Instruction: Generate impression based on findings.

Input: 40 year-old female with history of grade 2 meningioma status post resection x 2 and radiation therapy, surveillance imaging. Redemonstrated are postoperative findings related to right frontal craniotomy and partial resection of the right frontal lobe, such that the resection cavity communicates with the right lateral ventricle. There is diffuse thickening and enhancement of the dural deep to the craniotomy, which is unchanged. There are also postoperative findings related to left frontotemporal craniotomy. There is an enlarging focus of T2 hyperintensity along the medial aspect of the surgical cavity measuring up to 8 mm in maximal dimension (previously 4 mm) which is nonenhancing (best seen on image 22 series 601). The remaining previously demonstrated confluent T2 hyperintensity surrounding the resection cavity, as well as areas of cystic encephalomalacia in the remaining portions of the right frontal lobe, are unchanged. There is no evidence of acute intracranial hemorrhage or acute infarct. The skull and extracranial soft tissues are unchanged.

Output: There is an enlarging focus of T2 hyperintensity along the medial aspect of the surgical cavity measuring up to 8 mm in maximal dimension (previously 4 mm) which is nonenhancing and of uncertain clinical significance. The remaining extensive post-treatment findings are stable in appearance.


Instruction: Generate impression based on findings.

Input: Female 50 years old; Reason: pre-EGD/biopsy of GEJ mass at OSH. 50F with h/o L RCCA s/p nephrectomy. Requested by Interventional GI (contact p7943) History: worsening pain mid-chest and dysphagia CHEST:LUNGS AND PLEURA: No pleural effusions.MEDIASTINUM AND HILA: Left para-aortic lymph node measuring 1.3 x 1.3 cm (image 17/series 501). CHEST WALL: Surgical changes above the xiphoid process.ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. There are postsurgical changes in the caudate. There is a new poorly enhancing lesion within the right hepatic lobe measuring 0.8 x 0.8 cm (image 12/series 2605), suspicious for metastatic disease. There is mild intrahepatic delayed ductal dilatation. Gallbladder is unremarkable.The hepatic and portal veins are patent.SPLEEN: The spleen is absent.PANCREAS: The pancreatic body and tail are severely atrophic. This is possibly due to radiation. Pancreatic duct is mildly prominent but not dilated.ADRENAL GLANDS: Right adrenal gland is unremarkable. Left adrenal gland has been resected.KIDNEYS, URETERS: Status post left nephrectomy. Right kidney is unremarkable.RETROPERITONEUM, LYMPH NODES: There postsurgical changes near the gastroesophageal junction.BOWEL, MESENTERY: Diffuse circumferential wall thickening of the distal esophagus near the GE junction. There is also thickening of the gastroesophageal junction. This is in the region of prior nodal tumor. There is focal soft tissue thickening involving the gastric wall near the fundus about the gastroesophageal junction measuring 2.3 x 2.1 cm (image 308/series 2101). No bowel obstruction.BONES, SOFT TISSUES: Postsurgical changes in the intra-abdominal wall and chest wall.OTHER: No upper abdominal fluid collections.

Output: 1.Findings of diffuse distal esophageal wall thickening with a soft tissue nodule measuring 2.3 cm in the adjacent gastric wall. This is located in the site of prior nodal disease and likely represents recurrent disease.2.No esophageal obstruction.3.Subcentimeter right hepatic lobe metastases.4.Enhancing nodule adjacent to the aorta in the mediastinum. Likely represents mediastinal nodal metastases


Instruction: Generate impression based on findings.

