Instruction: Generate impression based on findings.

Input: Patient was initially noted to have a rise in his PSA to 4.8 ng/mL in 2013 during routine screening. Per pt, a TRUS biopsy was performed a that time with a small focus of Gleason 6 disease. He elected to undergo active surveillance. His last TRUS biopsy was in 2015 and per pt was negative for disease. Recently his PSA has risen to 6.8 on 11/7/2016, from 5.7 on 4/5/16. PELVIS:PROSTATE:Prostate Size: 4.9 x 3.8 x 4.6 cmPeripheral Zone: 14 x 6 mm left ADC low (series 308 image 384) and T2 low (series 501 image 19) near the junction of the peripheral zone and central zone. There is enhancement of this lesion (series 1201 image 2970).Central Gland: Multiple hyperplastic nodules, one of them may have focal hemorrhage.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: No definite evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: Bilateral nonenlarged nonspecific external iliac lymph nodes. Questionable nonspecific retroperitoneal lymph node only seen on sequence 1401 near the aortic bifurcation.BONES, SOFT TISSUES: Soft tissue density in the left inguinal canal is presumably from inguinal hernia repair, please correlate with prior surgical history.OTHER: No significant abnormality noted.

Output: 1.Left peripheral lesion as above, intermediate, PI-RADS 3.PI-RADS™ v2 Assessment Categories:PIRADS 1 – Very low (clinically significant cancer is highly unlikely to be present) PIRADS 2 – Low (clinically significant cancer is unlikely to be present)PIRADS 3 – Intermediate (the presence of clinically significant cancer is equivocal)PIRADS 4 – High (clinically significant cancer is likely to be present) PIRADS 5 – Very high (clinically significant cancer is highly likely to be present)https://www.acr.org/~/media/ACR/Documents/PDF/QualitySafety/Resources/PIRADS/PIRADS%20V2.pdf


Instruction: Generate impression based on findings.

Input: Ms. Donovan is a 38 year old female with known left breast cancer on neoadjuvant chemotherapy who presents for MRI evaluation of the response to the treatment. There is scattered fibroglandular tissue in both breasts. Minimal parenchymal enhancement is noted bilaterally.There is complete interval resolution of the abnormal enhancement in the left breast. There is no suspicious enhancement in the left breast.No abnormal enhancement is seen in the right breast. No abnormal axillary lymph nodes are identified in either axillary region.

Output: 1. Complete imaging response of the left breast malignancy to the chemotherapy.2. No MRI evidence for malignancy in the right. BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Reason: 59M with metastatic melanoma, please assess for new lumbar mets to explain right leg weakness and pain History: right leg weakness and pain Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment. Multiple marrow replacing lesions present throughout the visualized portions of the thoracic spine and sacrum and also throughout the lumbar spine. These were also present on the prior exam. There are associated compression fractures at L4 and T11 which are stable when compared to the prior exam. The conus medullaris on sagittal imaging is grossly intact. At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is facet and ligamentum flavum hypertrophy at this level, loss of disk space height, disk desiccation, diffuse disk bulge, endplate osteophytes and endplate reactive changes with associated narrowing of the neural foramina bilaterally.At L4-5 there is a mass extending from the right half of the L4 through body and to the right paravertebral space as well as the epidural space and the right neural foramen. This results in narrowing of the spinal canal and encroachment of the thecal sac with spinal stenosis as well as encroachment of the exiting nerve roots the neural foramina. This appearance is not substantially changed since the previous exam. There is also facet ligamentum flavum hypertrophy at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is facet and ligamentum flavum hypertrophy at this level.At L2-3 there is no significant compromise to spinal canal or neural foramina. There is a large Schmorl's node present at this level.At L1-2 there is no significant compromise to spinal canal or neural foramina.There is mild compression of the T11 vertebral body and some narrowing of the spinal canal at the T10-T11 level.There is a large parapelvic cyst in the right kidney which is unchanged since the prior exam.There is right pelvic retroperitoneal mass present which is not entirely included on this exam.

Output: 1.There is redemonstration and no significant change in diffuse skeletal metastases to the spine associated with extraosseous extension at the L4 vertebral level resulting in spinal stenosis and right-sided neural foramen encroachment of exiting nerve roots. 2.There are some compression fractures present at L4 and T11 which are stable since prior exam.3.Large pelvic mass appeared please referred to PET CT for further comments. This appears to involve the expected location of the right lumbosacral plexus.4.Large right-sided renal cyst


Instruction: Generate impression based on findings.

Input: Foci of T2 hyperintense signal in the periventricular, deep and subcortical white matter, as well as corpus callosum appears similar to the prior exam. No new lesions are identified. There is no associated enhancement. The ventricles and sulci are within normal limits. The cisterns remain patent. There is no midline shift or mass effect. Normal flow-voids are demonstrated in the major intracranial vascular structures. There is a subcentimeter probable Thornwaldt cyst. There is asymmetric fluid in the pneumatized left anterior clinoid process.

Output: No appreciable change in the intracranial demyelinating lesions, without associated enhancement.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 42-year-old female with left leg/foot and right knee pain/swelling after a fall from a wheelchair. Right knee: Moderate osteoarthritis affects the right knee, particularly the medial tibiofemoral compartment, which has progressed since the prior examination. No acute fracture is identified. The extensor mechanism is not well-visualized and if further imaging evaluation is clinically warranted, MRI may be considered.Left leg: There is reticulation of the subcutaneous fat which indicates soft tissue edema, but no acute fracture is identified.Left foot: Mild soft tissue swelling along the dorsum of the ankle and foot, but no acute fracture is identified. Note is made of a plantar calcaneal spur.

Output: Osteoarthritis of the knee and soft tissue swelling of the left leg and foot without fracture evident.


Instruction: Generate impression based on findings.

Input: Patient is a 56-year-old female with personal history of right lumpectomy for invasive ductal carcinoma and DCIS in 2007. Patient received radiation and chemotherapy. No current breast related complaints. Family history of breast carcinoma in her maternal grandmother and maternal aunt. There is scattered fibroglandular tissue on the right, and a heterogeneous fibroglandular tissue on the left with mild background parenchymal enhancement bilaterally. Stable postsurgical changes from right lumpectomy are present within the upper inner right breast and right axilla. The small intramammary lymph node is seen in right and left breast. Scattered foci of enhancement are also stable within the left breast, compatible with the background parenchymal enhancement. None of them is more suspicious than the others. No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. Stable postsurgical changes in the right breast and right axilla. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: 31-year-old female with history of pancreatic pseudocyst status post cyst gastrostomy in March 2015. Patient now with abdominal pain, nausea, vomiting, and elevated lipase. ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesions. No biliary ductal dilation. Status post cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: There is fullness of the pancreatic head with an apparent rounded area measuring up to 2.7 x 2.2 cm (series 1204/63) demonstrating low T2 signal and relative hypoenhancement on delayed phase images. There is mild relative upstream dilation of the main pancreatic duct measuring up to 3-4 mm with multiple side branches visualized with transition point in the pancreatic body, appears to be upstream from the pancreatic head findings. Definite restricted diffusion is not seen. Cyst gastrostomy tube is present, but there are no significant peripancreatic fluid collection seen.There appears to be occlusion of the portal confluence with the splenic vein not visualized. The main portal vein appears to be reconstituted by collateral vessels.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Prominent peripancreatic lymph nodes are seen around the pancreatic head, but these are not pathologically enlarged by size criteria.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Overall, pancreatic head findings as detailed above are nonspecific and may relate to sequela/devascularization or necrosis from pancreatitis, focal type autoimmune pancreatitis another differential consideration, underlying masslesion not entirely excluded. Clinical and endoscopic correlation is suggested.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain. Incidental note is made of bilateral staphyloma.

Output: Negative MRI of the brain including gadolinium enhancement. Specifically, there are no MRI findings to explain the patient's headaches.


Instruction: Generate impression based on findings.

Input: 28-year-old with BRCA1 positive, strong family history of breast cancer There is extreme amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: There is no acute infarct, mass effect, or cerebral edema. The cerebellar tonsils remain above the foramen magnum. There are no discrete matter heterotopia, cortical dysplasia or evidence of mesial temporal sclerosis. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable.

Output: Unremarkable exam without discrete structural abnormalities.


Instruction: Generate impression based on findings.

Input: Ms. Dougherty is a 39-year-old female who is BRCA1 positive. She has a strong family history of breast and ovarian cancer. Personal history of benign left breast MRI-guided biopsy in 5/2015 for focal PASH. She has no current breast complaints. There is heterogeneous amount of fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary or internal mammary region.

Output: No MRI evidence for malignancy. Breast imaging is optimally performed when prior studies are available to detect changes. If the patient's prior mammograms/MRI's are submitted, then comparisons will be made for future exams. Otherwise, patient will be due for a screening mammogram, beginning at the age of 40.BIRADS: 1 - Negative.RECOMMENDATION: NS - Routine Screening Mammogram.


Instruction: Generate impression based on findings.

