Instruction: Generate impression based on findings.

Input: 61-year-old male patient with cirrhotic liver morphology and lymph node seen on ultrasound. ABDOMEN:LIVER, BILIARY TRACT: There is mild intrahepatic biliary ductal dilatation. There is extrahepatic biliary ductal dilatation to the level of the ampulla, measuring up to 1.6 cm in maximal diameter in the common hepatic biliary duct and 1.1 cm in the common bile duct. No stone or enhancing lesion is seen at the level of the ampulla. Mild iron deposition is noted.Gallbladder containing gallstones.Hepatic vasculature is patent. No suspicious enhancing lesions in the liver parenchyma.SPLEEN: No significant abnormality noted.PANCREAS: The pancreatic duct in the head and neck is mildly dilated and measures up to 5 mm in maximal dimension. No mass is seen in the pancreas.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter T2 hyperintense lesions in the bilateral kidneys most likely represent cysts.RETROPERITONEUM, LYMPH NODES: Lymph node at the porta hepatis measures 2.2 x 1.1 cm (series 601 image 18).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Mild intrahepatic biliary ductal dilatation and extrahepatic biliary ductal dilatation to the level of the ampulla without evidence of obstructive stone or enhancing mass. These findings are suggestive of a benign stricture at the level of the ampulla.2.Stable lymph node at the porta hepatis.


Instruction: Generate impression based on findings.

Input: Neck pain In comparison with MRI cervical spine dated 3/27/2014, interval postsurgical changes of cervical laminoplasty are seen with spinous processes resection, right-sided laminectomies from C3 to C7, and placement of grafts at the C4 and C6 levels. Osseous changes are better appreciated on prior cervical spine CT. Compared to prior MRI there is evidence of increase in the spinal canal diameter with increased visualization of the posterior thecal sac from from C3 to C7 levels. There does however remain some deformity of the right ventral cord at C4-C5, C5-C6, and C6-C7 related to prominent osteophytes.Degenerative changes appear similar compared to 3/27/2014 with disc osteophyte complexes from C3-C4 to C6-C7, particularly prominent at the C5-C6 and C6-C7 levels. Again seen is bilateral moderate to severe neural foraminal stenosis at C3-C4, C4-C5, C5-C6, and C6-C7.There is abnormal T2 signal within the ventral lateral aspects of the cord bilaterally at C4-C5 which was present on preoperative MRI and more discrete particularly on the left on the current study likely related to evolution of myelomalacia.Vertebral body heights are maintained. Alignment is preserved without evidence of new kyphosis in the supine position. There is been evolution of postsurgical changes with small residual fluid collection noted in the posterior midline soft tissues superficial to the musculature.

Output: 1. Compared to preoperative MRI dated 3/27/2014, there has been interval laminoplasty from C3 to C7. Decompression of the cervical spinal canal is evident with improved visualization of the posterior thecal sac. There does remain mild deformity of the right ventral aspect of the cord related to the prominent osteophytes at the C4-C5, C5-C6, and C6-C7 levels. Moderate to severe neural foraminal stenosis at C3-C4, C4-C5, C5-C6, and C6-C7 is again seen and similar to prior.2. Abnormal T2 signal within the ventral lateral aspects of the cord bilaterally at C4-C5 which was present on preoperative MRI and more discrete, particularly on the left, on the current study and consistent with evolution of myelomalacia.


Instruction: Generate impression based on findings.

Input: Clinical question: Assess for cervical stenosis. Signs and symptoms: Neck pain hyperreflexia in upper extremities. Nonenhanced cervical MRI:Foramen magnum is unremarkable.C2 -- C3 is unremarkable.C3 -- C4 demonstrate minimal asymmetric right facet and ligamentum flavum hypertrophy with resultant mild right neural foraminal compromise.C4 -- C5 demonstrate minimal degenerative changes and unremarkable otherwise.C5 -- C6 demonstrates a shallow broad based central and leftward disk -- osteophyte complex which results in very subtle flattening deformity of the cord without detectable signal abnormality of the cord. There is mild central spinal stenosis and mild left neural foraminal compromise.C6 -- C7 demonstrate asymmetric left-sided uncovertebral hypertrophic changes with resultant moderate left neural foraminal compromise. Mild central spinal stenosis is also suspected. This finding is best appreciated on axial T2 series 701 images 8 and 9.C7 -- T1 is unremarkable.On sagittal T2 stir series 501 on images 8 through 11 there is evidence of subtle T2 hyperintensity of the intraspinous and supraspinous ligaments. This finding is also present on axial T2 Star series 602 on images 22 through 34. The findings could represent edematous changes of the ligaments possibly as result of an injury. Correlation with patient's clinical history and direct physical examination/palpation of the region of the left follow-up with additional imaging is recommended. Findings and concerns on this exam were discussed by phone with the referring clinical physician Dr. Kourosh Rezania #5744 at the time of review of exam.The signal intensity of the cervical and uppermost visualized thoracic cord remains within normal.

Output: 1.Nonenhanced MRI of the cervical spine demonstrate a left sided disk/osteophyte complex with resultant subtle flattening deformity of the cord and mild central spinal stenosis and mild left neural foraminal compromise. At C6 -- C7 there is a left-sided uncovertebral hypertrophic changes result in moderate left neural foraminal compromise and mild central spinal stenosis. Increased T2 stir signal intensity of the intraspinous and supraspinous ligaments at C6 -- C7 level which could represent edematous/inflammatory changes. Correlation with history and follow up is recommended. The findings and concerns on this exam were discussed with referring clinical physician Dr. Kourosh Rezania #5744 at the time of review of exam.


Instruction: Generate impression based on findings.

Input: 66 year-old male history of HCC. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Ill-defined heterogeneous lesion within the peripheral aspect of segment 6 extending to the capsule demonstrates heterogeneous, but rapid arterial enhancement and washout on subsequent delayed imaging as well as some areas of signal dropout on out of phase imaging. Maximal axial dimensions are 5.4 x 4.0 cm (image 497 of series 1002). There is an additional hyperenhancing focus in segment 8 measuring 7 mm which washes out on delayed imaging, also compatible with HCC (image 557 of series 1002). Other subcentimeter hyperenhancing foci scattered about the liver are indeterminant, but likely perfusional in etiology given appearance and lack of corresponding conspicuity on delayed imaging.The portal veins and hepatic arteries appear patent. No intra or extra hepatic biliary ductal dilatation.SPLEEN: Small splenule.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral renal cysts, some of which are complex and cortical scars.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: 1. Large segment 6 mass as above containing fat most compatible with HCC. Additional smaller focus of HCC in segment 8.2. Other scattered areas of hyperenhancement are indeterminant, but favored to be perfusional in etiology however close followup is recommended.


Instruction: Generate impression based on findings.

Input: Recent third ventriculostomy. There are postoperative findings related to recent third ventriculostomy with a small amount of subdural pneumocephalus and pneumoventricle, as well as trace blood products in the left frontal convexity subdural and bilateral occipital horns of the lateral ventricles. There is a jet of cerebrospinal fluid flow into the third ventricle from the basal cisterns via a small defect in the floor of the third ventricle. However, there is persistent dilatation of the third and lateral ventricles. Bilateral transfrontal ventricular catheters remain in position. There is no evidence of acute infarct. There is minimal high T2 signal in the periventricular white matter and along the left transfrontal ventriculostomy tract. There is no midline shift or herniation. The major cerebral flow voids are intact. There is scalp swelling at the sites of prior stereotactic head frame screw positions. The orbits are grossly unremarkable.

Output: Interval third ventriculostomy, which appears to be patent, but persistent dilatation of the third and lateral ventricles.


Instruction: Generate impression based on findings.

Input: Sphenoid wing meningioma status post resection. There are postoperative findings related to left pterional craniotomy. There is no measurable tumor in the region of the left sphenoid wing. There is no evidence of acute intracranial hemorrhage or infarct. There is minimal unchanged encephalomalacia along the anterior left temporal pole. The ventricles and basal cisterns are stable in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unchanged.

Output: Stable postoperative findings without evidence of intracranial tumor recurrence.


Instruction: Generate impression based on findings.

Input: Reason: Multiple myeloma staging History: Multiple myeloma staging Several sequences are limited by patient motion artifact. There is a subcentimeter focus of increased bone marrow signal abnormality on fluid sensitive sequences within the right ilium which demonstrates decreased signal abnormality on T1-weighted images and enhancement on postcontrast sequences, suspicious for a myelomatous deposit. There are additional foci of increased signal abnormality on fluid sensitive sequences in the L4 vertebral body, seen on the large field-of-view images, however, these are not completely included in the field-of-view on the additional sequences and are incompletely characterized. Please refer to the dedicated MRI lumbar spine report for additional details. Heterogeneous bone marrow signal within the image lower lumbar spine, sacrum, and left and right ilium likely reflect residual islands of red marrow, however, diffuse myelomatous involvement cannot be completely excluded. The prostate is enlarged and heterogeneous. There is enlargement and dilation of the right seminal vesicle which is nonspecific.

Output: 7 mm focus of enhancing bone marrow signal abnormality in the right ilium is suspicious for a myelomatous deposit. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Dizziness and giddinessClinical question: evaluate cause for dizzinessSigns and Symptoms: "dizziness for 2 months, had head trauma due go GLF about 2 months ago" The CSF spaces are appropriate for the patient's stated age with no midline shift. No foci of diffusion restriction are appreciated 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. Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin.

