Instruction: Generate impression based on findings.

Input: Clinical question: Using for hemorrhage and tumor resection. Signs and symptoms: Status post craniotomy for tumor resection. Pre and post enhanced brain MRI:Examination demonstrates postoperative changes of a right-sided suboccipital craniotomy for removal of tumor. Expected postprocedural hemorrhage within the surgical site and resection cavity is detected.There is interval partial resection of the inferior aspect of a large mass in the right posterior fossa and the fourth ventricle.The largest transverse diameter of the tumor in the inferior aspect of right cerebellum measures at approximately 25 mm compared to prior study measurement of 45. There is resultant widening of subarachnoid space at this level and better visualization of right vertebral artery that on prior exam appear to be surrounded by this large tumor.The remaining tumor in the inferior right cerebellum abuts and displaces the medulla to the left without significant change since prior exam. There is no detectable new signal abnormality of the medulla or the pons abutting the tumor.Extensive residual tumor superiorly on the right and within the fourth ventricle still remaining. The largest transaxial dimension of tumor in the right and including the intraventricular component measures at 41 x 44 mm compared to prior study measurement of 41 x 47.5 mm. Mass effect and leftward herniation of the fourth ventricle is again identified and without significant change.There is significant interval decreased size of shunted supratentorial ventricular system since prior study. A right frontal approach ventricular catheter with the tip in the right frontal horn of lateral ventricle remains identical to prior exam. Decreased ventricular size results in better visualization of cortical sulci and CSF spaces supratentorially.

Output: 1.Expected postoperative changes of right suboccipital craniotomy for partial resection of a large mass in the posterior fossa.2.Residual mass inferiorly in the right posterior fossa buts and displaces the medulla to the left without significant change.3.Large residual tumor more superiorly and including the tumor within the fourth ventricle demonstrate no significant change. Mass effect and leftward deviation of the fourth ventricle remains stable since prior exam.4.Significant interval decreased size of supratentorial ventricular system and stable right frontal approach ventricular catheter with the tip in the right frontal horn.


Instruction: Generate impression based on findings.

Input: Female; 60 years old. Reason: R knee pain, r/o meniscus tear History: locking and catching MENISCI: There is a complex, predominantly radial, tear of the inner half of the posterior horn of the lateral meniscus. There is deformity and intrasubstance signal of the body of the lateral meniscus, which likely reflects a combination of degeneration and extension of the aforementioned tear.There is mild intrasubstance signal seen in the medial meniscus indicating degeneration, but there is no evidence of tear.ARTICULAR CARTILAGE AND BONE: There is full thickness articular cartilage loss of the weight-bearing portions of the lateral femoral condyle and lateral tibial plateau. There is also a full thickness articular cartilage defect along the medial femoral condyle between the meniscal horns measuring approximately 1.5-cm in AP dimension. There is partial thickness articular cartilage degeneration of the patella at the median eminence.Tricompartmental osteophytes are seen. There is a 4-cm lobular lesion in the distal femoral diaphysis, which correlates with a calcified lesion on prior radiographs and which is consistent with an enchondroma.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1. Complex tear of the lateral meniscus as described above.2. Knee joint osteoarthritic changes with articular cartilage loss as described above.3. Multi-lobulated fluid collection in the soft tissues laterally, which may be due to a migrated parameniscal cyst or ganglion.4. Enchondroma of the distal femur.


Instruction: Generate impression based on findings.

Input: Male 66 years old with portal vein and superior mesenteric vein thrombosis, please assess clot burden and screen for HCC. ABDOMEN:LIVER, BILIARY TRACT: Nodular liver contour with widened fissures and central fibrosis consistent with cirrhosis. Siderotic nodules are again seen throughout the liver. No new or suspicious liver lesion is identified. There is trace perihepatic ascites.Chronic thrombosis of the portal vein with numerous small periportal collateral vessels appears similar to the previous exam. Visualized hepatic artery patent.SPLEEN: Splenorenal shunting is redemonstrated.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No hydronephrosis or suspicious renal lesion. Splenorenal shunting is redemonstrated.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Perigastric cardiac collateral vessels are again seen.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Cirrhotic liver with periportal fibrosis and siderotic nodules. No new or suspicious liver lesion although please note that evaluation is slightly limited also due to chronic portal vein obliteration.2.Chronic thrombosis of the portal vein with numerous small periportal collateral vessels appears similar to the previous exam.


Instruction: Generate impression based on findings.

Input: 31-year-old female Reason: history of multiple cancers, questionable lucency on XR. History: c/o pain in left shoulder. Decreased ROM There is mild heterogeneity of the medullary cavity of the humeral diaphysis which may reflect residual red marrow, but we see no focal lesion. There is a broad based bony excrescence along the posterolateral aspect of the proximal humeral diaphysis that may represent a small exostosis. The remainder of the humerus is unremarkable. As the field of view was enlarged to include the entire humerus, evaluation of the shoulder is limited. The acromion process is hypoplastic. We see no signal abnormality within the rotator cuff, although small tears could be missed on this examination. There is mild edema and enhancement between the distal clavicle and coracoid process. Prior radiographs suggest an anomalous coracoclavicular articulation and, hence, this edema and enhancement may represent a synovitis perhaps due to prior injury, or, perhaps a sprain of the coracoclavicular ligament. We see no fracture.

Output: 1. Broad based exostosis along proximal aspect of the humerus. We see no intramedullary humeral lesion. 2. Coracoclavicular edema and enhancement may represent synovitis at an anomalous articulation or, perhaps, a sprain of the coracoclavicular ligament.


Instruction: Generate impression based on findings.

Input: SLE, concern for lupus cerebritis given changes in behavior. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is unchanged minimal nonspecific cerebral white matter T2 hyperintensity. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

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


Instruction: Generate impression based on findings.

Input: Female, 24 years old, with migraine headache and normal neuro exam. The cerebral and cerebellar hemispheres and brainstem show normal signal intensity and morphology. No restricted diffusion is seen.No evidence of parenchymal edema, mass, or mass effect is seen. There is no evidence of intracranial hemorrhage or abnormal extra-axial fluid. The ventricular system is normal in caliber and morphology. Signal intensity of the bone marrow is unremarkable. A mucous retention cyst is evident in the right maxillary sinus.

Output: Unremarkable evaluation with no specific findings to account for the patient's headaches.


Instruction: Generate impression based on findings.

Input: 58-year-old female with fibroids, sciatica, unspecified pelvis and perineal pain. PELVIS:UTERUS, ADNEXA: Redemonstrated is an enlarged , lobular fibroid uterus. The uterus measures 9.1 x 10.6 x 8.5 cm. There is mass effect on the endometrial canal. The largest is a left intramural fibroid measuring 7.6 x 7.0 cm. There are subserosal fibroids on the right.BLADDER: No significant abnormality noted.LYMPH NODES: No significant lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Enlarged uterine fibroids as described above.


Instruction: Generate impression based on findings.

Input: Right lumpectomy followed by radiation and chemotherapy and hormonal therapy in 2004 for IDC. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally. Postsurgical changes are present within the right breast, compatible with patient's history of lumpectomy.No abnormal enhancement is seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: Neck pain, evaluate for disc herniation Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. There is straightening of the spinal curvature; alignment is otherwise maintained. Bone marrow signal is benign. The cervical spinal cord has normal signal characteristics and overall morphology.Individual levels as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: There is disc bulge slightly eccentric to the right with mild right neural foraminal stenosis. There is partial effacement of the ventral thecal sac without overall significant spinal canal stenosis. Left neural foramen is also patent.C4-5: Minimal disc bulge. No significant compromise to the spinal canal or neural foramina.C5-6: There is a relatively large left paracentral and foraminal disc extrusion with mild superior and inferior migration, measuring 12 mm in the craniocaudal dimension. The disc extrusion effaces the left ventral thecal sac and abuts the left ventral cord without significant compression. There is mild spinal canal stenosis involving the left aspect of the spinal canal. There is also moderate left neural foraminal stenosis. No significant right neural foraminal narrowing.C6-7: There is a small central disc extrusion which effaces the ventral thecal sac. There is mild spinal canal stenosis without significant mass effect on the cord. Neural foramina are patent.C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: There is a relatively large disc extrusion at the C5-C6 level and a smaller one at the C6-C7 level. There is mild spinal canal stenosis at these levels without cord compression or cord signal abnormality. There is also moderate left C5-C6 neural foraminal stenosis associated with the disc extrusion, where there may be impingement of the left C6 nerve root. Additional levels as above.


Instruction: Generate impression based on findings.

Input: 70-year-old male with history of Lynch syndrome and small bowel cancer status post resection. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: Mild parenchymal atrophy. Pancreatic duct measures upper limits of normal near neck, distal tapering noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is inadequate distention of small bowel loops, particularly jejunum. Status post subtotal colectomy with ileocolonic anastomosis. There is no evidence of obstruction or inflammatory changes. No enhancing tissue to suggest tumor recurrence. Scattered susceptibility artifact from prior surgery. BONES, SOFT TISSUES: Peripherally enhancing T2 hyperintense cystic focus in the right gluteus minimus muscle is not significantly changed when compared to the prior exam measuring 1.9 x 1.0 cm (series 14, image 60). This is felt to represent a paralabral cyst and is of questionable clinical relevance.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: As above.OTHER: No significant abnormality noted.