Input: History of pancreatitis of unclear etiology. Evaluation somewhat limited by incomplete examination due to early termination by patient.ABDOMEN:LIVER, BILIARY TRACT: Within the constraints of limited sequences, no focal hepatic lesions are identified. There is no biliary ductal dilatation. The gallbladder is minimally distended but lacks gallstones or evidence of cholecystitis.SPLEEN: No significant abnormality noted.PANCREAS: The pancreas appears edematous with loss of normal peripheral lobulations compatible with acute pancreatitis. A small amount of fluid is present surrounding the pancreas extending into the left greater than right perinephric spaces. No loculated fluid collections are identified. Portions of the pancreatic duct are not well visualized, but the visualized portions do not appear significantly dilated. No obstructing stones or lesions are identified on this limited examination.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter left renal cyst.RETROPERITONEUM, LYMPH NODES: Small amount of fluid surrounding the pancreas extending into the left greater than right perinephric spaces.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Trace left pleural effusion.

Output: 1.Exam was terminated early by patient and is limited.2.Acute pancreatitis. 3.No significant pancreatic ductal dilatation. Portions of the pancreatic duct are not well visualized which may be secondary to the pancreatitis. 4.Within the limitations of limited sequences and lack of intravenous contrast, no pancreatic mass or obstructing lesions are identified.


Instruction: Generate impression based on findings.

Input: Ankle pain TENDONS: No significant abnormality noted.LIGAMENTS: No significant abnormality noted.ARTICULAR SURFACES AND BONE: There is cortical irregularity and underlying marrow edema involving the medial tibial plafond. Small amount of increased marrow signal is also seen along the lateral talus. The talar dome is intact.ADDITIONAL

Output: Marrow edema and irregularity involving the medial tibial plafond without a discrete fracture line identified. Findings may relate to stress injury or prior impaction injury. The talar dome appears normal.


Instruction: Generate impression based on findings.

Input: Fall. History of agenesis of the corpus callosum and subdural hemorrhage. There is motion artifact at the convexities, however within this limitation there is stability in size (12 mm coronally) of the evolving left subdural hematoma which was first documented on the MRI performed 8/20/2013. There has been partial resolution of the previously described right parasagittal subdural hematoma. There are stable bilateral prominent CSF attenuating fluid collections. There are no new extra axial fluid collections identified.Previously described findings representing complete agenesis of the corpus callosum are stable. No new intracranial masses, mass effect including midline shift or CT evidence of acute hydrocephalus. Ethmoid air cells are aerated and maxillary sinuses are partially aerated. Sphenoid are opacified, as is appropriate for the patient's age. Mastoid air cells are unremarkable. There are no visualized bony abnormalities.

Output: 1.Stable evolving left subdural hematoma.2.Interval partial resolution of a right parasagittal subdural hematoma.3.Stable findings representing complete agenesis of the corpus callosum.4.Stable CSF attenuating extra-axial fluid collections bilaterally.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for lesion, hydrocephalus, review CT report from 9-18-15 signs and symptoms: Status post fall, generalized weakness and lethargy. Nonenhanced brain MRI:No acute intracranial process and negative diffusion weighted images.As was noted on prior head CT this examination demonstrates fairly extensive periventricular and subcortical confluent FLAIR hyperintensity of white matter as well as large focus of cortical, subcortical and basal ganglia FLAIR hyperintensity involving extensively the left temporal and frontal lobes. Findings are believed to represent advanced chronic nonhemorrhagic small vessel ischemic strokes as well as a large left MCA territory chronic ischemic stroke. There is resultant ex vacuo dilatation of the lateral ventricles (L>R) as well as bilateral sacral cortical sulci.Images through posterior fossa are unremarkable.The signal void of major intracranial arterial branches are identified. There is anatomical variation of a partially empty sella.The signal intensity of intracranial venous sinuses are within normal.Unremarkable calvarium however with evidence of a prior left-sided remote craniotomy.Unremarkable images through the orbits, paranasal sinuses and mastoid air cells..

Output: 1.No acute intracranial process and negative diffusion weighted series.2.Extensive bilateral hemispheric white matter and to a lesser degree of bilateral basal ganglia highly suggestive of chronic nonhemorrhagic advanced small vessel ischemic strokes. Large focus of encephalomalacia involving left temporal and frontal lobe highly suggestive of a large chronic nonhemorrhagic ischemic stroke in the left MCA territory.3.Constellation of above changes results in ex vacuo dilatation of lateral ventricles and the cortical sulci.4.Evidence of prior remote left sided craniotomy.