Output: 1.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 2.There is no evidence for acute ischemic cerebral infarction present.


Instruction: Generate impression based on findings.

Input: Squamous cell carcinoma of the scalp , status post surgery at outside hospital. There are postoperative findings in the left occipital scalp, where there is a wide skin defect at the incision that extends to the underlying dura. There is diffuse patchy enhancement along the margins of the defect and more discrete subcentimeter nodules inferior to the defect. There is also diffusely enhancing tissue between the scalp flap and underlying dura, especially posteriorly, where it measures up to 15 mm in thickness. There is patchy bone marrow enhancement along the margins of the craniotomy and the underlying dura is also diffusely thickened, In addition, there is wispy enhancement along the surface of the underlying left cerebellar hemisphere, with scattered areas of high T2 signal and restricted diffusion. There is also a small area of encephalomalacia in the left cerebellar hemisphere. There are also areas of encephalomalacia in the right corona radiata, right basal ganglia, and left thalamus. There is a background of patchy cerebral white matter T2 hyperintensity. The ventricles are normal in size. There is no midline shift. There are bilateral lens implants. There is mucosal thickening and retention cyst formation in the left maxillary sinus.

Output: 1. Postoperative findings in the left occipital scalp, where there is an open would that extends to underlying dura with diffusely enhancing tissue between the scalp flap and underlying dura, which may represent tumor and/or inflamed or granulation tissue, with what may represent adjacent osteomyelitis and pachymeningitis or tumor infiltration. Subcentimeter nodules inferior to the defect may represent mildly reactive lymph nodes, although neoplastic deposits remain a potential consideration. Wispy enhancement along the surface of the underlying left cerebellar hemisphere, with scattered areas of high T2 signal and restricted diffusion may represent cerebritis with ischemia.2. Chronic lacunar infarcts in the left cerebellar hemisphere, right corona radiata, right basal ganglia, and left thalamus.


Instruction: Generate impression based on findings.

Input: Left neck pain, muscle spasms, tension headaches, concern for cervical radiculopathy Craniovertebral junction appears within normal limits. There is minimal anterolisthesis of C2 on C3 and minimal retrolisthesis of C3 on C4 as seen on recent CT. Moderate degenerative changes are seen throughout the cervical spine with loss of intervertebral disc height, worst at the C3-C4 and to a lesser degree C5-C6 levels. The cervical vertebral bodies are appropriate in height. Bone marrow signal is benign with endplate signal changes involving C3 and C4 related to degenerative disease. There does appear to be progression of these changes at the intervertebral discs and endplates compared to MRI from 5/19/2009.The cervical spinal cord has normal signal characteristics and overall morphology.Degenerative changes are seen in the cervical spine as described below:C2-3: Mild disc bulge. No significant compromise to the spinal canal or neural foramina.C3-4: Loss significant loss of disc height with associated endplate marrow changes. There is a disc osteophyte complex with uncovertebral hypertrophy and a disc bulge eccentric to the right. There is mild spinal canal stenosis with effacement of the ventral thecal sac and mild indentation of the ventral cord. There is moderate right and mild left neural foraminal stenosis.C4-5: There is mild to moderate left and minimal right neural foraminal stenosis related to uncovertebral hypertrophy. No significant spinal canal narrowing.C5-6: There is disc bulge and bilateral uncovertebral hypertrophy resulting in moderate to severe right and moderate left neural foraminal stenosis. No significant spinal canal stenosis.C6-7: Minimal disc bulge and bilateral uncovertebral hypertrophy. There is mild to moderate bilateral neural foraminal stenosis. No significant spinal canal stenosis.C7-T1: Uncovertebral hypertrophy results in mild to moderate right neural foraminal narrowing. No significant left neural foraminal narrowing. No significant spinal canal stenosis. Facet arthropathy on the right.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: Multilevel degenerative changes in the cervical spine which have progressed since 5/19/2009. There is mild spinal canal narrowing at C3-C4. Multilevel neural foraminal narrowing as detailed above, relatively worse at the right C3-C4 and bilateral C5-C6 levels.


Instruction: Generate impression based on findings.

Input: 80-year-old female with right shoulder pain. Suboptimal examination secondary to the patient's inability to complete the examination. Only axial and coronal oblique sequences were obtained. Suboptimal examination secondary to patient motion artifact.ROTATOR CUFF: There is perhaps a interstitial tear of the supraspinatus tendon just proximal to the level of its insertion on the greater tuberosity extending proximally to the level of the myotendinous junction. There is near full thickness tearing of the undersurface fibers of the subscapularis tendon at the level of its insertion. The supraspinatus, infraspinatus, and teres minor tendons and muscles are otherwise grossly intact although evaluation of the rotator cuff is suboptimal on this examination.SUPRASPINATUS OUTLET: Mild degenerative changes affect the acromioclavicular joint with subchondral cyst formation within the distal clavicle.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is a large glenohumeral joint effusion with foci of low signal intensity internally suggesting synovitis. Degenerative changes affect the glenohumeral joint with subchondral cyst formation within the glenoid. Otherwise no bone marrow signal abnormality is identified.BICEPS TENDON: The long head of the biceps tendon is poorly visualized but appears to be dislocated medial to the bicipital groove. There is increased signal abnormality and thickening of the extra-articular portion of the long head of the biceps tendon suggestive of chronic tendinosis and longitudinal split tearing.ADDITIONAL

Output: 1. Limited examination. Large glenohumeral joint effusion with foci of low signal intensity internally suggesting a synovitis. Septic arthritis/superimposed infection could be considered in the correct clinical setting. Nonspecific inflammatory changes of the deltoid muscle and rotator cuff musculature.2. Limited evaluation of the rotator cuff with apparent interstitial tearing of the supraspinatus tendon and near full thickness tearing of the subscapularis.3. Medial dislocation of the long head of the biceps tendon which is poorly visualized. Findings suggestive of chronic tendinosis/longitudinal split tearing of the extra-articular portion of the biceps tendon.


Instruction: Generate impression based on findings.

Input: Patient with swelling and pain of the left lower extremity. Check for cellulitis. Rule out osteomyelitis Diffuse moderate soft tissue swelling and reticulation of the subcutaneous tissues of the left lower leg are observed. The stranding and inflammation observed throughout the subcutaneous soft tissues are more pronounced involving the lower leg and surround the ankle, yet specifically appear to extend up to the deep compartments but not involving these deep muscles. Mild enhancement of the subcutaneous tissues are otherwise observed.Specifically deep muscular compartments are intact without evidence of interposed abnormal fluid collections or signal abnormality. Vasculature is unremarkable other than mild venous dilatation, suggesting partial stasis. The underlying osseous structures and marrow signal are normal. Specifically no distinct osseous changes to suggest osteomyelitis. Again no abnormal enhancing tissue is observed in the deep compartments or osseous structures

Output: Subcutaneous soft tissue changes correlating with history of cellulitis without deep muscular compartment or osseous abnormalities


Instruction: Generate impression based on findings.

Input: 61 years Male (DOB:7/18/1954)Reason: ICH etiology History: cerebellar bleedPROVIDER/ATTENDING NAME: WENDY A. STOCK FERNANDO D. GOLDENBERG MRI of the brainThere is a 13 x 17 mm axial dimension hemorrhagic focus in the right cerebellar hemisphere associated with surrounding T2 and FLAIR signal hyperintensity compatible with vasogenic edema. Hemorrhagic focus is partially high signal on T1 and partially isointense to white matter on T1. It is heterogeneous signal on T2 imaging and has some susceptibility effect within it.There are is a punctate focus of susceptibility effect along the left frontal lobe subcortical white matter at the left middle frontal gyrus and another one at the subcortical white matter of the left orbital gyrusSmall amount of susceptibility effect is present along the posterior aspects of the trigones of the lateral ventricles.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate small mucous retention cysts.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin.MRA brain:The left posterior inferior cerebellar artery is partially visualized. The caudal tonsillar loop is obscured by lack of signal. It appears that the left posterior inferior cerebellar artery is dominant vessel which also supplies the vermis. The right anterior inferior cerebellar artery is also a dominant vessel and supplies part of the right posterior inferior cerebellar artery territory.No aneurysm or arteriovenous malformation is appreciated in connection with the patient's right cerebellar hemorrhage on this exam.Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is small to medium size. The posterior communicating arteries are small. The vertebral arteries are similar in size.

Output: 1.There is a right cerebellar hemorrhage present. There is no underlying lesion in the location identified on the prior MRI from 3/2/2016. There is a small amount of associated intraventricular blood identified.2.No evidence for intracranial aneurysm or arteriovenous malformation.3.There are couple microhemorrhages present in the left frontal lobe subcortical white matter, which in isolation would be difficult to considered to establish a specific pattern.


Instruction: Generate impression based on findings.