Output: 1.Postsurgical changes related to the bowel without evidence of recurrent disease.2.No pancreatic mass lesion as clinically queried.


Instruction: Generate impression based on findings.

Input: The cervical spine is in normal alignment. The vertebral body heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. No abnormal enhancement. The spinal cord is of normal caliber and signal. Mild degenerative changes are seen with disc bulges at the C4-C5, C5-C6, and C6-C7 level with mild to moderate spinal canal stenosis at these levels. There is moderate right C4-C5 and mild right C5-C6 neural foraminal stenosis. Examination is somewhat motion degraded however no high-grade neural foraminal stenosis is appreciated. There is an approximately 3 cm right paratracheal nodule abutting the right thyroid lobe which is better seen on outside CT from 11/17/2015.LUMBAR SPINE

Output: 1. There are no suspicious lesions involving the cervical or lumbar spine. Bone scan or PET may be helpful to assess extent of osseous disease.2. Mild multilevel degenerative changes in the cervical and lumbar spine as described above.3. 3 cm paratracheal mass involving or adjacent to the right thyroid lobe. Recommend ultrasound for further delineation and excluding possibility of an enlarged lymph node.


Instruction: Generate impression based on findings.

Input: Please evaluate neck and ear pain. Enhanced CT of the soft tissues of the neck:60 cc of Omnipaque 350 was administered.Limited images of the intracranial demonstrate findings suggestive of small was ischemic disease.Images through the skull base, cavernous sinuses, bilateral Petrus bones and paranasal sinuses are unremarkable. Mastoid air cells and middle ear cavities are pneumatized and unremarkable.Images through the neck demonstrate no evidence of a mass or any pathologic adenopathy.Calcification and cystic changes of left lobe of thyroid there is suspected of goiter. Very limited view of the apices of the lungs are unremarkable.Examination demonstrates extensive degenerative disk disease of the cervical spine and hypertrophic changes of posterior elements. No evidence of lytic or sclerotic changes. There is no evidence of fracture or malalignment. There is however unusual presentation of posterior arch of C1 projecting anterior to the posterior elements of C2. This may be result of extensive degenerative changes at C1 -- C2 level. This can be started around or through the dedicated MRI of the cervical spine.

Output: 1.Negative enhanced CT of soft tissues of neck for tumor or pathologic adenopathy.2.Excessive degenerative changes of cervical spine and with unusual appearance of location of posterior arch of C1 anterior to the posterior elements of C2. There is no evidence of fracture or malalignment. If patient's neck pain persists recommend follow-up with dedicated MRI of cervical spine.


Instruction: Generate impression based on findings.

Input: Treated small cell lung cancer with worsening weakness and pain. Possible brain metastasis. History of cavernoma. No evidence of acute ischemic or hemorrhagic lesion.There is about 9.5 mm sized left quadrigeminal plate cavernoma demonstrated, comparing to prior scan, the size, MR characteristics and enhancement patterns do not show any significant interval change.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement may suggest metastatic lesion. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1.No evidence of acute ischemic or hemorrhagic lesion.2. No evidence of metastasis.3. No interval change of known left quadrigeminal plate cavernoma since prior study.


Instruction: Generate impression based on findings.

Input: Clinical question: History of thoracic schwannoma, evaluate for recurrence. Signs and symptoms: Neck pain. Pre- and post enhanced thoracic MRI:Examination demonstrates stable chronic post operative changes of thoracic laminectomy without evidence of residual or recurrence of tumor/schwannoma.There is normal anatomical alignment of vertebra, with mild kyphosis without appreciable change since prior exam.Mild to moderate degenerative disc disease of the thoracic spine is again noted.There is a left ventral epidural hypointense defect at T6-T7 level consistent with a disc protrusion which results in flattening and posterior displacement of the cord without detectable signal abnormality of the cord or convincing evidence of central spinal stenosis. This finding demonstrate subtle interval progression since prior study.Mild bulging disc osteophyte complex on the left at T8-T9 results in subtle flattening deformity of the cord without detectable signal abnormality of the cord and similar to prior exam. Mild degenerative changes at other levels however without central spinal stenosis. Stable postoperative changes of prior laminectomy at T10-T12 without evidence of mass effect on the thecal sac.Nonenhanced lumbar MRI:T12-L1 demonstrate minimal degenerative changes of posterior elements and unremarkable otherwise.L1-L2 demonstrate mild degenerative disease and unremarkable otherwise.L2-L3 demonstrate mild degenerative changes and unremarkable otherwise. Next line L3-L4 demonstrate mild degenerative disc disease and moderate bilateral facet and ligamentum flavum hypertrophy however without spinal stenosis or neural foraminal compromise.L4-L5 demonstrate mild to moderate disc disease, moderate bilateral ligamentum flavum hypertrophy and to lesser degree of the bilateral facets with evidence of mild left facet effusion. There is mild grade 1 anterolisthesis, mild central spinal stenosis and mild left neural foraminal compromise. There is interval progression of degenerative changes at this level since prior exam.L5-S1 demonstrate moderate disc disease and loss of disc height, moderate to significant bilateral ligamentum flavum hypertrophy and moderate bilateral facet hypertrophic changes. There is a small right lateral disc extrusion best appreciated on axial T2 series 16 image 23 and sagittal T2/T2 STIR image 10 and 11. Findings results in right lateral recess compromise without central spinal stenosis. Moderate to severe right neural foraminal compromise is also noted.

Output: 1.Pre- and post enhanced thoracic MRI demonstrate postoperative changes of multilevel thoracic laminectomy without evidence of mass effect on the thecal sac. There is no detectable residual or recurrent social or normal. Moderate degenerative changes of thoracic spine with subtle interval progression of disc protrusion at T6-T7 on the left as detailed.2.Nonenhanced lumbar MRI demonstrate degenerative changes at L4-L5 with resultant mild central spinal stenosis as detailed. At L5-S1 there is extensive degenerative changes and a right lateral disc extrusion with resultant right lateral recess compromise. There is also right neural foraminal compromise at this level secondary to degenerative disease.


Instruction: Generate impression based on findings.

Input: Diagnosis: Malignant neoplasm of prostateClinical question: R/o cord compression Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is low T1 and T2 signal (compatible with sclerosis) involving the C2, C4, C5 and C6 vertebral bodies without compression fracture. There is multilevel disk dessication present.At C2-3 there is no significant compromise to the spinal canal or neural foramina. There is a broad based central disk protrusion at this level .At C3-4 there is no significant compromise to the spinal canal or neural foramina. There is a disk bulge and mild posterior ligamentous hypertrophy at this level associated with mild narrowing of the spinal canal and neural foramina. Overall there is a mild degree of spinal stenosis. There are small uncovertebral osteophytes at this level.At C4-5 there is no significant compromise to the spinal canal or neural foramina. There is are small uncovertebral osteophytes at this level.At C5-6 there is no significant compromise to the spinal canal. There is a broad based disk protrusion at this level encroaching on the left exiting nerve roots at this level.At C6-7 there is no significant compromise to the spinal canal or neural foramina. There is a mild disk bulge at this level.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.MRI thoracic spine:The thoracic vertebral bodies are appropriate in the overall alignment and height. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots. There are foci of low T1 and T2 signal intensity marrow replacement at T3, T6, T9 andT11 vertebral bodies and posterior elements as well as foci of marrow replacement within posterior elements at T7 andT10.There is 10mm T1 hyperintense lesion in theT2 vertebral body most likely representing hemangioma.There are Schmorl's nodes at T5-6, T9-10, T10-11, T11-12 .Foci of low T1 and T2 signal intensity marrow are also present in the right T7, left T8 and left T9 ribs.Lumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall height. The conus medullaris on sagittal imaging is grossly intact. There are foci of low T1 and T2 signal intensity marrow replacement at L1-L5 vertebral bodies and posterior elements. Foci of low T1 and T2 signal intensity marrow are also present in the sacrum (right sacral ala) and visualized right iliac bone.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is bilateral facet and ligamentum flavum hypertrophy at this level.At L4-5 there is is bilateral facet and ligamentum flavum hypertrophy at this level associated with a mild disk bulge and mild anterior subluxation of L4 on L5 resulting in moderate spinal stenosis and bilateral encroachment of exiting nerve roots..At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.There is enlargement of the left renal pelvis associated with a shunt catheter.There is a 4.2cm right renal cyst along it's inferior pole.

Output: 1.Multiple sclerotic lesions throughout the cervical, thoracic and lumbar spine without compromise to the spinal canal.2.Degenerative changes in the lumbar spine with spinal stenosis, mild subluxation and bilateral encroachment of exiting nerve roots.3.Degenerative changes are also present in the cervical spine with encroachment of the left exiting nerve roots at C5-6 and a mild degree of spinal stenosis at C3-4.4.Some degenerative changes are present in the thoracic spine.5.There is a spinal hemangioma at T3.6.There is enlargement of the left renal pelvis associated with a shunt catheter.7.Sclerotic lesions are also present in the sacrum, visualized right iliac bone and right T7, left T8 and left T9 ribs.8.There is a 4.2cm right renal cyst along it's inferior pole.


Instruction: Generate impression based on findings.