Input: Reason: herniated lumbar disc worsening low back and leg pain History: worsening low back and leg pain 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 a broad-based central disk protrusion which impresses on the ventral aspect of the thecal sac and abuts the nerve roots of the lateral recesses bilaterally effaces the fat at the lateral recess is bilaterally. Compared to the prior exam this has not changed substantially. There is some loss of disk space height at this level.At L4-5 there is some loss of disk space height as well as a left lateral recess broad-based disk protrusion which encroaches on the nerve roots of the left lateral recess and to a lesser degree right lateral recess. The fat of the lateral recesses is effaced and bilaterally left more than right . Compared to the prior exam protrusion appears to have mildly regressed. Overall there is a moderate degree of spinal stenosis at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.There is a central disk protrusion present at L5-S1 which encroaches on the nerve roots of the lateral recesses - left more than right- and has not change substantially when compared to the previous exam.2.There is a broad-based left lateral recess disk protrusion at L4-5 which encroaches on the nerve roots of the left lateral recess and to a lesser degree right lateral recess which is subtly partially regressed since the prior exam. Overall there is moderate spinal stenosis at this level.


Instruction: Generate impression based on findings.

Input: Clinical question:Thoracic radicular pain. R UE pain. Metastatic breast CA. Please compare to PET.Signs and Symptoms: thoracic radicular pain. RUE pain. Pre-and post enhanced cervical MRI:There is normal anatomical alignment and signal intensity column.There is normal signal intensity and caliber cervical cord.There is no detectable abnormal enhancement the vertebral column, cord or leptomeninges to suggest presence of a metastatic lesion.There is mild degenerative changes of cervical spine however without evidence of spinal stenosis at any level.Unremarkable images at the level of foramen magnum.No evidence of mural foramina compromise at any level.Unremarkable appearing spinal soft tissues.Pre-and post enhanced thoracic MRI:There is normal anatomical alignment the vertebral column however with mild exaggerated kyphosis of the upper thoracic.There is a mild chronic compression fracture of the superior endplate of T4 without associated bone marrow edematous changes or enhancement and consistent with a benign chronic fracture.Unremarkable signal intensity of vertebral column otherwise and without detectable abnormal enhancement.Normal signal intensity and caliber of thoracic cord and without evidence of enhancement.Minimal degenerative changes of thoracic spine are noted however without evidence of a spinal canal or neural foraminal compromise at any level.Pre-and post enhanced lumbar MRI:There is normal clinical alignment and vertebral column however right straightening of the lumbar lordosis. There is no detectable abnormal enhancement of the vertebral column.There is normal signal intensity of the lower most visualized thoracic cord, conus and cauda equina without abnormal enhancement.T2 -- L1, L1 -- L2 and L2 -- L3 levels demonstrate mild degenerative disease without spinal canal or neural foramina compromise.L3 -- 4 demonstrated moderate disk disease and loss of disk height, shallow broad-based left lateral and far lateral disk protrusion with subtle mass effect on the thecal sac however without spinal stenosis or neural foramina compromise is noted.L4 -- L5 demonstrate advanced disk disease and loss of disk height, extensive adjacent Modic bony signal changes of the endplates and mild ligamentum flavum hypertrophy is noted. No spinal stenosis or neural foramina compromise.Five chest one demonstrate mild degenerative changes without spinal stenosis or neural foraminal compromise.

Output: 1.Pre-and post enhanced MRI of cervical spine demonstrate mild degenerative disk disease and unremarkable otherwise. 2.Pre-and post enhanced MRI of thoracic spine demonstrate no evidence of metastatic disease. Mild chronic benign compression deformity of the superior endplates of T4 as detailed. Minimal degenerative disease without spinal canal or neural foramina compromise at any level.3.Pre-and post enhanced MRI lumbosacral spine demonstrate no evidence of metastatic disease. Moderate L3 -- L4 and severe L5 -- S1 disk disease is present, however there is no neural foraminal or central spinal stenosis at any level.


Instruction: Generate impression based on findings.

Input: Patient is a 55-year-old woman with strong family history of breast cancer. The patient submitted outside studies for review. Submitted for review are the following:-Bilateral screening mammogram 4/15/2015-MR 11/17/2015-MR guided Second Look ultrasound 11/30/2015.All of the studies were performed at Franciscan Alliance/St. Anthony Medical Center, Crown Point Indiana. For comparison,standard mammogram (2/21/2014, 3/15/2013, 12/29/2011) are available. BILATERAL SCREENING MAMMOGRAM 4/15/2015: Three standard views of both breasts and additional bilateral exaggerated CCL views were submitted. The breast parenchyma is extremely dense, unchanged in pattern and distribution. No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in either breast. A few bilateral microcalcifications are stable.Benign appearing lymph nodes are projected over the left axillae.BILATERAL SCREENING BREAST MRI 11/17/2015:There is large amount of dense heterogeneous fibroglandular tissue bilaterally. Mild amount of background parenchymal enhancement is present bilaterally. There are scattered subcentimeter rounded enhancing foci seen in both breasts, nonspecific and likely secondary to background parenchymal enhancement. This includes a 4 mm circumscribed rounded focus of enhancement seen in the right retroareolar region (series 10, image 50). This focus has typically benign kinetics on temporal evaluation.Normal size and morphology lymph nodes are seen in bilateral axilla, demonstrating fatty hilum.MRI GUIDED SECOND LOOK ULTRASOUND 11/30/2015:Targeted ultrasound was performed of the right retroareolar region further evaluate the foci of enhancement seen on MR. Unremarkable dense fibrotic tissue seen. No discrete suspicious solid or cystic masses are identified.Targeted ultrasound of the left axilla were also performed which demonstrate normal size and morphology lymph node with fatty hilum, similar to the mammogram and MRI.

Output: Probably benign 4 mm circumscribed focus of enhancement in the slightly medial right retroareolar region, with typically benign kinetics. No correlate found on second look ultrasound. A 6 month follow-up MRI is recommended to assess stability.BIRADS: 3 - Probably benign finding.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: 59-year-old female with first metacarpal changes and old MRI. Presents with pain at the basilar joint. Note is made of a focus of increased signal abnormality on fluid sensitive sequences within the first metacarpal with internal low signal intensity septations. There is thin peripheral enhancement on postcontrast sequences distally with more confluent enhancement proximally within the aforementioned lesion. There are subchondral cysts within the trapezium and scaphoid. The remainder of the bone marrow signal is within normal limits. There is fluid within the basilar joint. There is a tiny ossicle along the base of the first metacarpal which may represent a loose body within the basilar joint. Moderate osteoarthritis affects the basilar joint. Mild osteoarthritis affects the interphalangeal joint of the thumb. The imaged musculature is normal in appearance. The flexor and extensor tendons appear intact.

Output: 1. Enhancing lesion within the first metacarpal. Differential considerations include fibrous dysplasia, giant cell reparative granuloma, giant cell tumor, and less likely an enchondroma. 2. Osteoarthritis of the basilar joint with a mild synovitis.


Instruction: Generate impression based on findings.

Input: 43 year-old female with known left IDC presents for MRI guided biopsy for an enhancing lesion in the left lower outer breast. On subtraction images, a focal enhancing lesion seen on the prior outside MRI at lower outer quadrant in the left breast is not reproduced on this current MRI images. Therefore, MRI guided biopsy is canceled.

Output: MR guided biopsy of the left breast has been canceled due to non-visualization of the target lesion. The enhancing lesion on the prior outside MRI must be parenchymal enhancement.BIRADS: 1 - Negative.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Malignant neoplasm of base of tongue and confusion. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are minimal scattered punctate foci of T2 hyperintensity in the cerebral white matter. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is mild mucosal thickening in the inferior bilateral mastoid air cells.

Output: No evidence of intracranial metastases or acute infarct. Minimal scattered punctate foci of T2 hyperintensity in the cerebral white matter are nonspecific, but may represent chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: Reason: history of metastatic thyroid cancer with brain metastases (s/p resection of R occipital lesion followed by radiation therapy) Again seen are postoperative findings related to right occipital craniotomy. Given differences in technique and motion degradation, there is no significant change in dural thickening along the posterior falx cerebri and parenchymal enhancement within the right paramedian occipital lobe resection cavity. There is no significant change in confluent T2 hyperintensity along the margins of this resection cavity. No new abnormal intracranial enhancement is identified. There is an unchanged background of nonspecific cerebral white matter T2 hyperintensity, which may represent chronic small vessel ischemic disease. There is no evidence of acute intracranial hemorrhage or acute cerebral infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There are bilateral lens implants. Unchanged T1 hyperintense focus in the left frontal calvarium without destructive osseous lesions apparent.

Output: Motion degradation limits sensitivity for subcentimeter lesions. There is however no significant change in posttreatment changes in the right occipital region without evidence of new intracranial metastases.


Instruction: Generate impression based on findings.