Instruction: Generate impression based on findings.

Input: 47-year-old female with history of NASH cirrhosis. Evaluate for hepatocellular carcinoma. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology without evidence of suspicious arterial enhancing and washing out lesion.SPLEEN: Splenomegaly.PANCREAS: Persistent prominent pancreatic duct with numerous T2 hyperintense foci scattered throughout the pancreas, which is not significantly changed. The largest is 9 mm in the pancreatic tail.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Stable mildly prominent retroperitoneal and portacaval lymph nodes, likely sequela of cirrhosis.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Sequela of cirrhosis without evidence of arterially enhancing and washing out lesions to suggest hepatocellular carcinoma.2.Numerous nonspecific pancreatic cysts persist.


Instruction: Generate impression based on findings.

Input: There is a smooth, physiologic thoracic kyphotic curve. The vertebral body heights and disc spaces are maintained. Marrow signal intensity is benign throughout. The spinal cord has a smooth contour and is without focal atrophy, edema, abnormal enhancement, or myelomalacia. A T2 hyperintense dermal lesion is seen posterior to the level of T3 with peripheral enhancement. This is favored to represent a sebaceous cyst.A 2.4 cm left lower lobe mass is again seen adjacent to the level of T6. Enhancing left pleural nodularity is again noted. There is a small left pleural effusion.There is no central canal or neural foraminal narrowing.T7/8 demonstrates mild loss of disc height with a right paracentral disc bulge.There is mild disc desiccation at T8-9Minimal disc bulge is seen at T10-11.

Output: 1.Mild degenerative changes of the lower thoracic spine without central canal or neural foraminal narrowing.2.No significant change in left lung/pleural metastatic disease.3.Small left pleural effusion.


Instruction: Generate impression based on findings.

Input: Diagnosis: Secondary malignant neoplasm of brain and spinal cordClinical question: 74 yo F with metastatic melanoma to brain, eval for recurrence, prior SRS to L frontal resection cavity There is a focus of encephalomalacia associated with susceptibility effect located in the left frontal lobe. The patient is status post left frontal craniotomy.There is redemonstration of a 5 mm focus of enhancement along the anterior and medial aspect of the left temporal lobe at the anterior aspect of the fusiform gyrus which was also present on the prior exam and is unchanged.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.There is a small left temporal lobe lesion at the anterior aspect of the fusiform gyrus present which is fairly stable compared to the prior exam and compatible with metastasis.2.There is encephalomalacia in the left frontal lobe associated with some blood products at the prior surgical bed. There is no evidence for local recurrence.3.Examination was performed for purpose of treatment planning for stereotactic radiosurgery.


Instruction: Generate impression based on findings.

Input: Reason: 58 yo male w hx of prostate cancer scheduled for RALP, evaluate for nerve sparing. Patient with prostate adenocarcinoma of the left apex (Gleason 3+4), right mid gland (the Gleason 3+4), right apex (Gleason 3+4). PELVIS:PROSTATE:Prostate Size: The prostate measures 3.2 cm in transverse, 2.3 cm in AP, and 2.9 cm in craniocaudal diameter.Peripheral Zone: Diffuse hypointense T2 signal intensity.Central Gland: In the anterior-lateral right apex, there is a dominant lesion measuring 1.1 x 0.5 cm with T2 and ADC hypointense signal intensity (axial series 901 image 16, axial series 503 image 284). The tumor abuts the capsule for approximately 11 mm, however no obvious extracapsular extension is identified.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: As above.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Dominant lesion in the anterior-lateral transitional zone abutting the capsule and without obvious extracapsular extension.


Instruction: Generate impression based on findings.