Input: Clinical question: Status post SRS brain metastases. Please evaluate for interval change. Signs and symptoms: As above. Pre-and post-enhanced brain MRI:Examination demonstrate a stable extensive postoperative changes of right frontal craniotomy. Stable extensive underlying parenchymal flair hyperintensity with minimal internal chronic hemorrhagic changes and without associated mass effect or enhancement.Focus of vasogenic edema in the left occipital lobe surrounding a small necrotic tumor is again noted. There is interval increased vasogenic edema since prior study. There is also slight interval increased size of tumor since prior exam to 25 x 7.6-mm compared to prior study measurement of approximately 4.6 mm. Interval development of necrosis as a result of treatment could result in appearance of pseudo-progression of disease. Further follow-up is needed.Previously noted a small focus of hyperintensity in the left basal ganglial is again identified and with interval decreased size as well as complete resolution of previously noted enhancement/tumor. Nonspecific subtle periventricular foci of flair hyperintensity without hemorrhage or enhancement are nonspecific and could represent mild chronic ischemic strokes however overlapping post treatment change cannot be entirely excluded. This appears overall remains stable since prior exam.Ventricular system remain within normal size and is stable since prior exam with maintained midline.There is no detectable new foci of parenchymal signal change or abnormal enhancement of brain parenchymal or the meninges.Small focus of right temporal bone enhancement demonstrate slight interval decreased intensity of enhancement however without change in size. This observation could indicate improvement.

Output: 1.Stable extensive postoperative changes of right frontal lobe tumor resection without evidence of recurrence of disease.2.Slight interval decreased focus of flair hyperintensity and complete resolution of enhancement in the left basal ganglia since prior exam.3.Slight interval increased flair hyperintensity surrounding the left occipital lobe tumor. The tumor demonstrates interval central necrosis and resultant subtle increased size from prior measurement of 4.6 mm the current study measurement of 5 x 7.6mm which could represent pseudo-progression. Further follow up is needed.4.Although there is no appreciable change in the size of a small right squamosal temporal bone metastasis, the decreased intensity of enhancement could conceivably represent improvement. However further follow-up is needed.


Instruction: Generate impression based on findings.

Input: 10 years Female (DOB:6/5/2006)Reason: posterior fossa tumor for surgical planning History: headache, vomiting, gait instabilityPROVIDER/ATTENDING NAME: LAZARO N SANCHEZ-PINTO There is a cyst and mural nodule mass present in the posterior fossa which involves the upper half of the vermis and has multiple peripheral nodules. There is associated compression of the fourth ventricle and upper brainstem as well as lateral ventricular enlargement and third ventricular enlargement. Lateral ventricles measure 51 mm biventricular diameter and a third ventricle measures 15 mm width. The temporal horns of lateral ventricles are dilated. There is associated periventricular T2 and FLAIR signal hyperintensity. There is also associated tonsillar herniation. The cerebellar tonsils extend 24 mm below the level of the foramen magnum. There is also transtentorial herniation with superior extension of the mass through the tentorial notch. There is compression of the brainstem associated with this mass as well. Differential considerations include a primary neoplasm such as a pilocytic astrocytoma. Other lesions I can't be cyst and mural nodule at this age may include pleomorphic xanthoastrocytoma and even cysticercosis in the appropriate clinical settingNormal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: There is a large posterior fossa mass centered along the upper vermis which is associated with mass effect, compression of the brainstem, transtentorial upward herniation and foramen magnum tonsillar herniation as well as ventriculomegaly with findings suspicious for subependymoma migration of spinal fluid..


Instruction: Generate impression based on findings.

Input: Female 74 years old with epigastric pain radiating to back 1 month ago, abnormal liver tests, and cholelithiasis on abdominal ultrasound. Liver tests are now normal but she has intermittent epigastric pain. Assess for choledocholithiasis, pancreatitis. ABDOMEN:LIVER, BILIARY TRACT: No focal liver lesion, biliary ductal dilation, or ascites. Cholelithiasis. A subcentimeter T2 hypointense focus within the distal common duct (series 7, image 33) consistent with a nonobstructing stone (no upstream extrahepatic or intrahepatic biliary duct dilatation seen), focus is identical in appearance and signal to stones seen in gallbladder. There is no evidence of acute cholecystitis.SPLEEN: No significant abnormality noted.PANCREAS: There is mildly decreased intrinsic T1 signal of the pancreas, nonspecific but may represent sequela of prior pancreatitis.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: Inverted duodenal sweep better depicted on prior small bowel follow-through.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Nonobstructing distal common bile duct stone seen.2.Cholelithiasis, without evidence of acute cholecystitis.


Instruction: Generate impression based on findings.

Input: 59-year-old male with probable muscular injury years prior, difficulty with hip range of motion, antalgic gait ACETABULAR LABRUM: The labrum is not well visualized due to severe degenerative changes affecting the right hip.ARTICULAR CARTILAGE AND BONE: Joint space narrowing, subchondral cysts and large osteophytes compatible with severe osteoarthritis. No significant joint effusion.Moderate osteoarthritis affects the left hip.SOFT TISSUES: Atrophy of the right pelvic and thigh muscles relative to the left. No significant fatty infiltration. No evidence of muscle tear. ADDITIONAL

Output: 1.Severe osteoarthritis of the right hip as described above.2.Asymmetric atrophy of right pelvic and thigh muscles without significant fatty infiltration or evidence of muscle tear.


Instruction: Generate impression based on findings.

Input: 38-year-old female with right breast cancer. MRI for further evaluation. There is extreme amount of fibroglandular tissue in both breasts. Marked parenchymal enhancement is noted bilaterally, a limitation to this study.There is non-mass enhancement within the left medial breast, extending 4.0 x 2.1 x 2.9 cm, including anteriorly to the retroareolar region. This projects to within 7 mm of the nipple. There is associated susceptibility artifact within the posterior aspect of the enhancement, compatible with clip from outside hospital biopsy. There is no evidence of chest wall invasion. There is no abnormal enhancement within the left breast.A single lymph node within the right axilla has equivocal cortical thickening, measuring 3mm. Lymph nodes in each axilla are otherwise normal.

Output: 1.Biopsy proven right medial breast non-mass enhancement, consistent with known cancer, spans 4 cm AP and projects to within 7 mm of the nipple. Given that the enhancement on this exam and extent of calcifications on mammography are similar, and if further tissue diagnosis for extent is needed, stereotactic biopsy could be performed. 2.Equivocal cortical thickening of a right axillary lymph node. 3.No MR evidence of malignancy within the left breast.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Reason: eval for labral tear right hip versus psoas strain/tear History: hip pain with running ACETABULAR LABRUM: A linear band of increased signal intensity traverses the anterior labrum at the two o'clock position, indicative of a full thickness tear. The remainder of the labrum appears intact.ARTICULAR CARTILAGE AND BONE: There is a 4-mm linear defect within the articular cartilage of the acetabulum, along its posterior/superior aspect. There is an approximately 1 cm focus of poorly defined edema-type signal within the posterosuperior aspect of the femoral head, and while nonspecific, may be degenerative in etiology or perhaps represent bone contusion. We see no additional marrow abnormality involving the right hip. We see no frank CAM deformity.SOFT TISSUES: There is mild edema along the proximal semimembranosus tendon, which may represent a strain injury, but the tendon itself remains normal. The conjoined tendon appears normal. The gluteal muscles and tendons are within normal limits. There is mild edema along the iliopsoas tendon, as it courses anterior to the hip, which may represent mild strain, but this is equivocal.ADDITIONAL

Output: 1.Full thickness anterior labral tear.2.Mild edema along the right the right semimembranosus, right iliopsoas, and the right posterior sacroiliac joint, as described above, which may represent strains/sprain, of questionable clinical significance.3.Subcentimeter focal defect in the acetabular articular cartilage with underlying edema in the posterosuperior aspect of the femoral head, which may represent a bone contusion or be degenerative in etiology.4.We see no stress fracture.


Instruction: Generate impression based on findings.

Input: Inflammatory arthritis LIGAMENTS: No significant abnormality noted.TRIANGULAR FIBROCARTILAGE COMPLEX: No significant abnormality noted.TENDONS: There is increased fluid signal surrounding the fourth flexor tendons, as well as the adductor pollicis and opponens pollicis tendons. There is a mild amount of subcutaneous edema surrounding the soft tissues of the thumb but the underlying marrow signal is normal. BONES: No significant abnormality noted. ADDITIONAL

Output: Tenosynovitis of multiple flexor tendons described above with nonspecific subcutaneous edema of the thumb. There are no osseous erosions or joint effusions identified.


Instruction: Generate impression based on findings.

Input: Aneurysm of unspecified site [442.9], Reason for Study: ^Reason: h/o ophthalmic aneurysm; need to visualize carotid bifurcation in preparation for clipping History: preop planning Neck MRI:Multinodular thyroid mass on bilateral lobes and isthmus with inhomogeneous enhancement indicating multinodular goiter. Detailed imaging characteristics and extent might need ultrasound examination and if necessary fine needle biopsy.There is no sizable neck lymphadenopathy.The oral cavity, oro/nasopharynx, hypopharynx, larynx and subglottic airways are unremarkable/patentLimited coverage of the brain shows linear tissue defects on the left thalamus indicating prior hemorrhagic stroke.Neck MRA:3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The vertebral artery origins are normal. Bilateral common carotid arteries were laterally displaced due to large thyroid goiter and the bifurcation of right CCA is around C23 level and that of the left side is mid C3 vertebral body level.The proximal cervical segment of bilateral ICAs are located retropharyngeal space but from the level of C12, they are within carotid space. About 7mm x 11mm sized right para-ophthalmic aneurysm and 5mm x 6mm sized left para-ophthalmic aneurysm are seen, no significant interval change since prior scan.There is normal flow enhancement through the bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries.