Input: History of intraosseous catheter placement complicated by osteomyelitis and septic arthritis. Now with persistently elevated ESR, pain at right knee at prior IO catheter site. Please evaluate for recurrent/persistent infection. MRI images of the right tibia/fibula and knee again show branching signal abnormality and enhancement within the proximal tibia extending from the tibial plateau into the proximal diaphysis over a craniocaudal distance of approximately 11 cm compatible with osteomyelitis. There now appears to be a more confluent area of decreased T1 signal within the proximal tibial metadiaphysis with adjacent new destruction of the anterior tibial cortex with overlying enhancing soft tissue thickening. No discrete drainable fluid collection is identified. Also again seen is less well defined signal abnormality within the distal tibia along with small foci of enhancement which also may represent infection.There is a small amount of fluid within the knee, however, no effusion; septic arthritis cannot be excluded on this examination.Although this examination was not protocoled to evaluate for internal derangement of the knee, the cruciate ligaments and menisci appear grossly intact.

Output: Residual osteomyelitis which appears progressed from the prior examination with new cortical destruction.


Instruction: Generate impression based on findings.

Input: 57-year-old female with history of ALH and LCIS from stereotactic biopsy of left breast in November 2012 and benign MRI biopsy of the left breast in March 2013. Follow-up examination. No current breast complaints. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. An MRI guided biopsy clip is located within the left lower inner quadrant. A stereotactic X-shaped biopsy clip is located within the left upper outer quadrant. Scattered bilateral benign calcifications are appreciated.No dominant mass, suspicious microcalcifications or areas of architectural distortion in either breast.

Output: No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: Epilepsy. There are bilateral transoccipital and left transtemporal deep brain electrodes that terminate in the bilateral anterior temporal lobe regions. There is confluent T2 hyperintensity in the anterior left temporal lobe. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation.

Output: Surgical planning MRI demonstrates bilateral temporal lobe deep electrodes and what may represent edema in the anterior left temporal lobe.


Instruction: Generate impression based on findings.

Input: Tenderness over the left hip, evaluate for fracture Avascular necrosis of the femoral head with subchondral collapse. Severe secondary degenerative changes of the hip. Marked soft tissue swelling of the thigh again noted.

Output: Avascular necrosis of the left femoral head with subchondral collapse. Marked soft tissue swelling of the thigh again noted.


Instruction: Generate impression based on findings.

Input: Reason: CNS involvement of AML? meningeal enhancement? History: headache, cervical spine tenderness, relapsed AML Brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a focus of diffusion restriction present along the splenium of the corpus callosum. This is associated with T2 and flair signal hyperintensity. There is no associated contrast enhancement.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses and demonstrate some mucosal thickening in the left maxillary sinus, sphenoid sinuses and ethmoid air cells and near complete opacification of the right maxillary sinus. The visualized portions of the mastoid air cells demonstrate scattered opacities. The visualized portions of the orbits are intact.Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord demonstrates a small syrinx at the C6 and C5 vertebral body levels measuring up to 1.5 mm in diameter. No abnormal enhancing lesions are identified in the cervical spine. The marrow signal generaly diminished.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1. A lesion in the splenium of the corpus callosum is nonspecific . Often times these lesions are reversible. They have been associated with influenza, chemotherapy treatment and seizure.2. there is opacification of the right maxillary sinus with an obstructive pattern suggestive of obstruction of the right ostiomeatal complex unit or hiatus semilunaris.3. Small spinal cord syrinx.4. Periventricular and subcortical white matter signal changes of a mild degree are present which are nonspecific. They could be vascular related, related to demyelination, trauma, vasculitis, sarcoid. They are nonspecific. 5. Finding suggests diffuse marrow replacement. In the context of acute myeloid leukemia this may be related to myeloproliferation.


Instruction: Generate impression based on findings.

Input: Transphenoidal surgery for pituitary tumor resection: none- surveillance. There are postoperative findings related to transphenoidal pituitary resection. There is no significant interval change in the enhancing lesion in the right pituitary, which measures up to 13 mm. The lesion extends slightly into the right cavernous sinus, without evidence of carotid encasement or narrowing. The mass also extends across the midline and causes slight deviation of the pituitary stalk to the left. The suprasellar cistern and optic apparatus are intact.

Output: No significant interval change in the pituitary lesion.


Instruction: Generate impression based on findings.

Input: 57-year-old female with a strong family history of breast cancer in her mother and maternal grandmother, and sister diagnosed at age 38. History of benign left breast biopsy in 1998. History of basal cell carcinoma of right upper lip diagnosed at age 50. No current breast complaints. There is heterogeneous amount of fibroglandular tissue in both breasts.Minimal parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: History of leukemia and abnormal LFTs. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology and size, measuring 19 cm in craniocaudal dimension.1.1 cm T2 hyperintense cyst in the posterior segment of the right hepatic lobe.No suspicious lesion is evident.Normally distended gallbladder.No intra or extrahepatic biliary ductal dilatation. Mild irregularity near the the proximal common hepatic duct likely represents a crossing vessel.SPLEEN: The spleen is normal in size measuring 9 cm in length. No focal lesion.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No findings to account for the patient's abnormal LFTs.


Instruction: Generate impression based on findings.

Input: Female 61 years old Reason: rectal cancer staging History: rectal mass PELVIS:UTERUS, ADNEXA: Patient is status post hysterectomy. Subcentimeter ovarian cysts noted bilaterally.BLADDER: No significant abnormality noted. LYMPH NODES: Subcentimeter, nonspecific lymph nodes are noted in the left perirectal fat (3/30) in the right iliac chain (3/51).BOWEL, MESENTERY: There are postsurgical changes from recent adenoma excision involving the entire rectum. There is edema in the bowel wall and perirectal inflammation which limits evaluation for malignancy.No polypoid mass is identified. The sphincter complex is normal.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Postsurgical changes from recent abnormal excision which limits evaluation for malignancy. No polypoid mass identified and sphincter complex is normal.2.Nonspecific subcentimeter left perirectal and right iliac chain lymph nodes.


Instruction: Generate impression based on findings.

Input: Patient is POD 14 from radical hysterectomy and is having persistent leaking of urine around the Foley and urine in vagina. Looking for evidence of vesicovaginal fistula versus ureterovaginal fistula. PELVIS:UTERUS, ADNEXA: Post-surgical findings of hysterectomy. Ovaries are unremarkable in appearance.BLADDER: Foley catheter terminates in a partially collapsed bladder. Secondary inflammatory thickening of the posterior bladder wall due to the central pelvic fluid collection described below.LYMPH NODES: Post-surgical findings of lymph node dissection. Prominent inguinal lymph nodes, likely reactive.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Bilateral well-circumscribed fluid signal foci along the bilateral external iliac chains consistent with nonspecific post-surgical fluid collections, possibly lymphoceles; special attention on follow-up scans. The larger one on the right measures 4.2 x 2.9 cm (series 401, image 50).Post-surgical subcutaneous edema in the anterior pelvic wall.OTHER: Fistulous communication between the distal left ureter and a 3 x 2.5 cm left hemipelvis collection located posterior to the proximal external iliac vasculature (series 1001, image 373; series 1005, image 370). Additional fistulous connection between this left sided collection and a central 6.2 x 2.9 cm collection immediately superior to the vaginal cuff (series 1001, image 298).No discrete fistulous tract between the vagina and bladder is identified on background of extensive surgical change.Small amount of nonspecific pelvic fluid, possibly represents urine.

Output: Left ureterovaginal fistulous network communicating through two fluid collections in the left hemipelvis and at the vaginal cuff.


Instruction: Generate impression based on findings.

Input: Male 65 years old Reason: Recurrent PSC, weight loss, eval for CCA and dominant strictures History: s/p OLT with recurrent PSC ABDOMEN:LIVER, BILIARY TRACT: Liver has a cirrhotic morphology with widened fissures and a nodular contour. There is biliary ductal dilatation with areas of stricturing. There is stricturing of the bile ducts near the Klatskin point. The common bile duct measures 10 mm. There is mild to moderate intrahepatic biliary ductal dilatation. There are postsurgical changes from hepaticojejunostomy. There is wall thickening and enhancement of the ducts indicating inflammation. The biliary ductal dilatation extends to the level of the biliary enteric anastomosis. Patency of the anastomosis cannot be fully evaluated on this exam. No dominant mass is identified.SPLEEN: No significant abnormality noted.PANCREAS: Subcentimeter cystic focus in the head of the pancreas as seen on image 28/series 10 is likely connects with adjacent duct and may represent a small IPMN.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Cirrhotic liver with findings of recurrent sclerosing cholangitis with areas of stricturing and biliary wall thickening. There is no dominant mass. The ductal dilatation terminates at the biliary enteric anastomosis. If patient has findings of jaundice or biliary obstruction, further evaluation for obstruction at this level and the Klatskin point is suggested.


Instruction: Generate impression based on findings.

Input: MRI brain: There are nonspecific T2/FLAIR hyperintensities in the periventricular and subcortical white matter most consistent with chronic small vessel ischemic disease and similar to prior MRI from 2011. A chronic lacunar infarct is seen in the right centrum semiovale and unchanged. There is no restricted diffusion. There are scattered foci of susceptibility consistent with chronic microhemorrhages in the bilateral cerebral hemispheres as well as the in the cerebellum with a nonspecific distribution. Ventricles are normal in size. There is no evidence of intracranial mass effect, midline shift, or herniation. No evidence of acute hemorrhage. There is mild global parenchymal volume loss, commensurate with patient's advanced age. There is prominence of the lacrimal glands which is again seen.MRA brain: The cerebral internal carotid arteries are patent. The anterior cerebral arteries are patent. The middle cerebral arteries demonstrates no significant stenosis. The posterior cerebral arteries are patent. The vertebral arteries are also patent with no flow-limiting stenosis or aneurysm.MRA neck: The cervical common and internal carotid arteries as well as the vertebral arteries in the neck demonstrate no flow-limiting stenosis.