Input: Reason: Assess pituitary microadenoma History: blurry vision, dizziness, falls, Please note that contrast-enhanced sequences were not obtained due to patient's GFR.Lesion within the right aspect of the pituitary seen on prior exams is decreased in size measuring 0.9 x 0.6 cm (501/8) as measured on T2 sequences, compared with 1.4 x 1.1 cm previously. No significant mass effect on the chiasm. No carotid encasement. The adjacent cavernous sinuses appear normal. Nonspecific T2 hyperintensities in the frontal subcortical white matter are unchanged. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation.

Output: Pituitary lesion is decreased in size.


Instruction: Generate impression based on findings.

Input: Unspecified convulsions [R56.9], Reason for Study: ^Reason: r/o focal lesion History: focal seizure with right arm shaking Multifocal scattered restricted diffusion areas on bilateral hemispheres including right frontal lobe, right parietal lobe, right temporal lobe, posterior aspect the right insular cortex, and left parietal lobe. In particular, the right frontal lobe superior frontal gyrus and pre-central gyrus as well as cortex of the right post-central gyrus show susceptibility effects indicate hemorrhagic transformation.Cortical and subcortical gyriform and somewhat nodular enhancement of ischemic lesions demonstrate luxury perfusion.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: Multifocal bi-hemispheric acute ischemic infarctions with hemorrhagic transformation as described above.No abnormal enhancing mass lesion was found.


Instruction: Generate impression based on findings.

Input: 14 years, Male, severe frontal and at times occipital headache. Please evaluate for malformation of craniocervical junction and also for intracranial abnormalities. There is caudal descent of the cerebellar tonsils which measure up to 11 mm below the foramen magnum on the right and up to 7 mm on the left. There is mild crowding at the foramen magnum with partially diminished CSF spaces ventrally and dorsally. Cerebellar tonsils demonstrate a slightly elongated configuration. CSF flow sequence demonstrates present biphasic ventral and dorsal CSF flow, although mildly diminished posteriorly.No parenchymal signal abnormalities are seen. No intracranial mass. No midline shift or herniation. Ventricles are normal in size without evidence of hydrocephalus. No evidence of hemorrhage or ischemia. Major flow-voids are preserved. Bone marrow signal and extracranial soft tissues are grossly unremarkable. No syrinx is evident in the visualized cervical cord. Minimal T2 hyperintensity at the mid C2 level on the sagittal FIESTA sequence series 12 image 71 may be artifactual and not corroborated on additional sequences. Dedicated cervical spine MRI can be considered.

Output: 1. Findings compatible with a Chiari I malformation. CSF spaces and CSF flow are mildly diminished at the foramen magnum. Brain parenchyma appears otherwise unremarkable. 2. Dedicated spine imaging may be considered to assess for syrinx.


Instruction: Generate impression based on findings.

Input: Female, 15 years old, with left occipital simple partial seizures, right inferior quadrantanopsia, fluctuating area of left T2/FLAIR hyperintensity reported and MRIs. Again seen is ill-defined T2 hyperintensity involving the left paramedian occipital lobe cortex and subcortical white matter. No parenchymal destruction or significant distortion is seen. No associated pathologic enhancement is detected.The extent of this abnormality appears approximately similar to that seen on 08/10/16. It is noted, however, that over the patient's multiple prior examinations, the intensity of the signal has fluctuated. Single and multi voxel short TE spectroscopy was performed over the lesional tissue and compared to areas of normal parenchyma. The lesional tissue demonstrates significant reduction in the NAA peak, very slight elevation of the choline peak, and perhaps minimally elevated lipid relative to normal appearing parenchyma.Redemonstrated is evidence of ex vacuo dilatation of the left frontal horn which largely reflects loss of the caudate nucleus. No other significant areas of signal abnormality or parenchymal lesions are seen. No evidence of intracranial hemorrhage or any abnormal extra-axial fluid collection is detected. Except as above the ventricular system is within normal limits.