Output: 1. Multinodular goiter as described above.2. No change of the size and configuration of bilateral paraophthalmic aneurysms.3. The right carotid bifurcation is around C23 level and that of the left is around mid C3 level.4. Post hemorrhagic stroke tissue defect on the left thalamus.


Instruction: Generate impression based on findings.

Input: History of cholelithiasis status post cholecystectomy now with persistent right upper quadrant pain and elevated alkaline phosphatase. Questionable dropped gallstones on outside hospital CT scan. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in size, morphology, and parenchymal signal characteristics.There are multiple foci of susceptibility along the liver capsule both anteriorly and posteriorly (series 2101 image 62 and 44). These are presumably postsurgical in etiology and may reflect surgical clips or possibly retained gallstones.There is an additional focus of susceptibility adjacent to the common bile duct near the ampulla (series 2101 image 26). There is no associated enhancement or increased T2 signal. This may represent an additional surgical artifact, stone, or an ampullary diverticulum.SPLEEN: Spleen is normal in size and signal characteristic.PANCREAS: Spleen has normal morphology and signal characteristics. No pancreatic duct dilatation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Kidneys are normal in size and signal characteristic. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Multiple foci of susceptibility along the liver capsule both anteriorly and posteriorly that are presumably postsurgical in etiology and may reflect surgical clips or possibly retained gallstones. Correlation with the patient's outside hospital CT scan would be useful for definitive interpretation.2. Additional focus of susceptibility adjacent to the common bile duct near the ampulla may represent an additional surgical artifact, stone, or an ampullary diverticulum.


Instruction: Generate impression based on findings.

Input: Male, 22 days old, full-term infant with history of meningitis and seizures. Since the prior examination, extensive diffuse and symmetric cystic encephalomalacia has developed affecting both cerebral hemispheres. The basal ganglia and inferior anterior temporal lobes are relatively spared though not completely free of signal abnormality. The brainstem and cerebellum are spared. The affected tissue demonstrates T1 hyperintensity without susceptibility effect likely indicating laminar necrosis. No evidence of diffusion restriction is seen. The ventricles have increased in caliber from the prior examination though they are not significantly dilated. The flow voids corresponding to the transverse sinuses and the right sigmoid sinus are absent with evidence of T1 hyperintensity and susceptibility within the sinuses.

Output: Interval development of extensive supratentorial cystic encephalomalacia is noted. The brainstem and cerebellum are spared. The basal ganglia and anterior inferior temporal lobes are partially spared. The pattern and symmetry of the findings would favor hypoxic ischemic injury, though intracranial infection could also potentially produce or contribute to these abnormalities. Findings are also seen concerning for venous sinus thrombosis affecting the transverse and right sigmoid sinuses.


Instruction: Generate impression based on findings.

Input: Status post craniotomy for tumor resection. Assess tumor. Non-infused CT of brain:Extensive postoperative changes of right frontal craniotomy for removal of tumor. A small area of hemorrhage along the most medial aspect of the surgical cavity is a new finding since prior exam. This finding is best appreciated on axial image 12. The hemorrhage measures approximately 7 mm times 8-mm in transaxial dimension. Additional small patchy areas of high density material along the dorsal aspect of the surgical cavity are also believed to represent hemorrhage. I suspect possible minimal increase in these areas of hemorrhage as well. The foci of hemorrhage along the dorsal aspect of the surgical cavity are very small and slice positioning differences between the two studies may contribute to the difference in their appearance. There is interval absorption of air within the epidural space under the craniotomy flap since prior study. Epidural thickening along the inner table of bony flap is within the expected range of postop change.The brain parenchyma immediately posterior to the surgical cavity demonstrates subtle low attenuation this is also new finding since prior exam. I recommend further follow-up with an MRI examination to evaluate for residual/recurrence. Mass-effect and midline shift has improved since prior study. No significant midline shift is detected and ventricular system remains stable.

Output: 1.Subtle small areas of new hemorrhage in the most medial aspect of the surgical cavity.2.New low-attenuation of brain parenchyma surrounding the surgical cavity is concerning for new vasogenic edema or ischemic change.3.Follow-up with an infused MRI examination is recommended.4.Improvement in postoperative changes of right frontal craniotomy.


Instruction: Generate impression based on findings.

Input: Craniopharyngioma status post laser ablation. There are bilateral transfrontal catheter that terminate in the suprasellar craniopharyngioma, which appears to be unchanged. There is also unchanged patchy T2 hyperintensity in the adjacent brain parenchyma. There is no evidence of acute infarction. The ventricles are unchanged in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unchanged.

Output: No significant interval change in the suprasellar craniopharyngioma and ventricular size.


Instruction: Generate impression based on findings.

Input: 16 year old female with a history of chest pain of unclear etiology referred for cardiac MRI for further evaluation. Coronary Artery OriginNormal origin of right and left coronary arteries from the sinuses of Valsalva. Left VentricleThe left ventricle is mildly dilated with systolic function. The overall LV ejection fraction is 58%, the LV end diastolic volume index is 90 ml/m2 (normal range: 65+/-11), the LVEDV is 157 ml (normal range 109+/-23), the LV end systolic volume index is 38 ml/m2 (normal range 18+/-5), the LVESV is 66 ml (normal range 31+/-10), the LV mass index is 23 g/m2 (normal range 67+/-11), and the LV mass is 40 g (normal range 114+/-24). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. Pre-contrast native myocardial T1 relaxation times are normal (1070 ms). No evidence of myocardial iron overload. There is evidence of a spontaneously "closed/ healed" apical muscular ventricular septal defect. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is mildly dilated with normal systolic function. The overall RV ejection fraction is 51%, the RV end diastolic volume index is 109 ml/m2 (normal range 69+/-14), the RVEDV is 190 ml (normal range 110+/-24), the RV end systolic volume index is 54 ml/m2 (normal range 22+/-8), and the RVESV is 94 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Normal origin of right and left coronary arteries from the sinuses of Valsalva. 2. The left ventricle is mildly dilated with systolic function (LVEF 58%) without evidence of underlying myocardial fibrosis, inflammation, or infiltration.3. The right ventricle is mildly dilated with normal systolic function (RVEF 51%).4. There is evidence of a spontaneously "closed/ healed" apical muscular ventricular septal defect. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Reason: evaluate for presence of adenomyosis History: menometrorrhagia, postcoital bleeding, pelvic pain PELVIS:UTERUS, ADNEXA: There is borderline thickening of the junctional zone measuring between 11 and 13 mm. No cystic foci or T1 hyperintensities. No endometriomas or endometrial implants identified.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Borderline thickening of the junctional zone is suspicious for diffuse adenomyosis, although not definitive.


Instruction: Generate impression based on findings.

Input: 56 year old male with atrial fibrillation PULMONARY VEINS: The right inferior and middle pulmonary vein have a common ostium. The right superior pulmonary vein is normal in appearance.The left superior and inferior pulmonary veins are normal in appearance. No evidence of left atrial thrombus.Right superior pulmonary vein: 24 x 23mmRight middle pulmonary vein: 6 x 8mmRight inferior pulmonary vein: 17 x 25mmLeft superior pulmonary vein: 21 x 18mmLeft inferior pulmonary vein: 19 x 12mmLUNGS AND PLEURA: 4-mm micronodule the right upper lobe, image 58/153. No pleural effusions.MEDIASTINUM AND HILA: Common origin of the brachiocephalic artery and left common carotid artery, and a normal anatomic variant. Heart size is normal without pericardial effusion.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: No significant abnormality noted.

Output: 1. Three pulmonary veins on the right, a normal anatomic variant. Two pulmonary veins on the left.2. 4-mm micronodule in the right upper lobe. If the patient has no risk factors for lung cancer, such as smoking, no further follow up is recommended. If patient has history of smoking, 6 to 12 month follow up with CT is recommended.


Instruction: Generate impression based on findings.

Input: 60-year-old male with hemangioma versus cyst radiologist recommended MRI. Investigate incidental finding on CT lumbar spine. ABDOMEN:LIVER, BILIARY TRACT: Innumerable punctate T2 hyperintense foci throughout the hepatic parenchyma. The largest T2 hyperintense lesions are seen in the posterior right hepatic lobe measuring 1.4 x 1 cm in hepatic segment 6 (series 601 image 22) and 2.1 x 1.2 cm in hepatic segment 7 (series 601 image 27). The remainder of these lesions measure less than 1 cm in size. No enhancing components are identified.No intra or extrahepatic biliary ductal dilatation. The portal and hepatic veins are patent.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Innumerable small T2 hyperintense foci throughout the hepatic parenchyma could represent cysts versus biliary hamartomas. The majority of these lesions are too small to fully characterize however are still likely benign.


Instruction: Generate impression based on findings.