Input: 52-year-old male with chronic renal insufficiency presents with two weeks of abdominal pain, vomiting, diarrhea. Lack of intravenous contrast is noted to lower the sensitivity for detection of solid organ pathology.ABDOMEN:LUNG BASES: Bi-basilar scarring or atelectasis. Several prominent paraesophageal and paradiaphrgmatic prominent lymph nodes are appreciated, the largest measures 1.5 in length and is unchanged.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: Marked fat replaced atrophy of the pancreas is notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Mild diffuse perinephric fat stranding is seen bilaterally, likely product of chronic renal medical disease. No hydronephrosis. RETROPERITONEUM, LYMPH NODES: A few scattered subcentimeter mesenteric lymph nodes are also identified.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: A single bladder diverticulum from the posterior-superior aspect of the bladder wall near the right UV junction, may represent a Hutch diverticulum.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: There is abnormal fat stranding seen involving the proximal portion of the transverse colon in the region of the hepatic flexure. Findings may be seen with an inflammatory, infectious, or possibly ischemic etiologies. There is diffuse chronic gastric wall thickening which may be due to gastritis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Persistent abnormal fat stranding in region of hepatic flexure of transverse colon is identified, findings suggestive of an infectious process given acute abdominal pain, differential includes inflammatory or ischemic etiologies.No significant interval change since 9/9/08.


Instruction: Generate impression based on findings.

Input: Episodes of hands trembling. The images are degraded by patient motion. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brainstem, posterior limbs of the internal capsules, and perirolandic regions demonstrate T1 hyperintensity. However, there is no appreciable T1 hyperintensity of the anterior limbs of the internal capsules. The pituitary gland appears unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No discernible seizure focus. However, the degree of white matter myelination appears to be somewhat delayed for the patient's age, assuming a term birth.


Instruction: Generate impression based on findings.

Input: CCM yearly surveillance. Artifact related to dental braces obscures portions of the anterior head. Within this limitation, there are multiple unchanged punctate foci of susceptibility effect in the periventricular and subcortical white matter of the bilateral hemispheres. There is no evidence of acute intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation.

Output: Unchanged punctate cavernous malformations in the bilateral cerebral hemispheres.


Instruction: Generate impression based on findings.

Input: 49-year-old history of CHF 3 presenting with headache and dizziness x 2 days. Increased right-sided weakness and paresthesia. There is no evidence of intracranial hemorrhage, mass or edema. No definite acute cortical stroke is seen however MRI is recommended if concern for ischemia is present. Focal hypoattenuation in the left centrum semiovale consistent with old subcortical infarct. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: No evidence of acute cortical stroke. Old left subcortical stroke.


Instruction: Generate impression based on findings.

Input: T4aN2cM0 oral tongue cancer infiltrating the floor of mouth treated with CRT completed 10/2014. There are post-treatment findings in the upper aerodigestive tract, including marginal right mandibulectomy. There is unchanged small area of enhancement in the right mandible body adjacent to the mandibulectomy site. There is no evidence of measurable tumor in the oral cavity. There is no significant cervical lymphadenopathy by size criteria. The airways are patent. The thyroid and salivary glands are unchanged. There is degenerative cervical spondylosis without high-grade spinal canal stenosis. There is staphylomatous deformity of the left globe. There is mild mucosal thickening in the left maxillary sinus.

Output: Post-treatment findings without evidence of measurable tumor recurrence in the oral cavity or significant cervical lymphadenopathy. An unchanged small area of enhancement in the right mandible body adjacent to the mandibulectomy site may represent radiation or surgical effects, perhaps with osteonecrosis or inflammation.


Instruction: Generate impression based on findings.

Input: The ventricles and sulci are within normal limits. The cisterns remain patent. There is no midline shift or mass effect. There are no areas of abnormal signal or pathological enhancement. 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.

Output: Unremarkable MRI of the brain.


Instruction: Generate impression based on findings.

Input: 53 year old male with recent diagnosis of pulmonary sarcoidosis, and biventricular dysfunction. Referred for cardiovascular MRI to evaluate for cardiac sarcoid. Left VentricleThe left ventricle is mildly dilated with severely depressed systolic function. There is severe global hypokinesis with systolic and diastolic septal flattening. The overall LV ejection fraction is 17%, the LV end diastolic volume index is 105 ml/m2 (normal range: 74+/-15), the LVEDV is 226 ml (normal range 142+/-34), the LV end systolic volume index is 88 ml/m2 (normal range 25+/-9), the LVESV is 187 ml (normal range 47+/-19), the LV mass index is 79 g/m2 (normal range 85+/-15), and the LV mass is 171 g (normal range 164+/-36). There is late gadolinium enhancement of the inferior RV insertion point. The pattern is well described in patients with pulmonary hypertension. There is also a mid-wall/epicardial stripe of late gadolinium enhancement involving the basal to mid septal wall. The finding is atypical for prior myocardial infarction and suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process. The finding supports the diagnosis of cardiac sarcoidosis but it is unclear whether it represents sarcoid in the inflammatory stage or in the fibrotic stage. Cardiac FDG-PET may be helpful to differentiate these possibilities. No LV apical thrombus is noted.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is severely dilated with severely reduced systolic function. The overall RV ejection fraction is 11%, the RV end diastolic volume index is 179 ml/m2 (normal range 82+/-16), the RVEDV is 384 ml (normal range 142+/-31), the RV end systolic volume index is 159 ml/m2 (normal range 31+/-9), and the RVESV is 341 ml (normal range 54+/-17).Right AtriumThe right atrium is severely dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation. The valve is trileaflet.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is mild pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is at least moderate 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 mildly dilated (34mm).Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsLymph nodes and lung changes consistent with sarcoid noted. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Mild LV dilation with severely reduced systolic function (LVEF 17%).2. Severe RV dilation with severely reduced systolic function (RVEF 11%). Systolic flattening of the interventricular septum suggesting increased RV systolic pressure.3. There is late gadolinium enhancement of the inferior RV insertion point. The pattern is well described in patients with pulmonary hypertension. There is also a mid-wall/epicardial stripe of late gadolinium enhancement involving the basal to mid septal wall. The finding is atypical for prior myocardial infarction and suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process. The finding supports the diagnosis of cardiac sarcoidosis but it is unclear whether it represents sarcoid in the inflammatory stage or in the fibrotic stage. Cardiac FDG-PET may be helpful to differentiate these possibilities. 4. Severe right atrial dilation.5. At least moderate tricuspid regurgitation. Findings discussed with Dr. Estrada.


Instruction: Generate impression based on findings.

Input: Syrinx, 3 month postoperative follow up. There are postoperative findings in the lower thoracic spine region with interval decrease in size of the fluid collection in the surgical bed. There is redemonstration of a multicystic syringohydromyelia that extends from the T9 vertebral level to the T12-L1 level and measures up to 13 x 12 mm, which is unchanged. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The paravertebral soft tissues are unremarkable.

Output: No significant interval change in the multicystic syringohydromyelia in the lower spinal cord.


Instruction: Generate impression based on findings.

Input: 69-year-old female with cirrhosis. Evaluate for hepatocellular carcinoma. ABDOMEN: Examination is limited by lack of contrast enhancement.LIVER, BILIARY TRACT: Cirrhotic morphology of the liver with nodular surface contour. No focal hepatic lesions are identified. Small volume perihepatic ascites is unchanged.Patient is status post cholecystectomy. No significant interval change in the common bile duct dilatation measuring up to 14 mm. There is smooth distal tapering of the common bile duct near the ampulla which may represent a benign structure, measures approximately 7 mm in length. No overt stone or mass is evident. SPLEEN: No significant abnormality noted.PANCREAS: A tiny cystic lesion at the posterior aspect of the uncinate processes most likely a sidebranch IPMN is unchanged. No pancreatic ductal dilatation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is partially imaged nonspecific swirling of the mesenteric vessels as well as mesenteric stranding on this nondedicated examination. Additionally, there is unchanged right posterior peritoneal reflection thickeningBONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Examination limited by noncontrast evaluation. Cirrhotic liver morphology without focal hepatic lesion.2.Stable dilatation of the common bile duct, which may be sequela of cholecystectomy. However, there is a questionable short segment stenosis of the common bile duct near the ampulla, possibly due to benign stricture.3.Nonspecific partially imaged mesenteric vasculature swirling and mesenteric stranding.


Instruction: Generate impression based on findings.

Input: Female, 51 years old, with history of invasive breast cancer, now with contralateral nodal metastases and left arm paresthesias concerning for nerve impingement. Evaluate nerve involvement in the left neck. Bulky left supraclavicular, level four and level five adenopathy is again seen. In aggregate these lesions measure up to 53 mm CC x 50 mm AP x 32 mm TV. These tumors abut the scalene musculature and almost certainly impinge if not encase the brachial plexus. The adjacent paraspinal musculature is edematous.The left jugular vein is compressed by adjacent adenopathy. The arterial flow voids remain visible compatible with patency. More superiorly in the neck, adenopathy is also demonstrated at the left parotid tail. More distally, small enhancing nodular lesions are evident along the neurovascular bundle leading into the left axilla.Please note that a suspected lesion in the left pons seen on the prior CT is not included within the field-of-view of this examination.

Output: Bulky left supraclavicular adenopathy is seen which almost certainly impinges if not encases the left brachial plexus.


Instruction: Generate impression based on findings.