Output: Redemonstrated is ill-defined T2 hyperintensity involving the cortex and subcortical white matter of the left paramedian occipital lobe. No focal or masslike lesion is seen. MR spectroscopy demonstrates reduced NAA which generally reflects neuronal injury or loss, as well as a mild elevation of choline and perhaps minimally elevated lipid which are nonspecific findings. There are no features to suggest a high-grade neoplastic process.This type of ill-defined signal abnormality can be seen in parenchyma which has sustained severe prolonged seizure activity. In this scenario, the findings are considered to be the result of the seizure rather than the cause. As to the actual underlying cause, no definite or specific findings are seen. The differential would include inflammation from an infectious, inflammatory or autoimmune etiology; a subtle cortical dysplasia; gliosis from prior insult or injury; or perhaps a very subtle low-grade neoplastic process.Also noted is chronic loss of the left caudate nucleus which results in ex vacuo dilatation of the left frontal horn. This is of uncertain etiology but could indicate a remote ischemic insult, potentially even prenatal or perinatal.


Instruction: Generate impression based on findings.

Input: Female, 10 years old, with sellar mass. Presurgical planning exam. A large mixed cystic and solid, inhomogeneously enhancing mass is evident involving the sella and suprasellar cistern. Areas of low T2 signal within the lesion and around the periphery of the lesion likely reflect calcifications noted on outside CT. The lesion abuts and may slightly narrow the ICAs, but the major intracranial vascular flow voids are preserved. The lesion splays the optic apparatus and cerebral peduncles. The lesion invaginates into the region of the third ventricle which is deformed as a result. The lateral ventricles and fourth ventricle are normal in size. Crescentic T2 hyperintensity is seen within the left basal ganglia. Incidentally noted is a developmental venous anomaly which traverses the left cerebral hemisphere.

Output: Large cystic and solid inhomogeneously enhancing mass involving the sella and suprasellar cistern.The lesion exerts significant mass effect upon the optic apparatus and cerebral peduncles.Curvilinear T2 hyperintensity within the left basal ganglia could represent edema or an ischemic lesion.


Instruction: Generate impression based on findings.

Input: Female 55 years old restaging cervical cancer prior to brachytherapy. PELVIS:UTERUS, ADNEXA: There is a large heterogeneous cervical mass best seen on T2 weighted images, it measures 2.9 x 2.7 x 3.6 cm (series 601, image 46 and series 401, image 35). It demonstrates heterogeneous enhancement, evidence of parametrial extension particularly on the left, and extension into the lower aspect of the uterus. The endometrial canal is fluid-filled, likely due to to obstruction from the mass.The adnexa are unremarkable.BLADDER: No significant abnormality noted.LYMPH NODES: A right external iliac lymph node measures 1.4 x 0.8 cm (series 804, image 549) and is indeterminate but suspicious for metastasis.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No hydroureter.

Output: 1.Large cervical mass with parametrial extension.2.Right external iliac lymph node is indeterminate but suspicious for metastasis.


Instruction: Generate impression based on findings.

Input: Female 45 years old Reason: Rectal cancer please assess and evaluate extent of disease prior to start of therapy. Please follow protocol IRB # 14-0288. Additional history per electronic medical record: patient underwent colonoscopy which showed a 6mm sessile polyp in the rectum as well as a 60% circumferential friable, nodular, ulcerated mass about 3 cm from the anal verge. Biopsies confirmed moderately differentiated adenocarcinoma which was microsatellite stable. The other polyp was tubular adenoma. EUS showed a fungating mass beginning at the anal verge and extending 4 cm cephalad with probable invasion into sphincter muscle. This was uT3N0. Overall image quality: ExcellentPELVIS:UTERUS, ADNEXA: Uterine fibroids. Normal variant nabothian cysts. The ovaries appear within normal limits.BLADDER: No significant abnormality noted. LYMPH NODES: Lymph nodes in the perirectal space, within the mesorectal fascia: Several subcentimeter lymph nodes are present within the perirectal space, at least one of which on the left abuts the mesorectal fascia (series 4, image 24).Lymph nodes outside the mesorectal fascia: Several subcentimeter internal iliac and pelvic sidewall lymph nodes the largest of which is on the left and measures 6 mm in short axis (series 4, image 17).BOWEL, MESENTERY: Rectal Tumor:Size: 1.3 cm AP x 2.7 cm TR x 5.0 cm CC (series 4, images 36 and 37; series 3, image 22)Tumor appearance on T2-weighted images: Iso to hyperTumor location: Involving the lower rectum as described below.(For lower rectal tumors):Distance of the lower edge of the tumor to the anal verge (lower edge of the anal canal): 2.1 cm.Circumference of the rectum involved: Near circumferential.Relationship and proximity of the tumor to adjacent structures (uterus, cervix, vagina): There is possible focal invasion of the perineum/vagina anteriorly less than 5 mm.MRI T-stage: T3a - Tumor invades < 0.5cm into perirectal fat or extramural. Please refer to key images.Tumor Distance to Mesorectal Fascia: The tumor is located in the low rectum and abuts the external sphincter, right greater than left.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Trace ascites.