Input: 79 years Female (DOB:11/9/1936)Reason: Evaluate for spinal stenosis vs neural foraminal stenosis History: Decreased sensation right lower extremity, fallsPROVIDER/ATTENDING NAME: SUSAN B. GLICK SUSAN B. GLICK Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is some loss of disc space height, disc desiccation and diffuse disc bulge associated with some mild displacement of the nerve roots at the right lateral recess. The fat at the lateral recess is not effaced bilaterally. There is some mild facet hypertrophy present at this level. There is endplate reactive changes which is hyperintense on T1 at this level. There is some mild narrowing of the neural foramina as a result of the disc bulge. Although the neural foraminal are narrowed, within the neural foramina the exiting nerve roots are surrounded by fat. The patient is status post right hemilaminotomy at this level.At L4-5 there is loss of disc space height, a mild disc bulge and bilateral facet hypertrophy with fusion across the facet joints. There is mild anterior subluxation of L4 on L5. There are some endplate reactive changes present this level which are predominantly high signal on T1, however, there is some T2 signal hyperintensity adjacent to the disc at the inferior endplate of L4 on the left lateral aspect of the endplate. Although the neural foraminal are narrowed, within the neural foramina the exiting nerve roots are surrounded by fat.At L3-4 there is loss of disc space height, disc desiccation and diffuse disc bulge associated with some facet hypertrophy and mild anterior subluxation of L3 on L4. There is narrowing of the thecal sac at this level with some crowding of the nerve roots and overall a moderate degree of spinal stenosis. Although the neural foraminal are narrowed, within the neural foramina the exiting nerve roots are surrounded by fat.At L2-3 there is no significant compromise to spinal canal or neural foramina. There is a disc bulge at this level as well as some disc desiccation.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: There are degenerative changes present in the lumbar spine with moderate spinal stenosis at L3-4.


Instruction: Generate impression based on findings.

Input: 22-year-old male with right leg weakness and lower lumbar midline tenderness to palpation. Concern for disk herniation.IMAGE ACQUISITIONS: CT lumbar spine without contrast. The exam is limited secondary to excessive amount of noise within the images, due to patient's large body habitus.Alignment is anatomic. Vertebral body heights are preserved. Partially visualized is a nonspecific lucency in the right aspect of the T11 vertebral body. MRI can be considered for further evaluation if clinically warranted.At L5/S1 there is a left paramedian disk protrusion that causes stenosis of the left lateral recess and likely impingement of the left S1 nerve root. Please correlate with clinical history and exam.

Output: 1. Left paramedian disk protrusion at L5/S1 causing spinal stenosis likely impinging the left S1 nerve root. Please correlate with clinical history and exam. MRI will be helpful for further evaluation of this level and the rest of the lumbar spine.2. Nonspecific lucency in the right aspect of the T11 vertebral body. MRI can be considered for further evaluation as clinically warranted.


Instruction: Generate impression based on findings.

Input: Elevated PSA. Evaluate for prostate cancer. PELVIS:PROSTATE:Prostate Size: 2.8 x 5.1 x 4.5 cmPeripheral Zone: 6 x 4 mm lesion in the right medial mid gland/apex demonstrating decreased T2 weighted signal intensity (series 601/95), decreased ADC (series 503/364) and avid early enhancement (series 1 501/1 448).Additional punctate 4 mm focus in the medial apex demonstrates decreased ADC and T2 weighted signal abnormality (series 503/304).Central Gland: Mild changes of benign prostatic hyperplasia without a discrete suspicious lesion.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: The right medial mid gland/apex lesion has a broad base of abutment with haziness and mild bulging of the capsule. There is a equivocal enhancement just outside the prostatic margin.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.6 x 4 mm right medial mid gland/apex peripheral zone lesion is suspicious for prostatic adenocarcinoma with suspected local extraprostatic extension.2.No pelvic lymphadenopathy.


Instruction: Generate impression based on findings.

Input: There are postsurgical findings related to right-sided craniotomy and tumor resection with cavities in the right anterior temporal lobe and the inferior right frontal lobe. There is evidence of prior stereotactic biopsy in this region as well. Since the prior examination from 8/25/2016, there has been an increase in the confluent T2 hyperintensity in the anterior right frontal lobe and extending along the anterior genu of the corpus callosum, further into the left frontal lobe. There is an associated increase in marginal enhancement in the right anterior frontal portion and there is extensive confluent restricted diffusion in this region. These areas do not demonstrate increased cerebral blood volume, which may be related to Avastin therapy. There is also a slight increase in T2 intensity posterior to the resection cavity. There is unchanged mild midline shift to the right and mild ex vacuo dilatation of the right lateral ventricle due to volume loss. There is redemonstration of susceptibility in the right frontal region and multiple additional foci of susceptibility consistent with blood products surrounding the resection cavity. The brainstem and cerebellum are intact. The orbits are unremarkable.

Output: Compared to examinations on 8/25/2016 and 4/7/2016, increase in T2 signal abnormality, enlargement of the area of restricted diffusion, and enhancement of the lesion centered in the right anterior and inferior frontal lobe are suspicious for tumor progression, although at least some of the findings, such as "persistent diffusion-restricted lesions" may be attributable to superimposed effects of Avastin therapy. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: NMO clinical trial. Orbits: The optic nerves, extraocular muscles, globes, and orbital fat are unremarkable.Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The T2 hyperintensity in the inferior medulla has nearly resolved. The brain parenchyma and cerebellum otherwise appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Spine: There is decrease in the degree of T2 hyperintensity and swelling involving the majority of the cervical and thoracic spinal cord, with a few remaining patchy areas of signal abnormality. The cauda equina nerve roots are unremarkable. The vertebral column alignment is unchanged. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The paravertebral soft tissues are unremarkable.

Output: The edema involving the medulla has nearly resolved and the edema in the spinal cord has further diminished.


Instruction: Generate impression based on findings.

Input: Reason: 27yoM w/ Rt Knee swelling and pain, difficulty w/ ambulation. Exam notable for posterior fullness, c/f cyst, meniscal or tendon injury. History: Exam notable for posterior fullness, MENISCI: The medial and lateral meniscus appear intact.ARTICULAR CARTILAGE AND BONE: No full-thickness or near full-thickness articular cartilage defects are identified.LIGAMENTS: The cruciate and collateral ligaments appear intact. Lobulated foci of fluid signal intensity along the posterior aspect of the PCL may represent mucoid degeneration. There is nonspecific subcutaneous edema along the lateral aspect of the lateral collateral ligament proper and biceps femoris at the level of the conjoined tendon which may reflect a mild sprain injury in the correct clinical context. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Large Baker's cyst with findings suggestive of rupture or leakage as described above. Moderate size joint effusion.2. Nonspecific subcutaneous edema along the lateral aspect of the conjoined tendon may represent a mild sprain injury in the correct clinical context.


Instruction: Generate impression based on findings.

Input: 33 yo F with VHL with known h/o cervical spine hemangioblastoma s/p removal here; assess for new lesions. Brain: Again seen is a punctate focus of enhancement along the right posterior aspect of the medulla measuring 2 mm. There is also a subtle 2 mm focus of enhancement involving the left anterolateral lateral aspect of the medulla (high resolution axial postgadolinium 3D series series 7 image 55). Brain parenchyma appears otherwise unremarkable. No new intracranial mass or mass effect. Ventricles and sulci are within normal limits. Unchanged small pineal gland cyst without mass effect. Calvarium and extracranial soft tissues are unremarkable. No temporal bone masses are evident to suggest endolymphatic sac tumor. Spine: Again seen are postsurgical changes C6 and C7 laminectomy for resection of previous seen dorsal cervical cord hemangioblastoma at the C6-C7 level. No residual or recurrent enhancement or mass is appreciated involving the cervical cord. There is no abnormal enhancement or mass in the cervical, thoracic, or lumbar spinal canal to suggest hemangioblastoma. The vertebral column alignment is unchanged. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is a small left paracentral disc extrusion at the C5-C6 level which appears minimally larger than prior and is not associated with significant spinal canal or neural foraminal stenosis. No significant spinal canal or neural foraminal stenosis in the cervical, thoracic, or lumbar spine.

Output: 1. Subtle 2 mm foci of enhancement seen only on the high-resolution post gadolinium sequence involving the right posterior and left anterolateral surfaces of the medulla may possibly represent tiny hemangioblastomas, but given the small size of these foci of enhancement, normal vascular structures also remains a possibility. No findings to definitively suggest a new or enlarging lesion. Brain parenchyma is otherwise unremarkable. No temporal bone masses to suggest endolymphatic sac tumor.2. Postoperative changes related to prior resection of dorsal cervical cord hemangioblastoma at the C6-C7 level. There is no evidence of residual or recurrent tumor in the cervical, thoracic, or lumbar spine.3. Small left C5-C6 disc extrusion without significant spinal canal or neural foraminal stenosis.


Instruction: Generate impression based on findings.

Input: Reason: Right forearm soft tissue sarcoma in volar compartment that may originate from the median nerve, please evaluate for discernable plane between the nerve and the mass History: above There is a large mass within the anterior compartment of the forearm, which measures approximately 5.5 x 5.0 cm in transverse dimension and 13.0 cm in craniocaudal dimension. The flexor carpi radialis muscle/tendon are displaced laterally and the flexor carpi ulnaris muscle/tendon are displaced medially. What we believe to be the palmaris longus tendon is displaced volarly. The mass focally protrudes into the volar subcutaneous fat of the forearm just lateral to the palmaris longus tendon. Just distal to this, the palmaris longus tendon is focally enveloped by the mass. The remaining flexor tendons are displaced dorsally, although what we suspect to be the superficial flexor tendon of the middle finger is enveloped by the mass. The median nerve is dorsally displaced by the mass, and runs along the dorsal margin of the mass. The superficial branch of the radial nerve may contact the mass focally, but this is equivocal, and it does not appear to be enveloped by the mass. The mass itself is slightly hyperdense to skeletal muscle on T1-weighted images. It is heterogeneously hyperintense to muscle on fat-suppressed T2-weighted images and shows heterogeneous enhancement following intravenous administration of gadolinium. The mass also shows hyperintensity on the fat-suppressed T1-weighted images, which likely represents areas of hemorrhage. The proximal margin of the mass lies approximately 8 cm distal to the elbow joint with a small tail of enhancing edema extending more proximally. The distal edge of the mass is at the level of the radiocarpal joint. The median nerve within the carpal tunnel appears enlarged, likely reflecting neuritis. The bone marrow signal intensity appears normal.