Input: Metastatic papular thyroid cancer with single met to L3 vertebral body. Status post RT. Please assess for progression of disease. Unenhanced CT of thoracic spine:Axial immediate CT images of the entire thoracic spine were obtained. Sagittal and coronal 2-D reformatted images were acquired as well.The bony density in the alignment of the vertebral column is within normal limits. There is no evidence of a sclerotic or lytic changes of vertebral column. No minimal degenerative changes of the thoracic spine are noted. There is no evidence of any perispinal soft tissue abnormality. This examination remains stable since prior study.Unenhanced CT of the lumbar spine:Examination again demonstrates a stable findings of the L3 vertebrae. Subtle sclerotic changes of the L3 vertebrae are similar to prior exam. The exact etiology of this finding is not clear. Possibility of a hemangioma or a metastatic disease should be considered. CT exam is not the appropriate test for definitive diagnosis of metastatic bony lesions. MRI examination is recommended. There is however as mentioned above no change in the size, distribution and pattern of this not a specific L3 vertebrae. This lesion however can be further evaluated with biopsy if patient is unable to obtain an MRI examination.

Output: 1.Unremarkable CT of breath.Stable nonspecific sclerotic changes of L3 vertebrae since prior exam.


Instruction: Generate impression based on findings.

Input: 25 year healthy male presenting with new onset chest pain, found to have elevated biomarkers, cardiac CMR ordered to evaluate for myocarditis or pericarditis. Left VentricleThe left ventricle is mildly dilated with mildly reduced systolic function. There is mild hypokinesis of the basal inferolateral wall. The overall LV ejection fraction is 41%, the LV end diastolic volume index is 112 ml/m2 (normal range: 74+/-15), the LVEDV is 243 ml (normal range 142+/-34), the LV end systolic volume index is 66 ml/m2 (normal range 25+/-9), the LVESV is 144 ml (normal range 47+/-19), the LV mass index is 75 g/m2 (normal range 85+/-15), and the LV mass is 161 g (normal range 164+/-36). There are an atypical pattern of epicardial/ mid-myocardial late gadolinium enhancement that involves the basal to mid inferior wall, basal inferolateral wall, and the apical lateral wall. The basal inferolateral wall has increased T2-signal which suggests the presence of active inflammation/ edema. These abnormalities are highly suggestive of myocarditis and not consistent with myocardial infarction.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 47%, the RV end diastolic volume index is 105 ml/m2 (normal range 82+/-16), the RVEDV is 224 ml (normal range 142+/-31), the RV end systolic volume index is 55 ml/m2 (normal range 31+/-9), and the RVESV is 119 ml (normal range 54+/-17).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 trace 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. The left main and right coronary arteries originate normally from the aortic root.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 mild pericardial enhancement along the basal portion of the heart. A trivial pericardial effusion is noted. Extracardiac FindingsResidual thymus tissue is noted. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Mild LV dilation with mildly reduced systolic function (LVEF 41%) with mild hypokinesis of the basal inferolateral wall.2. There are an atypical pattern of epicardial/ mid-myocardial late gadolinium enhancement that involves the basal to mid inferior wall, basal inferolateral wall, and the apical lateral wall. The basal inferolateral wall has increased T2-signal which suggests the presence of active inflammation/ edema. These abnormalities are highly suggestive of myocarditis and not consistent with myocardial infarction. 3. Normal RV size with mildly reduced systolic function (RVEF 47%).4. Mild pericardial gadolinium enhancement suggestive of mild pericarditis.


Instruction: Generate impression based on findings.

Input: 21 year old male with leg pain. Assess for stress reaction, proximal lateral tibia, distal tibia. There is bandlike signal abnormality within the medial aspect of the proximal tibial epiphysis compatible with a stress fracture. A small amount of fluid signal intensity is seen in the adjacent soft tissues. The bone marrow signal intensity of the remainder of the tibia is unremarkable. The musculature is within normal limits. The bone marrow signal intensity of the fibula is within normal limits. There is minimal bone marrow signal abnormality within the medial aspect of the tibial plateau of the right tibia which may represent a relatively mild stress reaction.

Output: Findings compatible with a stress fracture of the medial tibial condyle as described above.


Instruction: Generate impression based on findings.

Input: Bladder cancer now with pancreatic lesion on recent CT. Further evaluation. ABDOMEN:LIVER, BILIARY TRACT: No suspicious hepatic lesion. No intra or extra hepatic biliary ductal dilatation. The gallbladder is unremarkable.SPLEEN: No significant abnormality noted.PANCREAS: Cystic lesion within the proximal pancreatic body measures 0.8 x 0.6 cm, which is contiguous with the main pancreatic duct (series 9, image 19). A mid body cystic lesion contiguous with the main pancreatic duct measures 1.4 x 1.1 cm. A cystic lesion within the pancreatic head is also contiguous with the pancreatic duct and possibly contains internal septations (series 9, image 16). The pancreatic duct is normal in caliber. No inflammatory changes of the pancreas. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left renal cysts, unchanged. Right kidney is unremarkable. No hydronephrosisRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Anterior abdominal wall scarring. The bowel loops are normal in caliber. No evidence of bowel obstruction or ileus. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Cystic lesions within the pancreatic body contiguous with the pancreatic duct, probably small side branch IPMNs, unchanged since recent CT but new since 2011. Cystic lesion within the pancreatic head is also probably a sidebranch IPMN but contains septations. Follow-up is recommended.


Instruction: Generate impression based on findings.

Input: Stable postsurgical changes of left temporal craniotomy for resection of left temporal lobe metastatic lesion. Marked improvement of surrounding edema. Decrease in size of resection cavity. Minimal enhancement around the resection cavity compatible with treatment change. No evidence of residual or recurrent tumor at the resection cavity. There is no abnormal enhancement within the remainder of the brain to suggest new lesions. There are no masses, mass effect or hydrocephalus. There is no evidence for intracranial hemorrhage or diffusion-weighted abnormalities. Scattered white matter signal abnormality compatible with mild chronic small vessel ischemic disease. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. The orbits are unremarkable.

Output: 1.Evolving post-treatment changes without evidence of residual or recurrent tumor at the left temporal resection cavity. 2.No evidence of new intracranial metastasis.


Instruction: Generate impression based on findings.

Input: Question of high thyroglossal duct cyst on CT. Soft ballotable lesion behind frenulum at root of tongue, non painful. There is no significant narrowing of the trachea or discernible pyramidal lobe. There is globular enhancing tissue in the midline of the posterior root of the tongue that measures up to 15 mm. The thyroid is diffusely enlarged and contains nodules. The left lobe of the thyroid extends inferiorly to the level of the manubrium. There is no evidence of significant cervical lymphadenopathy based on size criteria. The salivary glands are unremarkable. The major cervical flow voids are grossly intact. The imaged orbits and intracranial structures are unremarkable. There is a retention cyst in the left maxillary sinus.

Output: Findings compatible with ectopic lingual thyroid and a multinodular goiter.


Instruction: Generate impression based on findings.

Input: 53 years Male (DOB:8/21/1963)Reason: 3T Scanner, aneurysm surveillance one year, s/p SAH and EVD placement/removal in 2015 History: 3T Scanner, aneurysm surveillance one year, s/p SAH and EVD placement/removal in 2015PROVIDER/ATTENDING NAME: ISSAM A. AWAD ISSAM A. AWAD MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a focus of susceptibility effect present along the central portion of the midbrain which measures approximately 14 x 4 mm axial dimensions on FLAIR imaging. It is stable compared to the prior exam. There is no new extension of this hematoma.A ventriculostomy tract courses through the right frontal lobe into the right lateral ventricle .There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. These are stable compared to the 8/14/2015 exam. Some patchy T2 and FLAIR signal hyperintensities in the brainstem are also stable compared to the prior exam.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. The posterior communicating arteries are not readily identified. The vertebral arteries are similar in size.Incidental note is made of dorsal origin of the left ophthalmic artery from the cavernous segment of the left internal carotid artery.The right v4 segment distal to the origin of the right PICA is hypoplastic.

Output: 1.No evidence for cerebrovascular occlusive disease.2.No evidence for intracranial aneurysm.3.There is a chronic stage hemorrhagic focus present in the midbrain which is stable since last year.4.Periventricular and subcortical white matter signal changes of a mild degree are present which are nonspecific. They could be vascular related, related to demyelination, trauma, vasculitis, or sarcoid. They are nonspecific.


Instruction: Generate impression based on findings.

Input: Male, 35 years old, history right frontal anaplastic astrocytoma status post surgery and radiation therapy, now on temozolamide. Evaluate for tumor growth. Findings are redemonstrated compatible with right frontoparietal craniotomy and tumor resection from the posterior right frontal lobe. The resection cavity and associated parenchymal encephalomalacia are unchanged. Likewise, the extent of T2 hyperintensity within the tissue surrounding the cavity is also unchanged.Mild gyriform T1 hyperintensity is evident along the operative margins. Non-masslike curvilinear enhancement within and along the resection cavity is unchanged. No evidence of any new or suspicious enhancement is seen.Brain morphology and signal characteristics are otherwise unremarkable. No enhancing lesions are detected outside of the resection bed. Ventricles are normal in size and morphology.