Output: Findings compatible with rectal cancer involving the lower rectum with suspected focal extraserosal invasion, please see details above.


Instruction: Generate impression based on findings.

Input: 17 year-old female status post trauma. Images through posterior fossa are unremarkable.Images through the supratentorial brain parenchyma demonstrates a subtle area of low attenuation in the periventricular white matter of the left parietal lobe. This is not associated with any additional areas of edema, hemorrhage, mass-effect, midline shift or hydrocephalus. This finding is not believed to be secondary to trauma. The exact nature of the finding is not clear and further evaluation with an MRI is highly recommended. This finding is best demonstrated on axial images 15 through 19. To exclude the possibility of a mass and MRI is recommended.Calvarium, soft tissues of the scalp, mastoid air cells and visualized portions of the paranasal sinuses are unremarkable.The above findings were relayed to Dr. Jeff Frank at the time of interpretation.

Output: 1.No definitive evidence of post traumatic findings.2.Focal area of low-attenuation in the periventricular white matter of the left parietal lobe which is non specific and nonhemorrhagic and does not appear to be a post traumatic finding. Further evaluation with an MRI is highly recommended.


Instruction: Generate impression based on findings.

Input: Reason: hx crani for tumor (meningioma). Yearly follow up for recurrence or change History: none- surveillance. Numerous supratentorial dural based extra-axial lesions consistent with meningiomas are again seen and measured on 3-D postcontrast T1 sequences. Tumors along the falx measure 1.4 x 0.8 cm, 1.2 cm, and 0.7 cm compared to 1.3 x 0.8 cm, 1.1 cm, and 0.6 cm respectively on the prior exam. Smaller lesions along the falx are also noted. A lesion along the right paramedian occipital and posterior parietal lobes measures 1.9 x 1.2 cm, previously 1.8 x 1.2 cm on the prior exam and extends into the superior sagittal sinus with invasion. A lesion along the right posterior frontal lobe measures 1.6 x 1.4 cm, previously 1.3 x 1.1 cm on the prior exam and 1.2 x 1.1 cm on the exam of 8/15/2013. A lesion along the right temporal lobe measures 0.9 x 0.7 cm, previously 0.8 x 0.7 cm. No new lesions are identified. There is a 4 mm focus of enhancement in the left internal auditory canal which may represent a vestibular schwannoma.Postsurgical changes of right-sided craniotomy. Underlying foci of encephalomalacia in the right posterior parietal lobe and right frontal lobe appear similar to the prior exam without evidence of local tumor recurrence. Areas of FLAIR hyperintensity which remain unchanged including surrounding the resection cavity are compatible with gliosis. There is FLAIR hyperintensity associated with the right frontal convexity lesion which is slightly increased compared to prior studies and likely represents mild vasogenic edema. 6 mm focus of susceptibility with associated increased T2 signal in the right posterior temporal lobe is unchanged in size since 2009. Additional punctate focus of susceptibility in the left occipital lobe is unchanged. No hydrocephalus or extra-axial collections. Remainder of the calvarium and extracranial soft tissues are unremarkable.