Output: Large heterogeneous mass in the anterior compartment of the forearm as described above with dorsal displacement of the median nerve.


Instruction: Generate impression based on findings.

Input: Ms. Cyrus is a 40-year-old female with a family history of breast cancer in sister (diagnosed at the age of 40) and a maternal aunt. Personal history of benign left breast MRI guided biopsy in 2014 for fibroadenomatoid change. There is heterogeneous amount of fibroglandular tissuein both breasts.Mild parenchymal enhancement is noted bilaterally.Scattered T2 intense nonenhancing cysts are identified bilaterally. Scattered foci of enhancement are seen in both breasts, including at site of benign left breast biopsy, all of which are stable compared to prior examinations. No abnormal enhancement is seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.Stable T2 hyperintense hepatic lesions.

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


Instruction: Generate impression based on findings.

Input: Clinical question: Optic neuritis, please perform multiple sclerosis protocol. Compared to prior exam. Signs and symptoms: Optic neuritis. Pre and post enhanced brain MRI:Examination demonstrates a punctate new foci of T2 hyperintensity in the corpus callosum (sagittal 3-D FLAIR series 801 image 179) which demonstrate enhancement (axial post enhanced series 901 image 43 and 44) concerning for new enhancing demyelinating plaque.Compared to prior exam there is interval resolution of previously noted enhancing demyelinating plaque.Additionally there is subtle interval decreased size of few of the previously known demyelinating plaques. This observation is particularly noticeable in plaques in the bilateral posterior temporal periventricular white matter and the left parietal subcortical enhancing lesion.There is no convincing evidence of signal abnormality or enhancement of the suprasellar visual complex or the intracranial optic nerves.Subtle increased T2 signal intensity of right optic nerve in the retro-orbital space (axial FLAIR series 601 image 25) could represent a demyelinating plaque or possibly artifactual signal. Post contrast images are not fat saturated and assessment of enhancement in the retro-orbital space is not possible.

Output: 1.New tiny focus of T2 hyperintensity and enhancement in the anterior body of corpus callosum since prior exam.2.Artifact or a true demyelinating plaque of the right retro-orbital optic nerve as detailed. Postcontrast images are not fat saturated and assessment of enhancement in the retrorectal space is not possible.3.Interval resolution of enhancement of a left parietal demyelinating plaques since prior exam.4.Intervertebral decreased size of a few of the previously present lesions as detailed.


Instruction: Generate impression based on findings.

Input: 55 year old female. Evaluate for bleeding/trauma. Prominent cerebral sulci and cerebellar folia consistent with volume loss, unchanged.There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Cerebral volume loss with no acute intracranial abnormality seen.


Instruction: Generate impression based on findings.

Input: Evaluate for biliary ductal dilation or pancreatic mass, left lower quadrant pain ABDOMEN:LIVER, BILIARY TRACT: No evidence of intra or extrahepatic biliary ductal dilation. Subcentimeter enhancing lesion in the left hepatic lobe, likely a hemangioma.SPLEEN: No significant abnormality noted.PANCREAS: No evidence of pancreatic mass or atrophy. The pancreatic duct is normal.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.

Output: No evidence of biliary ductal dilation or pancreatic mass.


Instruction: Generate impression based on findings.

Input: 50 years Female (DOB:1/15/1966)Reason: evaluate for degenerate ive disc disease, herniated disc History: lumbar back painPROVIDER/ATTENDING NAME: DALIA H. ELMOFTY DALIA H. ELMOFTY Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is a disc bulge at this level There is bilateral facet and ligamentum flavum hypertrophy of a moderate degree at this level. There is mild triangulation of the thecal sac compared to the prior exam this has not significantly progressed.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is a mild disc bulge and mild ligamentum flavum hypertrophy.At L2-3 there is no significant compromise to spinal canal or neural foramina. There is a mild disc bulge present this levelAt L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: There are some mild degenerative changes present in the lumbar spine without significant compromise to the spinal canal or exiting nerve roots. This appears to be relatively stable compared with previous exam.


Instruction: Generate impression based on findings.

Input: Sciatica. Right calf pain and weakness on walking with reproducible distance. Resolves with rest. No pain when biking. Evaluate for spinal canal and neural foraminal stenosis. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign with scattered foci of T1 hyperintensity compatible with focal fat or hemangiomas.. The conus medullaris is normal in position.Multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: No significant disc disease. No spinal canal or neural foraminal stenosis. Small synovial cyst is noted dorsal to the right facet joint.L4-L5: There is mild disc bulge, ligamentum flavum thickening, and moderate bilateral facet arthropathy. Small bilateral facet effusions are noted. There is a 3 x 5 mm cystic structure likely representing a synovial cyst along the ligamentum flavum on the right which contributes to the spinal canal stenosis. There is moderate to severe spinal canal stenosis at this level. There is mild bilateral neural foraminal stenosis. Tiny cystic structure is also seen involving the left L4 lamina which may represent a subchondral cyst related to facet arthropathy.L5-S1: No significant disc disease. No spinal canal or neural foraminal stenosis. Prominence of the epidural fat. Thecal sac terminates just below this level.Paraspinous soft tissues are within normal limits.

Output: Moderate to severe spinal canal stenosis at the L4-L5 level related to disc bulge, ligamentum flavum thickening, and facet arthropathy. There is a 3 x 5 mm synovial cyst on the right which also contributes to the stenosis.Mild bilateral neural foraminal stenosis at L4-L5. Otherwise no significant spinal canal or neural foraminal narrowing at the other levels.


Instruction: Generate impression based on findings.

Input: There is reconstruction of areas of relatively symmetric T2/FLAIR hyperintensity within the periatrial white matter bilaterally without sparing of the subcortical U fibers, slightly more anteriorly extending on the left into the posterior aspect of the left external capsule. There are areas of transcortical involvement along the occipital lobes. There has been interval progression of associated volume loss with areas of encephalomalacia appearing subcortical regions, with relative sparing of the periventricular white matter. There is again mild ex vacuo dilatation of the atria with respect to the remainder of the lateral ventricles. Otherwise, myelination pattern appears appropriate for stated age in areas of preserved white matter.There is redemonstration of an oval-shaped area of gray matter signal on all sequences measuring opacity 9 x 6 mm along the lateral margin of the posterior body of the right lateral ventricle. This is best appreciated on 201/17 and 601/19.The ventricles and sulci are otherwise within normal limits. The basal cisterns remain patent. There is no midline shift or mass effect. 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. Major vascular flow voids are preserved.There is moderate fluid opacification of right and mild opacification of the left mastoid air cells. There is scattered mild mucosal thickening in maxillary and ethmoid sinuses.

Output: 1. Redemonstration of relatively symmetric T2/FLAIR abnormality within predominantly the subcortical white matter within the cerebral hemispheres posteriorly, although there are small areas of transcortical involvement along the occipital lobes. This again is favored to represent leukomalacia although of uncertain etiology, perhaps relating to a chronic ischemic insult.2. Stable focal subependymal heterotopia along the lateral margin of the right lateral ventricle.


Instruction: Generate impression based on findings.

Input: Chiari malformation, developmental delay with speech, evaluate for syrinx or tethered cord: Chiari malformation spine survey for abnormalcies. The cerebellar tonsils extend up to approximately 15 mm inferior to the foramen magnum and demonstrate a peg-shaped configuration with impeded CSF flow in this area. There is mild retroflexion of the dens. The vertebral column alignment is otherwise within normal limits. The spinal cord displays normal signal and morphology, without evidence of syringohydromyelia. The conus medullaris is located at the L1-2 level. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The paravertebral soft tissues are unremarkable.

Output: Findings compatible with Chiari I malformation, but no evidence of syringohydromyelia or low-lying conus medullaris.


Instruction: Generate impression based on findings.