Output: 1. There is no evidence of acute infarct. No intracranial mass or mass effect. No hydrocephalus.2. Evidence of mild chronic small vessel ischemic disease which appears similar to MRI 10/14/2011. Multiple scattered supratentorial and infratentorial foci of chronic microhemorrhages are again seen in a nonspecific distribution.3. MR angiogram of the brain and neck demonstrates no flow-limiting stenosis or aneurysm.


Instruction: Generate impression based on findings.

Input: Images are slightly limited by patient motion. There is a stable right frontal approach ventriculostomy catheter with its tip terminating in the region of the right foramen of Monro. There is susceptibility artifact resulting from the ventriculostomy catheter, limiting evaluation of surrounding structures. There is persistent moderate prominence of the lateral ventricles.There is suggestion of the third ventriculostomy defect, with a small T2 hypointense flow-void extending through this area implying patent ventriculostomy. Phase contrast images demonstrate conspicuous bidirectional CSF flow through the third ventriculostomy site. There is no significant flow detected through the aqueduct which is again narrowed without proximal funneling.A few foci of nonspecific T2/FLAIR hyperintensity are again seen in the left frontal periventricular white matter. There is minimal persistent gliosis along the ventriculostomy catheter. Again noted is a focus of susceptibility in the right inferior medial frontal lobe. The previous focus in the right brachium pontis is not well visualized. Small pineal cyst with fluid-fluid level is unchanged. Aerated secretions are noted in the left sphenoid sinus.

Output: Continued stable exam with patent third ventriculostomy and stable moderate dilatation of the lateral ventricles. Stable right frontal approach ventriculostomy catheter.


Instruction: Generate impression based on findings.

Input: Female, 61 years old, with left upper extremity weakness, assess cord edema and possible tumor. Please note that only precontrast images were obtained due to patient intolerance.Pathologic cord T2 hyperintensity and thickening is seen most conspicuously affecting the cord between C4 and C7. Abnormal signal without thickening extends superiorly to the C1 level and inferiorly to the T4 level. Findings are unchanged relative to the prior examination. At the levels of most prominent involvement, the internal architecture of the cord is obscured and there are small foci of very bright signal abnormality which may reflect cystic or cavitary tissue.The cervical lordosis is straightened. Vertebral body heights are preserved. Marrow signal characteristics remain within normal limits. Multilevel disc osteophyte formation is is seen in the cervical spine resulting in canal narrowing at C3-4, C4-5 and C5-6. However, minimal if any cord impingement or deformation is seen at these levels. Bulky facet arthropathy is demonstrated on the left at C2-3 and bilaterally at C3-4. Moderate to severe foraminal narrowing is seen on the left at C3-4 and on the left at C5-6. Minimal disc degeneration is present in the thoracic spine without significant spinal canal or foraminal compromise. Small bilateral pleural effusions are noted.

Output: Examination was limited by patient tolerance which prevented acquisition of the postcontrast images. An extensive area of spinal cord signal abnormality is redemonstrated centered on the C4-C7 levels but with extension superiorly to C1 and inferiorly to T4. The internal architecture of the cord is obscured by this process and there is the suggestion of small areas of cord cavitation or cyst formation. A primary tumor of the cord remains high on the differential diagnosis with an inflammatory process considered less likely.


Instruction: Generate impression based on findings.

Input: Cardiac arrest, cause unspecified [I46.9] / Unspecified coma [R40.20], Reason for Study: ^Reason: prognostication after cardiac arrest History: absence of mental status There are multifocal symmetric diffusion restriction lesions on bilateral occipital lobe, parietal lobes and frontal lobes. There is also focal diffusion restriction on the left basal ganglia.There is focal susceptibility artifact on the left inferior medial aspect of temporal lobe (series 901, image 92). There is no associated surrounding edema. The differential diagnosis include focal hemorrhage, parenchymal calcification or an artifact.The ventricles, sulci and cisterns are symmetric and unremarkable.The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: Symmetric acute ischemic infarctions involving bilateral frontal, parietal and occipital lobes which is consistent with global hypoxic injury.


Instruction: Generate impression based on findings.

Input: 48 year old BRCA 2 mutation carrier. High risk breast screening MRI requested. History of breast cancer in sister and maternal great aunt. There is heterogeneous amount of fibroglandular tissue in both breasts.Minimal parenchymal enhancement is noted bilaterally.There is a new enhancing mass at posterior 4 o'clock position in the left breast, measuring 9 x 7 x 9 mm (AP x LR x CC).No abnormal enhancement is seen in right breast. No abnormal lymph nodes are identified in either axillary region.

Output: New enhancing mass at posterior 4 o'clock position in the left breast, for which ultrasound study with possible biopsy is recommended. If no sonographic correlation is detected, MR guided biopsy should be considered.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration.


Instruction: Generate impression based on findings.

Input: Evaluate left odontogenic tumor seen on recent CT scan. There is a smoothly contoured, but heterogeneous lesion without discernible enhancement that arises from the left maxillary alveolus and projects into the maxillary antrum. The lesions measures up to approximately 40 mm and extends superiorly to abut the floor of the left orbit. There is a small right sphenoid sinuses retention cyst. The other paranasal sinuses and nasal cavity are unremarkable. The nasal septum is essentially midline. The nasopharynx, facial soft tissues, orbits, and imaged intracranial structures appear to be unremarkable.

Output: A lesion measuring up to approximately 40 mm that that arises from the left maxillary alveolus and projects into the maxillary antrum likely represents a form of odontogenic cyst, perhaps with superimposed prior hemorrhage or infection.


Instruction: Generate impression based on findings.

Input: Fatigue, paresthesias and urinary frequency. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is no midline shift or mass effect. There are a few unchanged scattered nonspecific punctate foci of T2hyperintensity in the cerebral white matter. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There are subcentimeter probable retention cysts in the maxillary sinuses.

Output: Few, unchanged, scattered, nonspecific punctate foci of T2 hyperintensity in the cerebral white matter.


Instruction: Generate impression based on findings.

Input: Proximal humerus neoplasm Note that the examination is limited by the patient's inability to tolerate the procedure and by the patient's body habitus.An aggressive soft tissue mass is seen situated adjacent to the infraspinatus muscle resulting in cortical destruction of the posterior aspect of the humeral head. It measures approximately 3.8 x 3.4 x 3.6 cm in the greatest transverse, craniocaudal, and AP dimensions and there is solid enhancement following gadolinium administration. Soft tissue edema and enhancement is seen surrounding the mass.There is abnormal marrow signal throughout the humerus extending from the level of the mass through the majority of the long bones. This is evidenced by abnormal increased marrow signal on coronal STIR sequence (series 9 image 11/19) and on T1 sequence (series 6 image 17/35) to the level of the distal metadiaphysis (series 6 image 17/35). Abnormal enhancement is also evident to the level of the distal metadiaphysis (series 12 image 15/32). Islands of normal marrow signal are interspersed throughout the diaphysis.

Output: Aggressive soft tissue mass of the left humerus consistent with known sarcoma. Abnormal marrow signal extending throughout the humerus to the level of the distal metadiaphysis is concerning for malignant involvement.


Instruction: Generate impression based on findings.

Input: Female; 68 years old. Reason: Evaluate IPMN, pancreatic tail lesion. On recent EUS, there was a 10 x 10 mm cystic lesion in the pancreatic neck suspected to be an IPMN as per EPIC notes. ABDOMEN:LIVER, BILIARY TRACT: No suspicious hepatic lesions or biliary ductal dilatation. SPLEEN: No significant abnormality noted.PANCREAS: There is a T2 hyperintense, non-enhancing lesion in the region of the pancreatic head that appears to communicate with the main pancreatic duct. This lesion measures 9 x 8 mm, previously 10 mm and not significantly changed, compatible with a sidebranch IPMN (series 4, image 46). Additional subcentimeter T2 hyperintense lesion located more distally in the pancreas also likely represents a sidebranch IPMN which was seen on prior MRI (series 4, image 31). No pancreatic ductal dilatation. Area of decreased T1 signal in the pancreatic tail now measures 1.4 x 0.8 cm, previously 1.7 x 1.0 cm and compatible with sequela of prior pancreatitis (series 11, image 50). ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral subcentimeter renal cysts. No hydronephrosis. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Levoscoliosis of the thoracolumbar spine, unchanged.OTHER: No significant abnormality noted.

Output: 1.No significant interval change in sidebranch pancreatic head IPMN as described above. Additional subcentimeter IPMN again noted more distally. 2.Interval decrease in size of T1 hypointense pancreatic tail signal, likely representing sequela of prior pancreatitis.


Instruction: Generate impression based on findings.