Output: Stable post operative and treatment related findings without evidence of progressive disease.


Instruction: Generate impression based on findings.

Input: 47 year-old with strong family history of breast cancer. Benign appearing focal asymmetry was seen in the right breast on the recent mammogram. There is scattered fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: 61-year-old woman with history of pancreatitis, evaluate for CBD stone or mass. ABDOMEN:LIVER, BILIARY TRACT: Scattered simple hepatic cysts noted along with a subcentimeter hemangioma in segment 3. No additional focal lesion identified.There is cholelithiasis with thickening of the gallbladder wall. The common bile duct is borderline enlarged, however there is no obstructing stone or extrinsic mass identified.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Duplicated right renal collecting system. The kidneys and ureters otherwise appear normal.RETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: Small amount of ascites noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Cholelithiasis with gallbladder wall thickening and pericholecystic fluid suggestive of cholecystitis.2.Common bile duct at the limits of normal without obstructing stone or extrinsic mass.3.Simple hepatic cysts and subcentimeter hemangioma.


Instruction: Generate impression based on findings.

Input: Male, 15 years old, status post posterior fossa tumor resection. Evidence of recent occipital craniotomy is again seen for debulking of the cystic and solid posterior fossa tumor. Relative to the preoperative examinations, the dominant cystic portion of the lesion, which sits predominantly at the level of the CP angle cistern, has decreased in size likely representing resection or drainage. For example, the cystic portion now measures up to 33 mm in AP dimension, previously 38 mm. The more solid portion of the lesion, which is situated along the right aspect of the medulla and right foramen of Luschka projecting into the fourth ventricle has also been debulked to some degree. A small amount of T1 hyperintense blood product is evident within this portion of the lesion compatible with recent surgery.Ventriculomegaly appears similar to the prior exam. No evidence of any new supratentorial parenchymal signal abnormality or pathologic enhancement is seen.

Output: Findings compatible with interval debulking of a large cystic and solid posterior fossa pilocytic astrocytoma.


Instruction: Generate impression based on findings.

Input: Clinical question: Rule out hemorrhage. Signs and symptoms: Facial droop. Nonenhanced head CT:There is no detectable acute intracranial process. CT however is insensitive for detection of acute nonhemorrhagic ischemic stroke.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and gray -- white matter differentiation.Unremarkable calvarium and soft tissues of the scalp.Unremarkable orbits.All visualized paranasal sinuses and bilateral mastoid air cells/middle ear cavities are well pneumatized.

Output: Negative nonenhanced head CT.


Instruction: Generate impression based on findings.

Input: History of pancreatic divisum, IPMN and ductal dilatation. ABDOMEN:LIVER, BILIARY TRACT: Unchanged nonenhancing T1 hypointense lesion in the right hepatic dome, likely cyst. The liver is normal in morphology size, signal intensity and enhancement without a focal suspicious lesion biliary ductal dilatation or vascular abnormality. Cholelithiasis within a normally distended gallbladder without evidence of gallbladder inflammation.The common bile duct measures up to 8 mm and tapers smoothly, unchanged.SPLEEN: Normal splenic size without a focal lesion.PANCREAS: Pancreas divisum. The main pancreatic duct measures up to 9 mm at the level of the pancreatic body and head. It tapers smoothly at the level of minor ampulla without a discrete mass. There is mild pancreatic parenchymal atrophy with otherwise normal T1-weighted signal intensity. Pancreatic head/uncinate process cystic focus measures 1.1 x 0.9 cm in the coronal plane. It appears to communicate with the ventral pancreatic duct.No suspicious postcontrast enhancement of the cystic lesion or main pancreatic duct.Following secretin administration there is no significant enlargement of the pancreatic duct, compatible with decreased compliance. However, there is adequate excretory response. No definite side branch ectasia delineated.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable left renal superior pole hemorrhagic cyst with overlying mild cortical scarring. Additional punctate to small to characterize nonenhancing foci.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Descending colon diverticulosis without diverticulitis.BONES, SOFT TISSUES: In the left lower lobe posteriorly there is a 1.6 cm nodule, seen on CT chest dated 6/17/2014 where it was characterized as a hamartoma.OTHER: Cardiomegaly.Unchanged cystic lesion in the right hemipelvis.

Output: 1.Pancreas divisum with main pancreatic ductal dilatation (stable to mildly increased when compared to earlier study) measuring up to 9 mm without suspicious postcontrast enhancement.2.Unchanged 1.1 x 0.9 cm pancreatic head/uncinate process intraductal papillary mucinous neoplasm without suspicious postcontrast enhancement.


Instruction: Generate impression based on findings.

Input: Female, 81 years old, with non-Hodgkin's lymphoma. Surveillance scan. On comparison with the prior examination, continued interval regression is seen of the infiltrative pathologic enhancement and thickening involving the right orbital structures including the superior and lateral recti, the lacrimal gland, and the orbital fat. Minimal residual stranding persists, but there is no longer any definite or significant mass effect on the orbital structures.No additional pathologic enhancement is identified in the orbits or intracranially. Scattered punctate foci of T2 hyperintensity within the bilateral cerebral white matter have not significantly changed from prior and are nonspecific. No evidence of parenchymal edema or mass effect is seen. No intracranial hemorrhage or abnormal extra-axial fluid is seen. The ventricular system is stable and within normal limits for size.

Output: 1.Continued interval regression of an infiltrative lesion involving the structures of the right orbit. There is only minimal residual stranding in the orbit with no evidence of significant mass effect.2.No findings to suggest intracranial disease involvement.


Instruction: Generate impression based on findings.

Input: 29-year-old female patient with chronic right knee pain status post ACL repair and meniscus "buffing". Evaluate for structural knee damage. MENISCI: The medial and lateral menisci are intact.ARTICULAR CARTILAGE AND BONE: The articular cartilage of three compartments is intact. Bone marrow signal is within normal limits.LIGAMENTS: Post-surgical changes of an anterior cruciate ligament repair with intact ACL graft. The posterior cruciate ligament, collateral ligaments, and popliteus tendon are intact.There is globular low signal intensity likely representing fibrous tissue anterior to the ACL graft within the intercondylar notch, which likely represents arthrofibrosis.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: Post-surgical changes of an ACL repair with intact graft and findings consistent with arthrofibrosis.


Instruction: Generate impression based on findings.

Input: The risks (including, but not limited to, those of bleeding, infection, allergic reaction, temporary nerve block, pain, and inability to access the joint) and benefits of the procedure were explained to the patient, and informed written consent was obtained. A pre-procedural “time-out” form was completed.he patient was placed supine on the fluoroscopy table. The right hip was localized fluoroscopically, and a spot radiograph was obtained. The course of the femoral artery was noted on the patient's skin using an ink marker. The skin was cleansed and covered with a sterile drape. The skin and subcutaneous tissues were anesthetized with 1% lidocaine using 25-gauge and 22-gauge needles.Under fluoroscopic guidance, a 20-gauge spinal needle was advanced into the joint. Attempted aspiration yielded no fluid. Next, 10 ml of a 50/50 mixture of Omnipaque 240 (to confirm the intra-articular position of the needle) and dilute Multihance (0.1 cc in a 10 cc vial of Marcaine, for subsequent MR imaging) were injected into the joint. Contrast opacified the joint in the expected manner. A spot radiograph was obtained for documentation. The needle was withdrawn. Blood loss was negligible (<1cc), and patient tolerated the procedure well without immediate complication. An adhesive bandage was placed on the patient’s skin. Routine post procedure instructions were communicated to the patient. The patient was escorted to the MRI suite for further imaging in stable condition. Please refer to the subsequent MRI report for further information.Exposure time: 1:03

Output: Successful right hip injection. MRI arthrogram to follow.


Instruction: Generate impression based on findings.

Input: History of hepatocellular carcinoma in transplanted liver. ABDOMEN: The study is limited by extensive susceptibility artifact from the patient's surgical hardware.LIVER, BILIARY TRACT: Orthotopic liver transplant.A large portion of the liver cannot be evaluated due to susceptibility artifact from the patient's stent.Multiple small liver lesions are again noted some of which demonstrate intrinsic T1 weighted intensity and/or arterial enhancement, some with washout, again suspicious for dysplastic nodules and/or multifocal HCC. The reference segment 5 lesion measures approximately 1 cm (series 12/64). No definite new lesion although evaluation is markedly limited.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: Demonstrated again are bilateral heterogeneous periaortic masses.The right periaortic mass measures approximately 9.8 x 7.4 cm, compared to 9.6 x 7.2 cm previously.The left periaortic mass measures approximately 10.1 x 9.4 cm, compared to 10.2 x 9.3 cm previously.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Ventral midline incisional fat-containing hernia.OTHER: Large right-sided pleural effusion with right lower lobe compressive atelectasis with an enhancing pleural-based nodule measuring approximately 1.6 cm (series 11/29), unchanged.

