity in the medial cerebellar hemispheres along the margins of the resection cavity, but no gross evidence of tumor. There are also unchanged scattered punctate foci of susceptibility effect in the cerebral hemispheres and along a right occipital surgical tract. There is no evidence of acute intracranial hemorrhage or infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The skull appears unchanged. There are diffuse inflammatory changes in the paranasal sinuses.Spine: The spinal cord and cauda equina nerve roots display normal signal characteristics. There is no evidence of abnormal enhancement within the spinal canal. The vertebral bone marrow displays diffuse T1 and T2 hyperintensity, compatible with fatty marrow conversion related to radiation effects. The vertebral column alignment is within normal limits. The vertebral body heights are preserved. The paraspinal soft tissues are unremarkable.

Output: 1. No convincing evidence of tumor recurrence in the posterior fossa. 2. No evidence of drop metastases in the spinal canal.3. Findings suggestive of pansinusitis.


Instruction: Generate impression based on findings.

Input: 31-year-old male with left eye and brow pain and history of conjunctivoplasty. Evaluate for orbital inflammation. Orbits: There is an apparent punctate focus of low signal in the skin of the left lateral supraorbital region. The orbital contents are otherwise unremarkable, without evidence of gross tumors or inflammatory changes. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is mild scattered paranasal sinus mucosal thickening.

Output: 1. A punctate low signal intensity focus in the skin of the left lateral supraorbital region may represent post-procedural effects. The orbital contents are otherwise unremarkable, without evidence of gross tumors or inflammatory changes. 2. The intracranial contents are unremarkable.


Instruction: Generate impression based on findings.

Input: Reason: h/o MGUS and severe lumbar pain, r/o compression fracture vs myeloma lesion vs DDD History: see above Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is loss of disk space height, disk desiccation and diffuse disk bulge at this level associated with moderate bilateral facet hypertrophy with ligamentum flavum hypertrophy. There is mild narrowing of the neural foramina at this level. The exiting nerve roots are surrounded by fat within the neural foramina.At L4-5 there is loss of disk space height, disk desiccation and diffuse disk bulge at this level associated with bilateral facet hypertrophy at this level. There is mild anterior subluxation of L4 on L5 at this level. There is partial effacement of fat at the lateral recesses at this level. Overall there is mild to moderate spinal stenosis at this level. There is mild narrowing of the neural foramina at this level. The exiting nerve roots are surrounded by fat within the neural foramina. There is minimal progression since the priro exam.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.There is a 3cm cortically based cyst present along the superior pole of the right kidney.There is a 10mm cyst along the inferior pole of the right kidney.

Output: There are degenerative changes in the lower lumbar spine worse at L4-5 where there is mild subluxation and mild to moderate spinal stenosis. There is a slight progression since the prior exam.


Instruction: Generate impression based on findings.

Input: Female, 86 years old, with persistent dizziness. Fairly extensive patchy periventricular and brainstem T2 hyperintensity is seen. In addition, there are numerous chronic lacunar infarcts of the basal ganglia and thalami. A focus of encephalomalacia within the pons is also likely related to prior ischemia.No restricted diffusion is seen to suggest acute ischemia. No evidence of parenchymal edema or mass effect is detected. There are a few scattered punctate foci of susceptibility in the brain parenchyma likely representing chronic microhemorrhage, but no areas of acute intracranial hemorrhage are suspected. The ventricles are normal in size and morphology. There may be cystic degeneration of the pineal gland.A nonspecific soft tissue nodule is evident within the left parotid space.A fluid level is present in the right maxillary sinus and the mastoid air cells show mild opacification.

Output: 1.Sequelae of extensive prior microvascular ischemic disease.2.No evidence of any definite acute intracranial abnormality.3.A nonspecific nodule is partially visualized in the left parotid space. This could be further assessed with ultrasound if clinically warranted.


Instruction: Generate impression based on findings.