Input: Reason: r/o osteo History: osteo on Xray, pain There is confluent decreased T1-weighted and increased T2-weighted signal within the proximal and middle phalanx of the fifth toe, with overlying soft tissue defect, compatible with osteomyelitis. The pathologic fracture of the fifth proximal phalanx is better evaluated on recent radiograph. There is associated bone marrow edema within the distal phalanx of the fifth toe, as well as the fifth metatarsal head.Low T1-weighted signal associated with increased T2-weighted signal within the middle phalanx of the fourth toe is also compatible with osteomyelitis.Additionally, confluent decreased T1-weighted and increased T2-weighted signal in the distal first phalanx is compatible with osteomyelitis. There is an ulceration along the medial aspect of the great toe.No discrete fluid collections are identified in the soft tissues, however, evaluation is somewhat limited given the lack of intravenous contrast.

Output: Osteomyelitis affects the proximal and middle phalanx of the fifth digit, the middle phalanx of the fourth digit, as well as the distal phalanx of the great toe.


Instruction: Generate impression based on findings.

Input: Shoulder pain ROTATOR CUFF: There is mild tendinopathy of the distal supraspinatus but otherwise there is no evidence of a full-thickness rotator cuff tear. There are mild cystic degenerative changes of the greater tuberosity.SUPRASPINATUS OUTLET: Trace amount of fluid is noted within the subacromial subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: No significant abnormality noted.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: Mild tendinopathy of the rotator cuff without evidence of tear or other internal derangement.


Instruction: Generate impression based on findings.

Input: Transient unresponsiveness. MRI: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is a small focus of encephalomalacia in the left pons. There is also a background of scattered cerebral white matter T2 hyperintensity, particularly in a periventricular distribution. There is disproportionate volume loss involving the bilateral medial temporal lobes. 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 no evidence of significant steno-occlusive lesions or aneurysms.

Output: 1. Chronic lacunar infarct in the left pons and probable chronic small vessel ischemic white matter disease, but no evidence of acute infarct.2. Disproportionate volume loss involving the bilateral medial temporal lobes can be manifestation of Alzheimer disease.3. No evidence of significant steno-occlusive lesions or aneurysms.


Instruction: Generate impression based on findings.

Input: Pain in left shoulder. Evaluate for labral pathology. ROTATOR CUFF: There is fraying of the undersurface of the supraspinatus comprising less than 50% of the tendon. No full-thickness tear is identified. There is subchondral cystic change at the supraspinatus footprint on the greater tuberosity.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenoid labrum and bicipital labral complex are intact.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: Moderate fraying of the undersurface of the supraspinatus tendon, with no full-thickness tear or other significant abnormality identified.


Instruction: Generate impression based on findings.

Input: 50 year old man with heart/kidney transplant on 10/22/15, referred for serial MRI as part screening for cardiac allograft rejection. Left VentricleThe left ventricle is normal in size with borderline systolic function. The overall LV ejection fraction is 54%, the LV end diastolic volume index is 51 ml/m2 (normal range: 74+/-15), the LVEDV is 123 ml (normal range 142+/-34), the LV end systolic volume index is 23 ml/m2 (normal range 25+/-9), the LVESV is 58 ml (normal range 47+/-19), the LV mass index is 40 g/m2 (normal range 85+/-15), and the LV mass is 100 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is a small area of nontransmural mid wall late gadolinium enhancement in the lateral wall to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. Quantitatively, the myocardial to skeletal T2-enhancement ratio is 1.6 which is in the normal range. The global relative enhancement is 2.9, which is in the normal range and has normalized since the last exam. The native myocardial T1 time in the interventricular septum is borderline at 1000-1100 ms, which is borderline/elevated and may indicate edema or fibrosis, but this value measures similarly to the previous study. The extra-cellular volume fraction (ECV) is 30%, which is similar to that obtained on the previous exam.Left AtriumThe left atrium is consistent with transplant. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 51%, the RV end diastolic volume index is 53 ml/m2 (normal range 82+/-16), the RVEDV is 131 ml (normal range 142+/-31), the RV end systolic volume index is 26 ml/m2 (normal range 31+/-9), and the RVESV is 64 ml (normal range 54+/-17).Right AtriumThe right atrium is consistent with transplant.Aortic ValveThe aortic valve opens widely and there is trace 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 are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsSternotomy wires present. There is diffuse low signal of the liver and spleen, which was seen on the previous study. Polycystic kidney disease, as before. 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 borderline systolic function. The overall LV ejection fraction is 54%. There are no regional wall motion abnormalities present. There is a small area of nontransmural mid wall late gadolinium enhancement in the lateral wall to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. Quantitative measurements for edema and inflammation essentially unchanged from previous scan. 2. The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 51%. Compared to previous study, the small area of LGE is better seen today but was present on previous exam. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Achilles tendon repair with wound dehiscent. Pain Marked abnormal thickening and signal abnormality is observed in the Achilles tendon throughout the entire course of the then the distal most 1 to 2 cm attachment distally. Specifically focal disruption with approximately 1.5 cm of distraction underlies and correlates with the posterior soft tissue defect approximately 5 cm above the calcaneal insertion. No definite intact fibers are observed. Surrounding additional soft tissue inflammation is otherwise identified without extension into alternate muscles or compartments. Specifically no discrete focal fluid collection or additional findings to support a discrete abscess. Surrounding soft tissue changes are are otherwise nonspecific and at minimum inflammatory.Remaining ankle tendons are otherwise grossly intactThe underlying osseous structures are otherwise intact with otherwise grossly normal marrow signal given suspected heterogeneous marrow placement secondary to suspected disuse.

Output: Pronounced Achilles tendon abnormality consistent with suspected disruption and degenerative changes observed approximately 6 cm above the calcaneal insertion. Loss of tendon integrity with retraction is also suspected. See details provided.


Instruction: Generate impression based on findings.

Input: Diagnosis: Retinal ischemiaSigns and Symptoms: Retinal Ischemia MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus. The right vertebral artery is small.The visualized portions of the paranasal sinuses demonstrate minor opacities. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI orbits:The eyeballs are intact. No intraconal or extraconal space mass is identified. The extraocular muscles are intact. The lacrimal glands are symmetric and within normal limits in size and configuration. There is no optic nerve enhancement appreciated. The suprasellar cistern is intact .

Output: Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: 83-year-old male with a history of a left renal complex cysts (Bosniak 3). Follow-up examination. ABDOMEN:LIVER, BILIARY TRACT: There is a focus of nonenhancing linear increased T2 signal abnormality in the right lobe of the liver, which is nonspecific.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Note is made of a 2.8 x 2.6 cm complex cystic lesion along the lateral aspect of the interpolar region of the left kidney, with associated increased T1 signal abnormality (22; series 6). There is a thick septation which enhances on postcontrast sequences.Note is made of a complex cyst in the superior pole of the left kidney, with associated increased T1 signal abnormality. Multiple additional subcentimeter foci of fluid signal intensity are identified within the kidneys bilaterally, which are too small to characterize, but likely represent simple cysts. No evidence of hydroureteronephrosis.RETROPERITONEUM, LYMPH NODES: No evidence of lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Complex left renal cyst with associated thick enhancing septation, consistent with the stated history of a Bosniak III renal lesion.


Instruction: Generate impression based on findings.

Input: History of prostate cancer. PELVIS:PROSTATE:Prostate Size: 2.0 x 4.2 x 4.5 cmPeripheral Zone: 1.0 x 0.5 cm right medial apex lesion demonstrating decreased T2 weighted signal intensity (series 1/16), restricted diffusion (series 1003/304) and arterial enhancement with washout (series 2101/6 79).Additional focus in the left medial apex measuring 6 x 5 mm with similar imaging characteristics (series 801/60).5 x 5 mm focus in the anterior right lateral mid gland demonstrating decreased T2 weighted signal intensity and restricted diffusion (series 801/19).Central Gland: Changes of benign prostatic hyperplasia.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: The right mid gland lesion abuts and bulges the adjacent fibromuscular capsule (series 801/19) without frank extraprostatic extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: Bowel containing left inguinal hernia is incompletely characterized. Heterogeneous marrow signal intensity with a focus of enhancement in the left ischial tuberosity.OTHER: No significant abnormality noted.

Output: 1. Suspected multifocal prostatic adenocarcinoma with a dominant lesion in the right medial apex. No evidence of seminal vesicle invasion. Possible extraprostatic extension of a right anterior lateral mid-gland lesion.2. Heterogeneous bone marrow signal intensity, with an enhancing focus in the left ischial tuberosity without definite corresponding increase in radiotracer uptake on the outside hospital nuclear medicine bone scan. This may be degenerative in etiology.3. Large left inguinal hernia containing bowel, incompletely imaged but without evidence of complication.


Instruction: Generate impression based on findings.

Input: 12 year-old female with dilated common bile duct on serial ultrasound, evaluate for choledochal cyst type I. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology with no focal hepatic lesions. No intrahepatic biliary ductal dilatation. Mild saccular dilatation of the mid common bile duct persists measuring up to 9 mm in diameter spanning approximately 2 cm. The gallbladder is slightly distended with no cholelithiasis or findings to suggest cholecystitis. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: The kidneys demonstrate symmetric enhancement with no evidence of hydronephrosis. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The bowel is normal in caliber with no evidence of bowel obstruction. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Unchanged mild dilatation of the mid common bile duct which may be a normal variant or could represent a type I choledocho cyst.