Output: 1.Essentially stable large masses of periaortic lymphadenopathy.2.The multiple liver lesions are not significantly changed in size or number, and again are suspicious for multiple dysplastic nodules and/or multifocal HCC. Please note evaluation is limited by extensive susceptibility artifact from the patient's IVC stent. Consider CT evaluation on follow-up examinations if more optimal visualization of liver parenchyma, portal veins, and/or hepatic veins would be helpful for clinical care.3.Stable large right-sided pleural effusion and 1.6 cm enhancing pleural nodule.


Instruction: Generate impression based on findings.

Input: 44-year-old male with left shoulder acute injury with pain, limited flexion. Evaluate for left shoulder RC tear. ROTATOR CUFF: There is complete rupture of the subscapularis tendon with retraction of the proximal tendon fibers to the level of the glenoid. There is a tear of the anterior fibers of the supraspinatus tendon in the setting of mild tendinosis. The supraspinatus muscle appears normal. The infraspinatus and teres minor tendons and muscles appear normal.SUPRASPINATUS OUTLET: Note is made of an os acromiale, a normal variant, with associated edema.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint alignment is anatomic. There is a moderate to large joint effusion with debris indicating synovitis. There is degenerative tearing of the glenoid labrum. Mild osteoarthritis affects the glenohumeral joint. There are bone marrow changes likely due to anemia secondary to renal failure.BICEPS TENDON: The long head biceps tendon appears normal.ADDITIONAL

Output: 1. Complete rupture of the subscapularis tendon with retraction to the level of the glenoid. In addition there is a tear of the anterior fibers of the supraspinatus tendon in the setting of mild tendinosis.2. Moderate to large glenohumeral joint effusion with debris indicating synovitis.3. Mild osteoarthritis affects the glenohumeral joint with degenerative tearing of the glenoid labrum.4. Edema within an os acromiale.


Instruction: Generate impression based on findings.

Input: 59-year-old male unresponsive off sedation status post CABG with history of polio. Large, well circumscribed focus of CSF density fluid with adjacent bony remodeling without significant mass effect occupying most of the left hemisphere may be suggestive arachnoid cyst.Multiple, nonspecific areas of low density in the right internal capsule, right basal ganglia and right temporal cortex consistent with acute ischemia. MRI is recommended for further evaluation if clinically warranted.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: Acute right hemisphere stroke as described above.


Instruction: Generate impression based on findings.

Input: History of hepatitis C with lesion in segment 5 on outside MRI. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology, size, signal intensity and enhancement. The T2 weighted hyperintense segment 7 peripheral lesion measures 1.2 cm without evidence of arterial enhancement, restricted diffusion or intracellular fat. There may be a thin enhancing septa within the lesion. The subtraction images are not reliable given the degree of misregistration due to motion. Punctate probable cyst in the right hepatic dome (series 7/27).No biliary ductal dilatation or vascular abnormality.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: The segment 7 1.2 cm lesion (likely corresponding to that reported on outside MR as segment 5 lesion) demonstrates no definite arterial enhancement or other suspicious imaging features. This may represent a septated cyst or fibrosed hemangioma (given the outside hospital ultrasound appearance of an echogenic lesion). Continued follow-up with ultrasound to document stability in 3-6 months is recommended.


Instruction: Generate impression based on findings.

Input: Migraine. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

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


Instruction: Generate impression based on findings.

Input: Dizziness and giddiness [R42] / Headache [R51] / Headache [R51], Reason for Study: ^Reason: investigate CPA, new vertigo History: as above There is no evidence of acute ischemic or hemorrhagic lesion.Scattered T2/FLAIR high signal intensity lesions on bilateral periventricular white matter are nonspecific.The ventricles, sulci and cisterns are unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. Nonspecific FLAIR/T2 high signal intensity white matter lesions. 3. No abnormal enhancement.


Instruction: Generate impression based on findings.

Input: 70 years Male (DOB:10/6/1945)Reason: Eval for signs of meningitis, infection and R/O PRES syndrome due to Tacrolimus History: Intractable Headache, Nausea, VomitingPROVIDER/ATTENDING NAME: MARK F MYREN GABRIEL T SAYER The CSF spaces are appropriate for the patient's stated age with no midline shift. On susceptibility imaging there are multiple punctate foci of signal loss scattered in the cerebellum, subcortical white matter and periventricular white matter. There is also a gyriform component of signal loss and susceptibility imaging in the right frontal gyrus.There is a T2 and FLAIR hyperintense focus measuring 8 mm in size located in the right occipital lobe it involves gray matter. It is not associated with contrast enhancement, susceptibility effect or diffusion restriction.No abnormal enhancing mass lesions are appreciated intracranially. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin.

Output: 1.There is no evidence for intracranial meningitis or abscess and no evidence for posterior reversible encephalopathy syndrome.2.There is a mild to moderate degree of multiple microhemorrhages scattered throughout the brain parenchyma. This is nonspecific. One possibility is it could be related to amyloid angiopathy though it could be related to anticoagulation or other etiologies.3.Findings suggest an old lacunar infarct in the right occipital lobe


Instruction: Generate impression based on findings.

Input: Female, 65 years old, with right L5 radiculopathy. The L5 vertebral body demonstrates a transitional lumbosacral morphology. Vertebral body heights are preserved. Spinal alignment is anatomic.Marrow signal characteristics are heterogeneous, likely representing a combination of scattered hemangiomas and degenerative change. In particular, there is evidence of progressive marrow edema centered at L4-5. Small developing Schmorl's nodes are evident along the superior and inferior endplates of L3. No destructive or aggressive osseous lesions are seen.The visualized distal spinal cord, conus and nerve roots of cauda equina are within normal limits. No epidural abnormalities are seen.L1-2: Unremarkable. L2-3: Facet arthropathy and ligamentum flavum thickening, unchanged. Progressive loss of disc height and T2 signal. Mild progressed disc bulging. Mild generalized spinal canal narrowing. Mild bilateral foraminal narrowing. L3-4: Facet arthropathy and ligamentum flavum thickening, unchanged. Disc bulging, mildly progressed. Moderate generalized spinal canal stenosis with effacement of the left lateral recess and crowding of the cauda equina, progressed. Moderate left and mild right foraminal narrowing, progressed. L4-5: Facet arthropathy and ligamentum flavum thickening, unchanged. Progressive loss of disc height and disc bulging. Mild generalized spinal canal stenosis, progressed. Mild bilateral foraminal narrowing. L5-S1: Facet arthropathy and ligamentum flavum thickening, unchanged. No significant spinal canal or foraminal stenosis.

Output: Multilevel degenerative findings are seen with mild progression at several levels. In particular, the spinal canal is now moderately narrowed at the L3-4 level where it was previously only mildly narrowed.


Instruction: Generate impression based on findings.

Input: 83-year-old male with history of common bile duct dilatation seen on recent CT. ABDOMEN:LIVER, BILIARY TRACT: No intra or extra hepatic biliary ductal dilatation. The common bile duct measures 5 mm. There is a low insertion of the cystic duct.The hepatic vasculature is patent.SPLEEN: No significant abnormality noted.PANCREAS: Findings suggestive of pancreas divisum. No pancreatic ductal dilation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral nonenhancing simple cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No intra or extrahepatic biliary ductal dilation. No suspicious masses.2.Findings suggestive of pancreas divisum.


Instruction: Generate impression based on findings.

Input: 9-year-old male with history of leukemia receiving treatment now with bilateral hip pain, evaluate for avascular necrosis. Right KneeMENISCI: Medial and lateral menisci are intact.ARTICULAR CARTILAGE AND BONE: Small focus of increased edema is seen within the lateral aspect of the lateral femoral condyle (series 701, image 8 and series 1001, image 12). No additional bone marrow signal abnormalities are identified. The articular cartilage appears to be intact. No acute fracture.LIGAMENTS: PCL, ACL, MCL, and LCL are intact. EXTENSOR MECHANISM: Extensor mechanism is intactADDITIONAL

Output: 1. Left knee: Proximal medial tibial metaphysis focus of low signal on T1 is associated with increased signal on T2. These findings are nonspecific but may reflect tibial metaphyseal edema, infarct, or leukemia infiltration. 2. Right Knee: Increased T2 hyperintensity in the right lateral femoral condyle and left medial femoral condyle without associated T1 low signal. These findings are nonspecific, but may reflect edema.


Instruction: Generate impression based on findings.

Input: Evaluate renal cysts and adrenal mass. History of renal cell carcinoma status post partial nephrectomy. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology and size without a focal lesion biliary ductal dilatation or vascular abnormality. Steatosis. Peripheral wedge shaped perfusional anomalies.Status post cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Stable enhancing left adrenal nodule with signal loss on out of phase imaging measuring 1.6 cm.KIDNEYS, URETERS: Postsurgical changes from a right renal inferior pole partial nephrectomy with adjacent susceptibility artifact. No evidence of local residual or recurrent tumor. No regional lymphadenopathy.The renal vein is patent.Several punctate probable right renal cysts are unchanged. Minimally complex cyst with several thin enhancing septations in the left renal upper pole measures 1.9 x 1.9 cm, not significantly changed from prior. RETROPERITONEUM, LYMPH NODES: Shotty retroperitoneal lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Stable examination including a left adrenal nodule, compatible with a lipid-rich adenoma, and bilateral simple and minimally complex cysts.