Input: 47 year old woman with history of NSVT and concern for ARVD, referred for cardiac MRI for further evaluation. Left VentricleThe left ventricle is normal in size with normal systolic function. There is a subtle wall motion abnormality involving the basal to mid anterolateral wall. The overall LV ejection fraction is 61%, the LV end diastolic volume index is 91 ml/m2 (normal range: 65+/-11), the LVEDV is 184 ml (normal range 109+/-23), the LV end systolic volume index is 36 ml/m2 (normal range 18+/-5), the LVESV is 72 ml (normal range 31+/-10), the LV mass index is 19 g/m2 (normal range 67+/-11), and the LV mass is 38 g (normal range 114+/-24). There is an atypical pattern of late gadolinium enhancement involving the midwall of the basal anterolateral segment and also the epicardium of the basal to mid inferior and inferoseptal walls suggesting the presence of an underlying fibrosing, infiltrative, or inflammatory process. The pattern is not consistent with prior myocardial infarction. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 60%, the RV end diastolic volume index is 73 ml/m2 (normal range 69+/-14), the RVEDV is 148 ml (normal range 110+/-24), the RV end systolic volume index is 30 ml/m2 (normal range 22+/-8), and the RVESV is 60 ml (normal range 35+/-13). There are no regional or focal RV wall motion abnormalities present.Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 61%. There is a subtle wall motion abnormality involving the basal to mid anterolateral walls. There is an atypical pattern of late gadolinium enhancement involving the midwall of the basal anterolateral segment and also the epicardium of the basal to mid inferior and inferoseptal walls suggesting the presence of an underlying fibrosing, infiltrative, or inflammatory process such as old myocarditis, sarcoidosis, etc. The pattern is not consistent with prior myocardial infarction. 2. The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 60%. There are no regional wall motion abnormalities present. There is no cardiac MRI evidence to support the diagnosis of arrhythmogenic right ventricular cardiomyopathy. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Patient with history of SLAP tear status post repair, presenting with persistent left shoulder pain, evaluate for rotator cuff tear/labrum. ROTATOR CUFF: Signal changes in the supraspinatus tendon insertion, consistent with supraspinatus tendinopathy without evidence of tear. The supraspinatus muscle is intact. Infraspinatus muscle and tendon are intact. Teres minor muscle and tendon are intact. The subscapularis muscle and tendon are intact. Injected contrast remains within the glenohumeral joint with no communication to the subdeltoid and subacromial bursa.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: Again noted is a grade II SLAP lesion which appears slightly more conspicuous as compared to the prior exam. Mild degenerative changes affect the glenohumeral joint, some of the prior exam.BICEPS TENDON: The proximal biceps tendon has been resected and reattached to the proximal humeral diaphysis, consistent with tenodesis.ADDITIONAL

Output: 1.Grade II SLAP lesion, grossly similar to the prior exam.2.Tendinosis of supraspinatus tendon, with no evidence of tear. Otherwise the rotator cuff is intact.3.Patient status post biceps tenodesis.


Instruction: Generate impression based on findings.

Input: History of hydrocephalus, neurogenic bladder, neurogenic dysphagia, vocal tremor, cerebral cyst, Chiari malformation with decompression, syrinx, ataxia, headache, falls, complicated UTI, hypothyroidism, and VA shunts. Brain: There are postoperative findings related to complex Chiari decompression surgery with extensive encephalomalacia and punctate foci of susceptibility effect in the medial portions of the cerebellum and left middle cerebellar peduncle. There is interval involution of the cystic cavity in the left cerebellomedullary angle cistern, while the cystic compartment in the right cerebellomedullary angle cistern persists, measuring 9 x 12 mm in axial cross-section. There is interval decreased T2 hyperintensity and swelling of the bilateral medullary olives. There is no evidence of acute infarct. There is a left transparietal ventricular shunt catheter that terminates in the right frontal horn. The third and lateral ventricles are nearly collapsed. There is linear encephalomalacia that traverses the body of the corpus callosum into the bilateral centrum semiovale. There is also a prior left transfrontal catheter track. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are unremarkable.Spine: There are postoperative findings related to complex Chiari decompression surgery with a persistent transverse low signal band that kinks the anterior aspect of the upper spinal cord at the level of the dens. There is persistent extensive central T2 hyperintensity throughout the cervical and upper thoracic spine. There is persistent lack of the usual cervical lordosis. The rest of the vertebral column alignment is otherwise anatomic. There is prominence of the epidural venous plexus in the anterior craniocervical junction region. There are scattered extramedullary intrathecal foci of low signal intensity throughout the spinal canal, particularly posteriorly. There also appears to be clumping of the lower cauda equina nerve roots. There is a small posterior disc-osteophyte complex at the C6-7 level, but no significant degenerative spondylosis in the thoracic and lumbar spine. The vertebral body heights are preserved.

Output: 1. Postoperative findings related to complex Chiari decompression surgery with persistent encephalomalacia and punctate foci of chronic hemorrhage in the medial portions of the cerebellum and left middle cerebellar peduncle and a cystic compartment in the right cerebellomedullary angle cistern, but interval involution of the cystic cavity in the left cerebellomedullary angle cistern. 2. Persistent extensive central T2 hyperintensity throughout the cervical and upper thoracic spine, which may represent a combination of edema and myelomalacia, perhaps aggravated by a persistent apparent fibrotic band that kinks the upper spinal cord at the level of the dens.3. Scattered extramedullary intrathecal foci of low signal intensity throughout the spinal canal and apparent clumping of the lower cauda equina nerve roots, which may be related to arachnoiditis incited be chronic hemorrhage. 4. The shunted third and lateral ventricles are nearly collapsed. 5. Interval evolution of hypertrophic olivary degeneration, which is now less conspicuous.


Instruction: Generate impression based on findings.

Input: Left ankle swelling, tender to palpation, evaluate for osteomyelitis Again noted are multiple regions of signal abnormality in the proximal and distal tibial metadiaphyses with geographic low T1 and T2 signal and punctate foci of T1 hyperintensity. There is no significant bone marrow edema. There is very little associated marrow enhancement, which has decreased compared to the prior exam. There is soft tissue edema about the ankle.

Output: 1. Lower extremity infarcts without evidence of osteomyelitis. 2. Left ankle soft tissue swelling.


Instruction: Generate impression based on findings.

Input: Evaluate for calcaneal stress fracture. Examination of the images reveals a linear focus of decreased signal on the T1-weighted images in the calcaneus representing a stress fracture. There is bone marrow edema throughout the posterior calcaneus.Note is made of an accessory soleus muscle which is somewhat edematous.The flexor tendons are unremarkable.The extensor tendons are unremarkable.Proteus brevis and longus tendons are unremarkableThe Achilles tendon is unremarkable. The lateral collateral ligamentous complex is intact. The sinus to the symphysis is unremarkableThe deltoid ligament is unremarkable

Output: Nondisplaced stress fracture in the calcaneus best seen in the series 501 image 15


Instruction: Generate impression based on findings.

Input: Lung cancer with new headaches. There is a new widely diffuse left calvarial lesion with irregular, enhancing left holocerebral convexity extra-axial tumor extension that measures up to 10 mm in thickness along the inferior left temporal lobe. There are foci of susceptibility effect associated with portions of the tumor, which may represent hemorrhage and/or calcification. There is also a fluid collection in the left frontal convexity subdural space that measures up to 8 mm in thickness. There is overall mild mass effect upon the underlying brain parenchyma and slight midline shift to the right. In addition, the tumor appears to compress or perhaps invade the left sigmoid sinus. The left calvarial tumor also extends into the overlying subgaleal space, measuring up to 7 mm in thickness. There are smaller enhancing lesions within the right and mid frontal calvarium without epidural or subgaleal extension. There is no evidence of intraparenchymal brain tumors or acute infarct. There is no herniation. The major cerebral flow voids are intact. There is scattered mucosal thickening within the left mastoid air cells, which may be related to compromise of the regional venous drainage. The orbits and paranasal sinuses are grossly unremarkable.

Output: New widely diffuse left calvarial metastasis with epidural tumor extension that measures up to 10 mm in thickness, with foci of susceptibility effect associated with portions of the tumor, which may represent hemorrhage and/or calcification. A fluid collection in the left frontal convexity subdural space that measures up to 8 mm in thickness may represent an epitumoral cyst. There is overall mild mass effect upon the underlying brain parenchyma and slight midline shift to the right. The left calvarial tumor also extends into the overlying subgaleal space, measuring up to 7 mm in thickness. There are smaller metastatic lesions within the right and mid frontal calvarium without epidural or subgaleal extension.


Instruction: Generate impression based on findings.

Input: Acute hypoxic event at birth. Evaluate brain structures. There is no evidence of intracranial hemorrhage, mass or edema. There is diffuse low attenuation in the subcortical tissues consistent with unmyelinated brain tissue, an expected finding given the patient's age. There are no CT findings of hypoxic injury -- if clinical concern remains recommend noncontrast MRI.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Unremarkable brain CT. If clinical concern remains for hypoxic injury, recommend noncontrast MRI.


Instruction: Generate impression based on findings.

Input: Conus cyst, epilepsy For the purposes of numbering, there are 5 lumbar type vertebral bodies. Again seen is a mildly expansile T2 hyperintense focus involving the distal thoracic cord at the T12 level measuring approximately 4 x 3 x 10 mm in the AP, transverse, and craniocaudal dimensions. There is suggestion of communication with the central canal superiorly (better seen on prior study sag T2 image 6). No abnormal enhancement is appreciated on the postcontrast sequences.Vertebral body heights are normal. Alignment is normal. Bone marrow signal is normal. No significant spinal canal or neural foraminal stenosis is seen at any level. Conus is in normal position at the L1-L2 level. No evidence of filar lipoma or other lesions involving the cauda equina or filum terminale. No evidence of tethered cord.

Output: Unchanged appearance of the minimally expansile cystic focus/defect involving the dorsal cord in the midline at the T10 level. Finding is favored to represent a developmental malformation, possibly related to incomplete neural tube closure (although the osseous elements are intact) or ventricularis terminalis cyst, and less likely myelomalacia related to prior injury or nonenhancing cystic neoplasm.


Instruction: Generate impression based on findings.