Instruction: Generate impression based on findings.

Input: 61 year-old female. Recurrent urothelial cancer, pelvic pain, evaluate for progression. 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: Expected mild hydronephrosis with diversion into a right lower quadrant ileal conduit.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postsurgical findings in the small bowel and colon from partial resection. Anterior mesenteric soft tissue nodule, likely a metastasis (series 11, image 30).BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Postsurgical findings of total vaginectomy. BLADDER: Postsurgical findings of cystectomy and right lower quadrant ileal conduit.LYMPH NODES: Left inguinal lymphadenopathy and soft tissue nodules in the left lower abdominal wall, likely metastaticBOWEL, MESENTERY: Postsurgical findings in the small bowel and colon from partial resection.BONES, SOFT TISSUES: 5 x 4.8 cm soft tissue mass in the central lower pelvis within the operative bed invading into the right labia consistent with residual tumor. Multiple soft tissue nodules inside the pelvis, studding a small bowel loop and sigmoid colon consistent with local metastasis. Additional multiple soft tissue nodule metastases are seen in the medial proximal pelvic musculature (obturator internus, obturator externus, pectineus) and in the perineum, including one on the left that is 2 x 2.1 cm. Comparison to prior is difficult given presence of extensive background post-surgical changes. Post-surgical findings of bilateral superior pubic rami resection and edema in the pelvic muscles.OTHER: No significant abnormality noted.

Output: Significant residual tumor in the operative bed in the central lower pelvis with multiple soft tissue metastatic nodules in the perineum and medial pelvic musculature.


Instruction: Generate impression based on findings.

Input: Wrist pain Evaluation is limited by motion artifact on some sequences LIGAMENTS: There is mild increased signal intensity within the membranous portion of the scapholunate ligament which may reflect intrasubstance degeneration; however contrast remains within the radiocarpal joint without extension to the midcarpal joint to suggest a scapholunate or lunotriquetral ligament tear.TRIANGULAR FIBROCARTILAGE COMPLEX: Although we see no contrast entering the distal radioulnar joint, there is a gap within the articular disc of the triangular fibrocartilage at its attachment to the distal radius indicating a tear. TENDONS: No significant abnormality noted. BONES: There is loss of the cartilage along the proximal margin of the lunate with underlying degenerative subchondral signal abnormality.ADDITIONAL

Output: 1. Tear of the articular disc of the triangular fibrocartilage at its radial attachment with chondromalacia of the adjacent lunate.2. Mild intrasubstance degeneration of the scapholunate ligament but there are no gadolinium-filled tears.


Instruction: Generate impression based on findings.

Input: Status post left knee patellar dislocation. Pain in left knee. MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: There is T2 hyperintensity within the lateral femoral condyle and tibial plateau, compatible with bone marrow edema.LIGAMENTS: There is complete rupture of the proximal to mid substance fibers of the ACL. The posterior cruciate ligament is normal in appearance. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: ACL rupture with large joint effusion.


Instruction: Generate impression based on findings.

Input: Male, 42 years old, with AVM planning for resection today, previously treated with radiosurgery in 2011. Again seen is a cystic focus with scattered surrounding patchy enhancement within the left post central gyrus, all appearing similar to the prior examination and likely corresponding to the site of the previously treated AVM. The degree of surrounding T2 hyperintensity is also unchanged.No new enhancing or nonenhancing parenchymal lesions are seen. Cerebral morphology is otherwise unremarkable. No new pathologic fluid collections are seen. The ventricles are stable in size. Non-fusion of the cerebellar vermis and nodulus with associated contour asymmetry of the fourth ventricle is unchanged and likely developmental.

Output: Limited examination for surgical planning purposes redemonstrates the treated AVM in the left postcentral gyrus.


Instruction: Generate impression based on findings.

Input: 57 year old female with right upper extremity pain and pain in the shoulder for many months with decreased mobility of the joint. ROTATOR CUFF: Full thickness tear of the supraspinatus measuring approximately 9 mm in the AP dimension with minimal retraction. Fibers of the supraspinatus can be traced to their insertion on the greater tuberosity. There is extension of tearing along the articular surface of the supraspinatus tendon more proximally. Moderate tendinosis affects the supraspinatus. Mild tendinosis affects the infraspinatus tendon. There is minimal fatty atrophy at the level of the myotendinous junction of the supraspinatus and infraspinatus muscles. Teres minor muscle and tendon appear intact. The subscapularis muscle and tendon appear intact.SUPRASPINATUS OUTLET: There is a small amount of fluid within the subacromial subdeltoid bursa. Mild degenerative changes affect the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: Mild to moderate degenerative changes affect the glenohumeral joint.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: Full thickness rotator cuff tear as detailed above.


Instruction: Generate impression based on findings.

Input: Left arm weakness, brisk reflexes, 30 pack-year history of smoking. Rule out cervical disc herniation or tumor compression. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is grossly maintained aside from mild reversal of cervical lordosis and minimal anterolisthesis of C3 on C4. Bone marrow signal is benign. No suspicious lesions to suggest neoplasm. The cervical spinal cord has normal signal characteristics.Degenerative changes are seen in the cervical spine with multilevel disc desiccation and moderate disc height loss at the C6-C7 level. Additional details as described below: C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: No significant compromise to the spinal canal or neural foramina.C4-5: There is disc bulge and mild bilateral uncovertebral hypertrophy. There is mild spinal canal stenosis. There is moderate right and mild left neural foraminal stenosis.C5-6: There is a left paracentral disc protrusion which indents the ventral left aspect of the cord with moderate stenosis primarily involving the left aspect of the spinal canal. There may be impingement of the left C6 nerve rootlets proximal to the neural foramen. There is minimal left and no significant right neural foraminal narrowing.C6-7: Small disc osteophyte complex with uncovertebral hypertrophy and ligamentum flavum thickening. There is mild spinal canal stenosis. There is mild to moderate bilateral neural foraminal stenosis. C7-T1: Minimal disc bulge with minimal narrowing of the neural foramina, relatively greater on the left. Spinal canal is patent. The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.Partially imaged brain demonstrates T2 hyperintensity involving the pons, better seen on prior brain MRI and may relate to chronic small vessel ischemic disease.

Output: 1. Multilevel degenerative changes in the cervical spine, worst at the C5-C6 level where there is a prominent left paracentral disc protrusion which indents the left lateral aspect of the spinal cord and may also be affecting the left-sided nerve rootlets proximal to the neural foramen. There is moderate stenosis involving the left aspect of the spinal canal at this level. No cord signal abnormality.2. There is also mild spinal canal stenosis at the C4-C5 and C6-C7 levels. There is also multilevel neural foraminal stenoses as detailed above, worst at the right C4-C5 level where there is moderate stenosis.3. No suspicious lesions to suggest neoplasm.


Instruction: Generate impression based on findings.

Input: Female, 72 years old, with history of multiple sclerosis and increased weakness in the left arm and leg as well as brisk reflexes in the right knee. Patchy ill-defined T2 signal abnormality is again seen throughout the cervical spinal cord with encephalomalacia and cord volume loss most conspicuous at C6-7. No enhancing lesions are seen. No significant interval change is noted.Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. No evidence of concerning marrow replacement, edema or enhancement is observed.Mild disc degeneration is seen with small disc osteophytes evident from C3-4 through C6-7. No spinal canal stenosis is observed. There may be mild neuroforaminal narrowing on the left at C4-5, and moderate narrowing on the left at C5-6, due largely to facet arthropathy.

Output: Patchy ill-defined cord signal abnormally along with myelomalacia at C6-7 are redemonstrated without significant interval change. Findings are compatible with chronic sequelae of demyelination. No evidence of any new or acute demyelinating lesion is seen.


Instruction: Generate impression based on findings.

Input: Reason: R knee OCD lesion assessment s/p fixation History: R knee pain/swelling MENISCI: The medial meniscus appears intact. Lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There are 4 radiolucent tubular fixation devices present within the medial femoral condyle extending to the articular surface. There is mild heterogeneity of the lateral articular cartilage of the medial femoral condyle as well as a tiny partial-thickness defect immediately distal to one of the screws, but otherwise the surface of the articular cartilage appears smooth and we see no full-thickness fluid-filled defect. There is mild edema within the marrow along the fixation devices, which is of questionable significance. Of note, the orientation of the distal end of the most posterior fixation device within the articular cartilage is slightly different than that of the remainder of the device, which could represent shearing, but this is of uncertain significance.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: There is thickening of the proximal patellar tendon with linear intermediate signal intensity traversing the tendon on the axial images, that may represent a combination of tendinosis and tearing or postsurgical changes. The quadriceps tendon appears intact.ADDITIONAL

Output: Surgical changes of osteochondral defect fixation as described above.


Instruction: Generate impression based on findings.

Input: Contrast was seen in the radiocarpal and pisiform sinus. Please refer to the subsequent MRI report for further information.Exposure time: 1 minute 55 seconds.

Output: Successful arthrogram of the midcarpal joint. Findings suspicious for scapholunate and lunotriquetral ligament tears.


Instruction: Generate impression based on findings.