Input: 16-year-old male with history of shoulder dislocation, evaluate for labral tear ROTATOR CUFF: Mild increased signal at the distal supraspinatus tendon consistent with tendinosis with more pronounced changes in the subscapularis with intact fibers extending throughout to the attachment. No evidence of discrete tear with retraction. Muscles appear normal without atrophy.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: Large labral tear inferiorly with associated mild detachment along the inferior margin and associated large cartilage defect measuring greater than 1 cm in the longer dimension extending towards the anterior labrum. The defect extends approximately from a 3 o'clock position to beyond 6 o'clock. The largest fragment is not entirely free and dependant, suggesting that the fragment remains partially attached along the inferior aspect (image 16 series 5). BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: Mild distal supraspinatus tendinosis. No discrete labral tear.


Instruction: Generate impression based on findings.

Input: 40-year-old female patient with abdominal pain, bloating, and intermittent bleeding. Patient has family history of digestive disorders. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No local inflammation or stenotic disease. The stomach remained distended during the entire examination.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No local inflammatory changes or stenotic disease.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No evidence of inflammatory bowel disease or other acute intra-abdominal findings.2.The stomach remained distended during the entirety of the examination, which is nonspecific, and may represent gastroparesis in the appropriate clinical setting.


Instruction: Generate impression based on findings.

Input: Preoperative planning, without attaching fiducial markers. There is ill-defined low signal intensity lesion on the inferior aspect of tectal plate around the inferior colliculus.The lesion is measured about 8.6mm x 8.6mmGadolinium-enhanced images do not show any evidence of enhancement.Third ventricle and bilateral lateral ventricles are slightly enlarged likely represent hydrocephalus due to tectal lesion.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: Inferior tectal intraaxial mass without showing any evidence of contrast enhancement, 8.6mm x 8.6mm, associated with obstructive hydrocephalus as described above.These findings are indicative of tectal glioma.


Instruction: Generate impression based on findings.

Input: There is no restricted diffusion to suggest acute ischemic infarction. There is no evidence of acute intracranial hemorrhage. There is a focus of signal abnormality within the right cerebellar hemisphere compatible with a chronic tiny lacunar infarct. Otherwise, there are no areas of abnormal parenchymal signal. There is mild prominence of the ventricles and cortical sulci compatible with mild volume loss. There is no midline shift or herniation. The midline structures and craniocervical junction are within normal limits. There is a small focus of enhancement along the right paramedian planum sphenoidale (series 1202, image 86) measuring 8 mm in the transaxial dimension x 3 mm in the craniocaudal dimension which probably represents a tiny meningioma. The major cerebral flow voids are intact. Mild scattered mucosal thickening is present within the paranasal sinuses. There is a 6 x 12 mm oval lesion within the right parietal skull which demonstrates high T2 signal, intermediate T1 signal, and avid enhancement.

Output: 1.No specific evidence of acute ischemic infarction or other acute intracranial abnormality.2.Mild cerebral volume loss which may be related to SLE.3.Tiny chronic lacunar infarct in the right cerebellar hemisphere.4.Probable tiny meningioma along the planum sphenoidale measuring up to 8 mm.5.Nonspecific small right parietal skull lesion, favor benign process such as hemangioma in the absence of known primary malignancy.


Instruction: Generate impression based on findings.

Input: Thoracolumbar scoliosis. There is severe scoliosis at the thoracolumbar spine, with a left convexity, apex at thoracolumbar junction. There is left lateral subluxation of L2 over L3. Degenerative changes are seen in the lumbar spine, with facet arthropathic changes, osteophytes, ligamentum flavum hypertrophy and disk bulging / herniation at multiple levels. There is spinal canal and neuroforaminal narrowing at multiple levels, as a result of the scoliosis and degenerative spine disease. There is resultant nerve impingement, which is better visualized on the MRI of same date.No evidence of segmentation anomalies, fracture, or par-interarticularis defect is seen.There is a large calcified lesion posterior to the left aspect of the uterus and may represent a fibroid. A large right renal cyst is noted.

Output: 1. Severe thoracolumbar scoliosis and degenerative disease of the lumbar spine resulting in spinal canal and neuroforaminal narrowing. Nerve impingement is present at multiple levels and is better defined on the MRI of same date. Please refer to MRI report for details.2. Right renal cyst.3. Uterine fibroid.