Instruction: Generate impression based on findings.

Input: Male, 74 years old, with history of petrous apex lesion, sixth nerve palsy. A lobular T1/T2 hyperintense lesion involving the right petrous apex with effacement of the adjacent Meckel's cave has not significantly changed in size or morphology measuring approximately 24 x 17 mm in the axial plane.Likewise, a small enhancing, T1 hypointense lesion occupying the right aspect of the clivus is unchanged in size and morphology measuring 11 x 8 mm in the axial plane.A few scattered small nonspecific white matter T2 hyperintense lesions are evident in the cerebral hemispheres. No parenchymal edema or mass effect is detected. No evidence of significant intracranial hemorrhage or any abnormal extra-axial fluid is seen. Ventricles are stable and normal in size. On postcontrast imaging, no pathologic parenchymal or leptomeningeal enhancement is detected.

Output: 1.No significant interval change in the size or morphology of a T1/T2 hyperintense lesion involving the right petrous apex which may represent a cholesterol granuloma.2.No significant interval change in size or morphology of a nonspecific T1 hypointense enhancing region involving the right clivus.3.No new or acute intracranial abnormalities are detected.


Instruction: Generate impression based on findings.

Input: Sinus/head/facial pain. There are postoperative findings related to bilateral maxillary antrotomies. There is mild to moderate left maxillary sinus mucosal thickening and mild inferior right maxillary sinus mucosal thickening. There is mild scattered ethmoid sinus mucosal thickening. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, mastoid air cells, and scalp soft tissues are grossly unremarkable.

Output: 1. Postoperative findings related to bilateral maxillary antrotomies with scattered paranasal sinus mucosal of thickening.2. No evidence of intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: Female, 65 years old, with hip pain, back pain, suspicion for metastatic cancer. Straightening of the lumbar lordosis is seen. Alignment is otherwise unremarkable. Patchy T1/T2 hyperintensity is seen through the vertebral body marrow. Most of these area suppress on fat suppressed images, and only one small lesion in L3 shows mild central enhancement. A band of strikingly low signal on all sequences is seen in the posterior superior right L2 vertebral body and pedicle. No worrisome spinal or paraspinal enhancement is seen.The visualized spinal cord and conus and cauda equina are unremarkable. L1-2: Unremarkable. L2-3: Mild loss of disk height and mild disk bulging. No significant spinal canal or neuroforaminal stenosis. L3-4: Mild facet hypertrophy. Mild bulging disc. No significant generalized spinal canal stenosis. No significant neuroforaminal narrowing. L4-5: Mild facet hypertrophy. Mild bulging disc with central annular fissuring and perhaps a tiny right paracentral protrusion. No significant generalized spinal canal stenosis. No significant neuroforaminal narrowing. L5-S1: Mild facet hypertrophy. Mild bulging disc with a small left paracentral protrusion. No significant generalized spinal canal stenosis. No significant neuroforaminal narrowing. Small renal cysts are seen.

Output: 1.No evidence of active neoplastic disease in the lumbar spine.2.Patchy areas of marrow T1/T2 hyperintensity most likely represent inhomogeneous fat and/or hemangiomas, including one small lesion with mild enhancement.3.Signal in the right L2 vertebral body and pedicle suggestive of dense sclerosis.


Instruction: Generate impression based on findings.

Input: Female 26 years old Reason: eval pancreas, chronic pancreatitis. Secretin stim test requested please History: pain ABDOMEN:LIVER, BILIARY TRACT: No intra- or extrahepatic biliary ductal dilatation. No gallstones.SPLEEN: No significant abnormality noted.PANCREAS: There is focal persistent restricted diffusion in the distal body and tail of the pancreas with subtle decreased enhancement. Again seen is thickening and loss of the normal fatty invagination. The pancreas demonstrates normal physiologic response to secretin.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: 1.Nonspecific thickening and signal abnormality is again seen involving the distal body and tail of the pancreas. Autoimmune pancreatitis/focal pancreatitis could have this appearance. There is normal physiologic response to secretin.


Instruction: Generate impression based on findings.

Input: 8 years Male (DOB:12/27/2007)Reason: evaluate for tethered cord History: urinary incontinence, small bladder capacityPROVIDER/ATTENDING NAME: ASHLEY A AXDAHL MOHAN S. GUNDETI Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. The prone position the conus medullaris is anteriorly. There is no evidence for fatty filum. The conus medullaris ends at approximately L1.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.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: No compromise to lumbar spinal canal or neural foramina. No evidence for tethered cord


Instruction: Generate impression based on findings.

Input: Questionable fracture of C6, please performed thin cut through C5 through C7 per attending. History of fall.IMAGE ACQUISITIONS: Noncontrast examination of the lower cervical spine was performed with thin cut images. Extensive degenerative changes affect the cervical spine with multilevel neural foraminal compromise. Please see cervical spine MRI for additional detail. Alignment of the cervical spine is anatomic. Linear lucencies traversing the bilateral pedicles of the C6 vertebral body are again noted confirming bilateral pedicular fractures (image 27 and 42 of sagittal series). Again, there is no evidence of malalignment of the pedicles at this level. Please see dedicated cervical spine MRI for additional detail regarding soft tissue injury.

Output: 1. Nondisplaced bilateral C6 pedicular fractures. Please see cervical spine MRI report for additional detail regarding soft tissue injury. 2. Extensive degenerative changes of the cervical spine.


Instruction: Generate impression based on findings.

Input: 69 year old male with history of lung cancer with metastases to the brain and thoracic spine. Patient had multiple new strokes recently. Rule out acute bleed or stroke. Curvilinear high density within the right subinsular cortex surrounded by low attenuation white matter corresponds to region of ischemia on MRI dated 11/5/2008 and likely represents dystrophic calcification within an area of chronic ischemia.There is no evidence of intracranial hemorrhage 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: No acute abnormality. Chronic ischemia within the right subinsular cortex with encephalomalacia and dystrophic calcification.


Instruction: Generate impression based on findings.

Input: 35-year-old with history of melanoma with focal nodular hyperplasia on prior exam. Evaluate for interval change. ABDOMEN:LIVER, BILIARY TRACT: Redemonstration of the patient's known left lobe mass which measures 6.3 x 5.6 cm (series 9 image 65), previously 6.5 x 6.0 cm. There is avid early arterial enhancement with delayed filling of a central scar. The lesion becomes isointense to the background liver and have increased in density on the delayed hepatobiliary phase images. Findings are again compatible with focal nodular hyperplasia.There is an additional lesion in segment 4 which has similar imaging characteristics and is also not significantly changed in size measuring 1.5 x 1.1 cm (series 9 image 62), previously 1.4 x 1.0 cm.There are additional smaller foci of arterial enhancement (series 9 image 65 and series 9 image 69) that appear similar to prior and also likely represent additional small foci of focal nodular hyperplasia. No new suspicious lesions.The liver parenchyma is normal in signal and morphology. The hepatic veins, hepatic arteries, portal 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.Multiple foci of focal nodular hyperplasia which are not significantly changed from prior. No evidence of metastatic disease.


Instruction: Generate impression based on findings.

Input: 74-year-old male with history of bladder cancer. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: A well-circumscribed segment 2/3 lesion measures 20 x 17 mm and demonstrates low T1, high T2, and thick peripheral enhancement with central hypointensity (image 8 of series 6). A similar appearing lesion is present slightly inferiorly in segment 3 measuring 20 x 17 mm (image 10 of series 6). A subcentimeter segment 7 lesion demonstrates high T2 signal and rapid enhancement. Other scattered subcentimeter nonenhancing lesions are present elsewhere in the liver, likely benign.SPLEEN: Small splenule.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Status post right nephrectomy. No evidence of recurrence in the resection bed. Prominent left collecting system. The middle 1/3 of the left ureter is not well visualized, however the remaining ureter is within normal limits.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: 1. No evidence of disease recurrence in the right nephrectomy bed.2. Multiple hepatic lesions are stable dating back to 2011. Some of these lesions have classic imaging characteristics suggestive of hemangioma, while others are indeterminant, but likely benign given long-term stability.


Instruction: Generate impression based on findings.

Input: HPV-positive, T2N2cM1 squamous cell carcinoma of the left tonsil progressed on pembro, Extreme(carbo/5fu/cetux), BKM 120/cetuximab. An occipital brain lesion was treated with SBRT. There is a newly apparent peripherally enhancing lesion in the right perirolandic region that measures up to 7 mm in width. Otherwise, a right occipital lobe enhancing lesion has markedly decreased in size, now measuring 2 mm in width, previously 7 mm. There is no evidence of intracranial hemorrhage or acute infarct. There is scattered cerebral white matter T2hyperintensity, predominantly in a periventricular distribution. 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: 1, A new subcentimeter right perirolandic lesion likely represents a metastasis.2. A right occipital metastatic lesion has markedly decreased in size in response to treatment.