Input: 19-year-old female with medial knee pain and patella pain. MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: No significant abnormality noted.LIGAMENTS: Postsurgical changes of an ACL repair. Small lesion with heterogeneous and predominantly intermediate signal anterior to the ACL repair compatible with arthrofibrotic scarring (cyclops lesion). Fibers of the ACL repair are seen extending to the proximal insertion.EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Heterogeneous soft tissue compatible with arthrofibrotic scarring anterior to the ACL graft.


Instruction: Generate impression based on findings.

Input: Redemonstrated is cerebellar ectopia descending to the level of the C1 posterior arch with an abnormal pointed morphology, effacing adjacent posterior CSF spaces. CSF flow analysis demonstrates a small flash of biphasic flow just distal to the tonsillar tips.Alignment is anatomic. There are no fractures or subluxations. There are no osseous dysplasias. The marrow signal is benign. The cord is normal in signal without evidence of syrinx. The conus is normal in signal and morphology and terminates at appropriate level, L1. There are no MRI findings suspicious for cord tethering.There is bilateral atelectasis, presumably secondary to the patient's sedated status.

Output: 1.Chiari 1 malformation without syrinx2.There is bilateral atelectasis, presumably secondary to the patient's sedated status.


Instruction: Generate impression based on findings.

Input: Fixed mass on the left temple. There is a well-defined heterogeneous predominantly high T2 and low T1 signal mass in the left temporal fossa that measures up to 25 mm. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is a probable chronic lacunar infarct in the left basal ganglia and mild scattered foci of T2 hyperintensity in the cerebral white matter. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are unremarkable. There is a subcentimeter left maxillary retention cyst.

Output: A well-defined mass in the left temporal fossa that measures up to 25 mm may represent a lymphatic malformation or perhaps an inclusion cyst.


Instruction: Generate impression based on findings.

Input: 33 year old female 2 weeks status post left hip arthroscopy. Assess for source of infection. There is a defect within the anterior aspect of the femoral head with underlying signal abnormality and enhancement; while it is impossible to exclude osteomyelitis, we suspect that this simply reflects changes from a surgical decompression procedure. The remaining bone marrow signal is normal. There is a small joint effusion as well as enhancement of the synovium of the hip; while we cannot exclude the possibility of infection, this also may be postoperative in etiology. Mild increased signal intensity of the hip fluid on T1-weighted images in relation to the skeletal muscle may represent blood products. A defect in the anterior capsule of the hip presumably reflects prior surgery. There is a defect in the iliotibial band at and below the level of the greater trochanter that is presumably postoperative in etiology. Within this defect there is a lobulated collection of heterogeneous signal intensity measuring approximately 6.0 cm x 3.0 cm x 4.0 cm. It contains foci of increased signal intensity on T1-weighted images which suggests subacute blood products and shows only mild peripheral enhancement post gadolinium administration; findings compatible with hematoma. There is mild edema and enhancement of the underlying anterior and lateral musculature of the hip suggesting mild inflammation. There is a small amount of fluid and enhancement along the posterior aspect of the greater trochanter suggesting mild bursitis. There is a bandlike signal abnormality of the anterolateral subcutaneous fat likely representing a surgical scar. The iliopsoas tendon is discontinuous as it courses along the anterior aspect of the acetabulum which we also presume is postoperative in etiology. Please note that this study was not protocolled for detailed evaluation of the acetabular labrum or articular cartilage of the hip. Small amount of free fluid in the pelvis.

Output: Postoperative changes as described above. Small amount of fluid and synovial enhancement within the left hip may simply be postoperative in etiology, although it is impossible to exclude infection on the basis of this study.


Instruction: Generate impression based on findings.

Input: Elevated PSA, evaluate for targetable lesion to biopsy PELVIS:PROSTATE:Prostate Size: Measures 4.7 cm in transverse dimension x 3.2 cm in AP dimension x 4.6 cm in craniocaudal dimension. Peripheral Zone: Located in lateral left peripheral zone at mid gland is rounded focus measuring 8 x 7 mm and better depicted on ADC sequence where there is associated decreased signal, corresponding decreased T2 signal and early arterial enhancement also visualized.Situated in left anterior transition zone at level of mid gland and involving lateral aspect of the anterior fibromuscular stroma is a lesion with indistinct borders measuring 1.5 x 1.2 cm and showing low ADC and low T2 signal (image 324 series 403), microextension into adjacent soft tissues suggested (image 16 series 801). Possible associated component seen just posterior also in transition zone on left side (see image 344 series 403), this may be contiguous with 8 mm left lateral peripheral lesion as well. Although definite suspicious postcontrast features are not seen related to this 1.5 cm anterior transition zone lesion, overall appearance and other imaging features are suspicious for malignancy.Additional more linear appearing T2 hypointense foci seen throughout peripheral zones bilaterally, favored to be postinflammatory in etiology or related to scarring. Central Gland: Moderate degree BPH Seminal Vesicles: Unremarkable in appearance Extracapsular Extension: Not seen. BLADDER: Mild circumferential wall thickening likely reflecting chronic changes secondary to long-standing bladder outlet obstruction related to enlarged prostate gland.LYMPH NODES: Subcentimeter right external iliac lymph node, nonspecific.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. 8 mm left lateral peripheral zone low ADC signal and T2 hypointense focus, suspicious for malignancy.2. Additional 1.5 cm lesion in left anterior prostate gland described above suspicious for transition zone neoplasm involving anterior fibromuscular stroma.


Instruction: Generate impression based on findings.

Input: 19-year-old male with knee pain and slight effusion after falling on left knee. MENISCI: There is intrasubstance signal within the posterior horn of the medial meniscus that may reflect prominent vascularity or degeneration, but we see no tear. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: The articular cartilage and bone marrow signal appears normal.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. No evidence of patellar chondral injury or PCL injury. No frank joint effusion.2. Elongated collection of fluid signal intensity within the popliteus muscle likely representing a ganglion of questionable clinical significance.


Instruction: Generate impression based on findings.

Input: Parafalcine melanoma metastases: headaches There are post-treatment findings related to laser ablation of a right superior frontal gyrus with interval evolution of the signal characteristics of the hemorrhage within the lesion and the adjacent lesion with surrounding subarachnoid hemorrhage and vasogenic edema. The small nodule within the bilateral occipital lobes and right precentral gyrus are better depicted on the prior MRI with contrast. There are a few scattered foci of nonspecific T2 hyperintensity in the cerebral white matter. There is no midline shift or herniation. There is no evidence of acute infarction. The ventricles and basal cisterns are normal in size and configuration. The skull, orbits, and scalp soft tissues are unchanged.

Output: 1. Post-treatment findings related to laser ablation of a right superior frontal gyrus with interval evolution of the hemorrhage within the lesion and the adjacent subacute hematoma or hemorrhagic metastasis with surrounding subarachnoid hemorrhage and edema, although assessment is limited by the lack of intravenous contrast. 2. Other subcentimeter intracranial metastases are better depicted on the prior MRI with contrast.


Instruction: Generate impression based on findings.

Input: Seizure. Some sequences are missing, as the study was terminated prematurely. There is a punctate focus of diffusion restriction in the right anterior cingulate gyrus, adjacent to the genu of the corpus callosum. There are small areas of encephalomalacia in the right midbrain and posterior limb of the internal capsule, left caudate, and left thalamus. Additional scattered periventricular and subcortical white matter T2 signal hyperintensity. There is mild global brain parenchymal volume loss. There is no mass effect, midline shift, or herniation. There is no evidence of gross intracranial hemorrhage on this limited exam. The major cerebral flow voids are intact. There is a 2 cm well-circumscribed mass within the left parotid gland. There are postoperative findings related to right parietal craniotomy. There are bilateral lens implants. There is degenerative spondylosis in the imaged upper cervical spine.

Output: 1.Acute punctate lacunar infarct in the right anterior cingulate gyrus, chronic infarcts in the right midbrain and posterior limb of the internal capsule, left caudate, and left thalamus, and a background of findings compatible with chronic microvascular ischemic disease.2.Partially imaged left parotid mass may reflect a benign mixed cell tumor, perhaps with associated focal ductal obstruction, but can be further evaluated with dedicated imaging as clinically warranted.3.Degenerative spondylosis in the imaged upper cervical spine.Findings were discussed via telephone with Dr. Harris at 10:20 AM on 03/19/2016.


Instruction: Generate impression based on findings.

Input: Postoperative changes are again seen from previous right temporal lobe lesion biopsy. Direct comparison to the prior MRI from October 2014 limited due to prior patient motion as well as differences in technique across the 2 exams. Within these limitations, there appears to be interval increased size of the triangle shaped area of CSF signal intensity involving the right fusiform gyrus, likely relating to an area of evolving cystic encephalomalacia. On 3-D T1 weighted images, this area currently measures 9 x 11 mm on 1101/69, compared to previous 7 x 11 mm in October 2013. On the more remote exams, there was more diffuse areas of FLAIR hyperintensity within the right temporal lobe subcortical white matter.Comparison of current coronal FLAIR imaging is slightly limited due to prior differences in angulation, although overall the previous somewhat ill-defined mildly expansile T2/FLAIR hyperintensity in the white matter of the right hippocampal gyrus now appears more diffuse, with involvement of the adjacent cortex and blurring of the gray-white junction.The ventricles and sulci are within normal limits. The basal cisterns remain patent. There is no midline shift or mass effect. There are no new areas of abnormal signal. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. There is mild mucosal thickening in the sphenoid sinuses and scattered ethmoid air cells bilaterally.