Input: Glioblastoma multiforme. Status post resection and sequential chemoradiation treatment. The patient developed recurrence which was re-resected in October 2015 followed by tumor vaccine (HSPPC96 vaccine trial). Recently started on Avastin. There are changes related to the previous resections of the left temporal glioblastoma. The extensive contrast enhancement in the adjacent left temporal parenchyma with extension along the posterior aspect of the internal and external capsules as well as the deep left parietal white-matter (reaching the lining of the left lateral ventricle) has significantly improved since the previous examination, in both intensity and extent. The associated extensive surrounding T2 hyperintensity is significantly improved with resolution of the midline shift and mass-effect on the left lateral ventricle. The more masslike, solidly contrast-enhancing nodule along the posterior resection margin has not changed and still measures up to 2.4 cm. It shows mild hyperperfusion on the relative cerebral blood volume color coded maps, unlike the remainder of the surrounding contrast enhancement, which is hypoperfused. There is no new postcontrast enhancement. There is no acute infarct. Mild, unchanged confluent T2-hyperintensity in the periventricular white-matter is nonspecific but may relate to previous treatment and chronic microvascular ischemia. There is mild ex vacuo enlargement of the left lateral ventricle. There is no gross orbital abnormality. Fluid signal in the left mastoid air cells has improved. There is new mucosal thickening and fluid in the right maxillary sinus, which in the proper clinical setting may reflect acute sinusitis. There is moderate mucosal thickening in the ethmoid sinuses.

Output: 1.Compared to previous examination from February 2016, there has been significant improvement of the extensive contrast enhancement surrounding the left temporal resection bed as well as the associated T2 signal and mass-effect as described above. This also remains hypoperfused and likely predominantly reflect post treatment change. The change is most probably the effect of Avastin.2.The more solid, contrast-enhancing nodule along the posterior left temporal resection margin remains unchanged and mildly hyperperfused and suspicious for recurrent tumor.3.Mucosal thickening and fluid in the right maxillary sinus may reflect acute sinusitis in the proper clinical setting.4.Improved left mastoiditis.


Instruction: Generate impression based on findings.

Input: 82 year old female who presents with signs and symptoms of stroke. Rule out CVA. There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration.Multiple age indeterminate scattered hypodensities are noted in the periventricular white matter bilaterally, which are nonspecific, and may represent small vessel ischemic disease. There is a linear hypodensity at the left basal ganglia extending into the internal capsule. This finding likely represents chronic infarction. However, if acute infarct remains a clinical concern further evaluation with MRI could be considered. Additionally, a foci of encephalomalacia is noted within the left cerebellar hemisphere.The calvaria and skull base are radiographically normal. There is mild mucosal thickening of the right maxillary sinus. These findings likely represent chronic mucosal sinus disease.

Output: 1. There is a linear hypodensity at the left basal ganglia extending into the internal capsule. These findings likely represent chronic infarction. However, if acute infarct remains a clinical concern further evaluation with MRI could be considered. 2. Multiple age indeterminate scattered hypodensities are noted in the periventricular white matter bilaterally which are nonspecific and may represent small vessel ischemic disease. 3. Focus of encephalomalacia within the left cerebellar hemisphere from prior small infarct.4. Right maxillary sinus mucosal disease.


Instruction: Generate impression based on findings.

Input: Cavernous malformation: surveillance. There is a small left posterior gyrus rectus subcortical white matter cavernous malformation, which appears unchanged. There is no evidence of intracranial hemorrhage or acute infarct and the rest of the brain appears unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: A small left posterior gyrus rectus subcortical white matter cavernous malformation appears unchanged.


Instruction: Generate impression based on findings.

Input: Cellulitis. Rule out "osteo" versus necrotizing cellulitis. The subcutaneous fat of the ankle is replaced with intermediate density compatible with edema that propagates through the subcutaneous fat along the dorsum of the foot. There is associated skin thickening, as well as blistering along the lateral aspect of the ankle and dorsal aspect of the forefoot. The musculature of the forefoot also appears edematous. Furthermore, there are multiple foci of gas density within the soft tissues surrounding the head of the second metatarsal and extending dorsal to the head of the first metatarsophalangeal joint and the proximal phalanx of the second toe, in close association with the extensor tendons of the 1st and 2nd rays. There is also a poorly defined collection of low density within the plantar musculature of the foot deep to the flexor tendons of the second ray beneath the second metatarsal diaphysis which could represent a developing abscess or septic tenosynovitis; small foci of gas are seen within this collection. I see no site of skin ulceration on this study to suggest a source for this gas, and therefore, I cannot exclude the possibility of a necrotizing infection. I see no specific imaging features of osteomyelitis. Osteoarthritis affects the first metatarsophalangeal joint and midfoot articulations.

Output: Soft tissue infection of the foot as described above.


Instruction: Generate impression based on findings.

Input: MRI Brain:There is no diffusion abnormality. No intracranial mass or mass effect. There are mild-moderate periventricular and subcortical punctate white matter FLAIR hyperintensities. The ventricles and sulci are within normal limits for age. 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.The eyeball lenses are thin.MRA Brain: The intracranial internal carotid arteries demonstrate no significant stenosis. There is occlusion of the left A1 segment as well as focal narrowing of the distal left M1 segment with attenuation of the superior division of the left MCA. There is a relatively small anterior communicating artery which is supplying the left A2 segment and beyond. The right middle and right anterior cerebral arteries are patent. The right V4 segment is small. The left vertebral artery, basilar artery, and posterior cerebral arteries also are patent with no significant stenosis. No evidence of aneurysms or vascular malformations. The right posterior communicating artery is medium-sized whereas the left posterior communicating artery is not readily identified.MRA Neck: There is a separate origin of the left subclavian artery, left common carotid artery, and brachiocephalic artery from the arch. There is approximately 20% stenosis of the proximal right ICA and approximately 25-30% stenosis of the left proximal ICA by NASCET criteria. There is occlusion of the right vertebral artery from its origin to the mid V2 region where the vertebral artery reconstitutes via collaterals. There is also a high-grade stenosis at the origin of the left vertebral artery.

Output: 1.Occlusion of the left A1 segment with the left A2 segment being supplied by a relatively small anterior communicating artery.2.Focus of narrowing at the distal left M1 segment at the inferior division with additional attenuation of the superior division of the left MCA.3.Occlusion of the right vertebral artery at its origin with collateral reconstitution at the mid V2 region and occlusion of the intracranial right vertebral artery.4.High-grade stenosis of the origin of the left vertebral artery.5.Approximately 20% stenosis of the proximal right ICA and approximately 25-30% stenosis of the left proximal ICA by NASCET criteria.6.There is no evidence for acute cerebral ischemic infarction.7.Periventricular and subcortical white matter lesions of a mild to moderate degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: 74-year-old male with right renal mass seen on prior ultrasound ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter T2 hyperintensity in segment six likely reflects a benign cyst.SPLEEN: No significant abnormality noted.PANCREAS: A 4 mm T2 hyperintensity in the pancreatic head without clear connection to the main pancreatic duct may represent a sidebranch cyst versus sidebranch IMPN.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple T2 hyperintense cysts in bilateral kidneys, right greater than left. In particular, the posterior interpolar lesion seen on prior ultrasounds is T2 hyperintense with mild septation and no nodularity on this limited noncontrast study.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: T2 hypointense lesion in the L4 vertebral body. Mild leftward curvature of the lumbar spine.OTHER: No significant abnormality noted.

Output: 1.Mildly complex cyst corresponding to the interpolar right kidney lesion seen on prior US on this limited noncontrast study.2.Probable 4 mm cyst versus sidebranch IPMN in the pancreatic head.


Instruction: Generate impression based on findings.

Input: 66-year-old male with new diagnosis of cutaneous B cell lymphoma. Scalp lesions. Staging evaluation. CHEST:LUNGS AND PLEURA: Multiple bilateral circumscribed lung nodules. In the left lung at image 42 of series 6 there is a 1 x 1.4 cm left upper lobe and a nodule. A right middle lobe lateral segment nodule measures 7 x 8 mm at image 69 of series 6.MEDIASTINUM AND HILA: Multiple subcentimeter mediastinal lymph nodes. No measurable lymphadenopathy.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: 1.5 cm diameter right adrenal nodule is indeterminate. If indicated, obtain an adrenal MRI to exclude metastasis. Appearance and size, however, suggest this is a benign adenoma. KIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Bilateral small lung nodules. No lymphadenopathy. Right adrenal nodule.


Instruction: Generate impression based on findings.

Input: History of prostate cancer. Interested in active surveillance. 6/29/2015 biopsy demonstrated 3+3 left base and 3+3 right apex adenocarcinoma. PELVIS:PROSTATE:Prostate Size: 2.7 x 5.0 x 4.9 cmPeripheral Zone: 5 x 4 mm left medial mid gland lesion demonstrating T2 weighted hypointensity (series 901/20), associated restricted diffusion (series 704/384) but no abnormal enhancement.Punctate foci of T2 weighted hyperintensity in the right apex are too small to characterize.Central Gland: Changes of benign prostatic hyperplasia.Seminal Vesicles: No seminal vesicle invasion.Extracapsular Extension: No evidence of extraprostatic extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 5 mm left medial mid gland lesion may represent a site of prostatic adenocarcinoma and is amenable to MR/ultrasound fusion biopsy.