Instruction: Generate impression based on findings.

Input: 63-year-old male with right shoulder pain and decreased range of motion. ROTATOR CUFF: There is thickening and intermediate signal abnormality within the supraspinatus tendon consistent with moderate tendinosis. The supraspinatus and infraspinatus muscles and tendons appear intact. The subscapularis and teres minor muscles and tendons appear intact. SUPRASPINATUS OUTLET: There is a small amount of fluid within the subacromial subdeltoid bursa which may represent a very mild bursitis. Mild degenerative changes affect the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: Mild degenerative changes affect the glenohumeral joint. Evaluation of the glenoid labrum is limited on this non arthrogram study.BICEPS TENDON: There is fluid within the tendon sheath of the long head of the biceps which may represent fluid extension from the glenohumeral joint. ADDITIONAL

Output: 1. Findings suggestive of adhesive capsulitis as described above.2. Tendinosis of the supraspinatus tendon without evidence of rotator cuff tear.


Instruction: Generate impression based on findings.

Input: One month old male with large soft tissue mass on right head and history of sepsis. Examination of intracranial content demonstrates normal morphology and density of brain parenchyma. Cortical sulci, ventricular system and all CSF cisterns remain within normal limits. There is complete opacification of the left middle ear cavity and mastoid air cells. These findings represent otitis media. Right mastoid air cells and middle ear cavity cavity are well pneumatized and are unremarkable.Bony density of calvarium demonstrates some periosteal thickening in the right posterior parietal in region of large soft tissue abnormality of the scalp that was noted on clinical exam. No definitive evidence of abnormal enhancement is detected. No definitive evidence of any cavity formation is present. Although possibility of infection cannot be entirely ruled out possibility an old sub periosteal hemorrhage should also be considered. No definitive evidence of any edematous changes of the adjacent subcutaneous fat is detected. There is no evidence of any abnormality of the inner table of the skull or the marrow space. Further evaluation with an infused MRI is recommended.

Output: 1.Unremarkable CT examination of intracranial content.2.Left otitis media.3.Large low-density mass like lesion involving right posterior parietal scalp with irregularity of the outer cortex and periosteum of the parietal lobe as detailed above.4.Further evaluation with an infused MRI of brain is recommended.


Instruction: Generate impression based on findings.

Input: NF1 with history of brainstem tumor and cerebellar tumor that may be growing slightly, followed at CHOP. There is a T2 hyperintense lesion in the left hippocampus that measures up to 10 mm and a T2 hyperintense lesion in the left medial cerebellar hemisphere that measures up to 6 mm. The brainstem and optic apparatus appear to be unremarkable. There is no evidence of intracranial hemorrhage or acute infarct. There is no abnormal intracranial enhancement. The right lateral ventricle is slightly larger than the left lateral ventricle. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and mastoid air cells are grossly unremarkable. There are a few small enhancing scalp nodules. There is a partially imaged infiltrative and enhancing oral cavity mass.

Output: 1. The T2 hyperintense lesion in the left hippocampus that measures up to 10 mm and a T2 hyperintense lesion in the left medial cerebellar hemisphere that measures up to 6 mm are likely stigmata of neurofibromatosis type 1. The brainstem and optic apparatus appear to be unremarkable.2. A few small scalp nodules likely represent cutaneous neurofibromas.3. A partially imaged infiltrative oral cavity mass may represent a plexiform neurofibroma. Dedicated imaging of this region may be useful for further evaluation.


Instruction: Generate impression based on findings.

Input: 47-year-old female with history of ulcerative colitis status post J-pouch with recent diagnosis of osteomyelitis. Last MRI with osteomyelitis of the coccyx with a sinus tract draining to the left gluteal fold. There is a sinus tract extending from the left gluteal fold towards the coccyx, less prominent when compared to the prior exam (series 8, image 26). Heterogeneous T1 signal in the fifth segment of the coccyx is nonspecific. No convincing abnormal marrow signal. The remainder of the bone marrow signal is unchanged.Partially visualized contents of the pelvis appears similar to the prior exam. Interval decrease in suprasphincteric sinus tract extending from the left lateral aspect of the rectum. Right lower quadrant ostomy. Partially visualized bilateral Tarlov cysts, unchanged.

Output: 1.No convincing evidence of osteomyelitis.2.Interval decreased in size of sinus tract from left gluteal fold. 3.Interval decrease in size of left lateral suprasphincteric rectal sinus tract.


Instruction: Generate impression based on findings.

Input: Female, 38 years old, history of craniopharyngioma status post drainage and radiotherapy in 2016, presenting with confusion and acute left-sided weakness. Evaluate for new lesions, diffusion changes, block to CSF flow. Image quality is degraded by motion artifact on several sequences. Within this limitation, the following observations are made.Redemonstrated is the patient's predominantly cystic and rim-enhancing lesion involving the sella and suprasellar cistern. As before, this lesion encroaches significantly upon the third ventricle, and there is a component of the lesion which projects through the left foramen of Monro into the left lateral ventricle. There has been no interval growth of either the cystic component or of the minimal solid tissue at its caudal aspect. However, there is a new fluid-fluid level layering dependently within the cystic component of the lesion.The left lateral ventricle remains significantly dilated and on close comparison with the prior examination the degree of dilatation has likely progressed by several millimeters. Dilatation has more clearly progressed when compared to older exams. In addition, there is progressive T2/FLAIR hyperintensity along the margins of the left lateral ventricle. The right lateral ventricle is compressed but shows slight increased caliber relative to the prior examination. The fourth ventricle is normal.No restricted diffusion is seen. No new intracranial lesions are detected. There is no evidence suggest acute intracranial hemorrhage.

Output: Although the patient's predominantly cystic craniopharyngioma shows no significant or gross interval change in size, there is a new fluid-fluid level layering dependently within the cystic component. This could represent layering proteinaceous debris or blood product.As on prior examinations, the lesion significantly encroaches upon the third ventricle and projects through the left foramen of Monro into the left lateral ventricle likely causing obstruction. The left lateral ventricle is dilated and this has worsened over multiple prior examinations. Periventricular signal abnormality around the left lateral ventricle has also increased likely representing transependymal CSF flow.


Instruction: Generate impression based on findings.

Input: Male; 52 years old. Reason: MRi prostate History: MRI prostate PELVIS:PROSTATE:Prostate Size: 2.5 x 4.5 x 4.5 cm.Peripheral Zone: Post ablation changes in the left mid peripheral zone are again seen.Central Gland: Heterogeneous with stable ill-defined hypointense signal of unknown etiology.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: None.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: Small fat-containing right inguinal hernia.OTHER: No significant abnormality noted.

Output: No significant interval change with post ablation changes again seen in the left mid peripheral zone.


Instruction: Generate impression based on findings.

Input: Diagnosis: Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with complex partial seizures, not intractable, without status epilepticusClinical question: h/o epilepsy s/p laser ablationSigns and Symptoms: surveillance of ablated area The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a focus of heterogeneous signal abnormality located in the right hippocampus which is associated with a ringlike pattern of susceptibility effect.There are linear foci of susceptibility effect along tracts of the previously placed electrodes coursing through the right occipital lobe and right lateral ventricle as well as through the right temporal lobe.. There are associated burr holes at the entry point of these probes.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.A focus of ablation is present in the right hippocampus.2.There are expected post treatment changes present as detailed above.


Instruction: Generate impression based on findings.

Input: The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain. Prominent adenoids and posterior cervical adenopathy is felt to be reactive.Images of the internal auditory canals demonstrate the seventh and eighth nerves to be normal in size and symmetric bilaterally without masses or enhancing lesions along the course of these nerves or in the cerebellopontine angle cisterns bilaterally. The inner ear structures are normal in appearance and symmetric bilaterally without congenital inner ear anomalies identified on either side. There are no vascular anomalies.

Output: Negative MRI of the brain and internal auditory canals including gadolinium enhancement. Specifically, there no MRI findings to explain the patient's sensorineural hearing loss.


Instruction: Generate impression based on findings.

Input: Reason: 61-year-old female with lower extremity weakness and numbness with upgoing babinski for several months, history of ALL. There continues to be no nodular enhancement involving the conus or cauda equina nerve roots. An isolated right-sided linear enhancing structure represents a congenital radicular vein. There remains minimal enhancement of cauda equina nerve roots which again are enhancing less so compared to the previous exam. These findings are nonspecific but may represent an inflammatory process. The conus medullaris shows normal signal. Alignment is notable for unchanged minimal retrolisthesis of L1 relative to L2 which is associated with desiccation and mild disc height loss. The other intervertebral discs are preserved in height. The vertebral bodies are preserved in height. There is no significant neuroforaminal or spinal canal stenosis. The bone marrow signal is preserved. There are changes of presumed bone marrow biopsies in the posterior iliac bones. These findings are unchanged.

Output: There continues to be no nodular enhancement involving the conus or cauda equina nerve roots. An isolated right-sided linear enhancing structure represents a congenital radicular vein. There remains minimal enhancement of cauda equina nerve roots which again are enhancing less so compared to the previous exam.