Output: Redemonstration of right temporal lobe findings, including evolving area of cystic encephalomalacia more laterally, as well as areas of abnormal signal and mild expansion/cortical thickening involving the hippocampus and para hippocampal gyrus, with gradual blurring of the gray-white junction when compared to more remote exams. Differential diagnosis again includes an area of cortical dysplasia with possible superimposed low-grade neoplasm.


Instruction: Generate impression based on findings.

Input: Low back pain with radiation into the right leg. Evaluate for discitis. There is minimal retrolisthesis of L3 relative to L4. There is minimal fat along the filum terminale. The conus medullaris and the included caudal spinal cord display normal signal. The vertebral body heights are preserved. However, Schmorl nodes are present along the inferior endplates of L3, L4 and L5, with the largest being at L4 right posterolaterally. These are associated with heterogeneous, contrast enhancing, edema-like marrow signal. The tip of the conus medullaris is at L1-L2 level. There is diffuse congenital narrowing of the spinal canal with superimposed focal degenerative spondylosis. At L2-L3, a disc bulge is eccentric to the left causing mild-to-moderate left and mild right neural foraminal stenoses. At L3-L4, a disc bulge and uncovering along with ligamenta flava thickening and facet arthropathy result in mild spinal canal stenosis, as well as mild-to-moderate neural foraminal stenosis. At L4-L5, a disc bulge, moderate ligamentum flavum thickening, and severe right and mild left facet arthropathy result in moderate central and right paracentral spinal canal stenosis. There is also severe right and mild to moderate left neural foraminal stenoses. There is enhancement involving the right L4-L5 facet associated with subjacent bone marrow edema, which also involves the neural foramen. At L5-S1, a disc bulge along with mild facet arthropathy result in mild narrowing of the right subarticular recess. There is also severe right and moderate left neural foraminal stenosis at this level.

Output: 1. Multilevel degenerative spondylosis associated with congenital spinal canal stenosis is most pronounced at L4-L5, where there is severe right foraminal stenosis and as moderate central and right paracentral spinal canal stenosis, as well as severe right and moderate left neural foraminal stenosis at L5-S1 and moderate right L3-L4 neural foraminal stenosis.2. Multiple Schmorl nodes with associated edema involving the L3, L4, and L5 vertebral bodies.


Instruction: Generate impression based on findings.

Input: Male 81 years old Reason: HCC s/p TACE RFA, follow up History: HBV cirrhosis ABDOMEN:LIVER, BILIARY TRACT: Liver has a cirrhotic morphology with advanced atrophy of the right hepatic lobe.There are 3 ablation sites in the liver.* Right hepatic lobe superior lesions measures 3.3 x 1.9 cm (image 27/series 11) previously, 3.2 x 1.8 cm.* Right hepatic lobe inferior lesion measures 2.6 x 1.8 cm (image 25/series 11) previously, 3.2 x 1.9 cm.* Left hepatic lobe ablation cavity measures 1.9 x 1.4 cm (image 31/series 11) previously, 2.1 x 1.8 cm.* In the right hepatic lobe adjacent to the IVC there is a focal enhancing lesion measuring 1.7 x 1.3 cm (image 29/series 10), the lesion shows subtle washout on delayed phase imaging and is mildly hyperintense on T2-weighted imaging and is suspicious for a new focus of hepatocellular carcinoma. Hypervascular lesion in the left lateral segment of the liver represents a small portal venous to hepatic venous shunt.Status post cholecystectomy with the common bile duct measuring 12 mm.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left kidney has a small hemorrhagic focus.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: Findings a new right hepatic lobe 1.7 cm lesion with imaging features compatible with a small hepatocellular carcinoma.3 ablation cavities in both lobes remain relatively stable.


Instruction: Generate impression based on findings.

Input: 8-year-old boy with history of Chiari malformation and syrinx status post decompression, 3 month follow-up. BRAIN

Output: 1.Compared to the immediate postoperative study, there has been decrease in the size of CSF space along the posterior neo-foramen magnum. There is associated significant decrease in CSF flow along the neo-foramen magnum and prepontine cistern, which now appears asynchronous as well. Please correlate clinically, as there may be development of adhesions.2.Compared to the preoperative study, the size of syrinx has decreased with residual cervicothoracic syrinx as described above.


Instruction: Generate impression based on findings.

Input: VHL: Evaluate for hemangioblastomas and endolymphatic sac tumors. Known retinal angiomas status post laser treatment. Brain: There is an unchanged punctate enhancing lesion along the posterior aspect of the cervicomedullary junction region. There is no evidence of intracranial hemorrhage or acute infarct. There is minimal scattered cerebral white matter T2 hyperintensity. The inner ear structures are unremarkable, without evidence of endolymphatic sac mass lesions. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is a left lens implant. There is slight irregularity along the left posterior globe.Spine: Aside from the lesion at the cervicomedullary junction, there is no evidence of abnormal enhancement or mass lesions elsewhere within the spinal cord or spinal canal. There is multilevel degenerative spondylosis of the cervical spine with spinal canal stenosis and mild indentation upon the spinal cord, as well as neural foraminal stenoses. There is associated mild straightening of the cervical spine in the sagittal plane. The vertebral column alignment is otherwise within normal limits. There are mild disc bulges at L4-5 and L5-S1 with mild neural foraminal stenoses, but no significant spinal canal stenosis. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable, aside from dependent subcutaneous edema in the lower back. There are left renal cysts.

Output: 1. An unchanged punctate enhancing lesion along the posterior aspect of the cervicomedullary junction region is compatible with a hemangioblastoma.2. No evidence of spinal hemangioblastomas.3. No evidence of endolymphatic sac tumors.4. Slight irregularity along the left posterior globe may correspond to the known retinal angiomas and/or laser treatment.5. Multilevel degenerative spondylosis of the cervical and lumbar spine.6. Left renal cysts. Please refer to the separate abdomen MRI report for additional details.


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.Localizing CT examination demonstrated a lytic lesion in the left humeral head with associated cortical destruction corresponding to the findings on recent MRI and PET/CT examination. Using CT guidance, a 16 gauge Achieve core biopsy needle was advanced into the lesion. Four 16 gauge core biopsy specimens were obtained and placed in formalin.The core biopsy specimens were hand carried to the Surgical Pathology lab.The 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: CT guided biopsy of left humeral head lesion.


Instruction: Generate impression based on findings.

Input: Diagnosis: AphasiaClinical question: assess for stenosisSigns and Symptoms: R MCA syndrome MRI of the brainNo diffusion weighted abnormalities are appreciated.There are punctate foci of T2 signal hyperintensity in the thalami bilaterally as well as the posterior limb of the left internal capsule. There are patchy foci of signal hyperintensity present in the midbrain and pons. There is atrophy of the cerebral peduncles. The left cerebral peduncle has signal hyperintensity associated with it as well as greater atrophy than on the right side. There is atrophy of the pons.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The right eye lens is thin.There are subdural effusions present in the posterior fossa.A punctate foci of T2 hyperintensity without associated FLAIR hyperintensity along the right cerebellar hemisphere.MRA brain:There is a 70% stenosis present at the left carotid siphon at the distal aspect of the cavernous segment of the left internal carotid artery.The proximal portion of the anterior temporal artery of the left middle cerebral artery is not readily appreciated. This is along the tortuous loops of the left middle cerebral artery.There is 70% stenosis at the distal most aspect of the left vertebral artery at its junction with the vertebrobasilar junction. There is 40% stenosis at the distal aspect of the right vertebral artery just proximal to the vertebrobasilar junction. There is mild narrowing of the basilar artery along its midportion just distal to the origins of the anterior inferior cerebellar arteries.Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The left A1 segment is small and tortuous. The right A2 segment is larger than the left A2 segment. The anterior communicating artery is small The posterior communicating arteries are intact. The vertebral arteries are similar in size.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is 25% stenosis present at the origin of the left internal carotid artery. The left internal carotid artery appears attenuated throughout its course possibly related to a distal stenosis. There is no significant stenosis along the course of the vertebral arteries. The left vertebral artery smaller than the right vertebral artery.

Output: 1.There is no evidence for acute ischemic cerebral infarction.2.There is 70% stenosis present at the distal left internal carotid artery. There is associated attenuation of the left internal carotid artery proximal to this suggesting this may be hemodynamically significant.3.Findings raise the question of stenosis at the proximal portion of the inferior division of the left middle cerebral artery. The left anterior temporal artery of the left middle cerebral artery is nondominant. Please note that this may be artifactual due to tortuosity and low flow in this vessel.4.There is 70% stenosis at the distal most aspect of the left vertebral artery at its junction with the vertebrobasilar junction. There is 40% stenosis at the distal aspect of the right vertebral artery just proximal to the vertebrobasilar junction.5.There are multiple punctate lesions present in the brainstem and thalami which are suspected to represent prior lacunar infarct. This affects the left thalamus and brainstem more than the right as some findings that suggest Wallerian degeneration on the left side.6.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related. 7.Old lacunar infarct in the right cerebellar hemisphere.