Output: 1.Multiple meningiomas are minimally increased in size as detailed above. Mild enlargement is relatively more notable of the lesion along the right frontal convexity which measures 1.6 x 1.4 cm, previously 1.3 x 1.1 cm on 8/14/2014 and 1.2 x 1.1 cm on the exam of 8/15/2013.2.Posttreatment changes including prior craniotomies and areas of FLAIR hyperintensity largely representing gliosis. There is FLAIR hyperintensity associated with the right frontal convexity lesion which likely represents mild vasogenic edema associated with the adjacent meningioma and minimally increased since prior studies from 2014 and 2013. No midline shift or herniation.3.6 mm focus of susceptibility with T2 hyperintensity in the right posterior temporal lobe is unchanged since 2009 and favored to represent a cavernous malformation. 4.4 mm focus of enhancement in the left internal auditory canal may represent a vestibular schwannoma and remains unchanged.


Instruction: Generate impression based on findings.

Input: 71-year-old female with history of ovarian cancer. Known liver lesions causing biliary obstruction, stent placement on 11/10/08. Now has increased pain and worsening LFTs. Rule out pneumobilia. Evaluate for stent obstruction. ABDOMEN:LUNG BASES: There are small bilateral pleural effusions, unchanged.LIVER, BILIARY TRACT: Redemonstration of multiple solid hypodense lesions. Reference right hepatic lesion is stable measuring 3.5 x 3.2 cm on image 32/96. There an internal biliary stent but no pneumobilia. The intrahepatic portions of metallic stents are in the posterior segment of the right hepatic lobe and anterior segment of the right hepatic lobe. Distal metallic stents are in the duodenum. Contrast noted previously in the anterior segment of the right intrahepatic ducts is not seen. Persistent left intrahepatic ductal dilatation is unchanged. Interval increase in the right-sided intrahepatic ductal dilatation.Gallbladder is surgically absent. Tumor invasion in main portal vein as seen on MRI is redemonstrated (series 4, image 39/96)SPLEEN: Calcified splenic granulomata are unchanged. Large metastatic lesion in the spleen measuring 5.7 x 5 cm on image 25/96 is unchanged.PANCREAS: Mild pancreatic ductal dilatation in the pancreatic head is unchanged.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Reference lymphadenopathy encasing hepatic artery in the porta hepatis is grossly unchanged, measuring 2.5 x 1.7 cm image 39/96. There is new small amount of fluid in the hepatoduodenal ligament. There is thin, curvilinear fluid noted in medial segment of the second portion of duodenum. Adjacent inflammatory fat stranding in the second and third portions duodenum is noted. No free air is seen. Findings suggest inflammatory change from instrumentation without complete perforation.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: 1) Stable internal biliary stent location with interval increase in right intrahepatic biliary dilatation and persistent left intra-hepatic biliary dilatation and decreased pneuomobilia suggests stent occlusion. 2) Stable inflammatory change and wall edema in second portion of duodenum from recent ERCP, but no free air is seen to suggest duodenal perforation.3) Stable small bilateral pleural effusions.


Instruction: Generate impression based on findings.

Input: 61-year-old male with right shoulder pain for 6 months, no improvement with injection ROTATOR CUFF: There is partial articular sided tear of the anterior distal supraspinatus, which measures approximately 9 mm in AP dimension. No fluid is noted within the subacromial- subdeltoid bursa. There is no muscular atrophy. The remaining rotator cuff tendons and muscles are intact.SUPRASPINATUS OUTLET: Moderate acromioclavicular joint osteoarthritis.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is globular increased signal within the anterior labrum consistent with degeneration. No fluid-filled defect is identified.BICEPS TENDON: The biceps tendon is intact and normally situated within the bicipital groove.ADDITIONAL

Output: 1. Partial articular sided tear of the anterior distal supraspinatus tendon.2. Degeneration of the anterior labrum without evidence of tear.3. Degenerative arthritic changes as described above.


Instruction: Generate impression based on findings.

Input: 71-year-old female patient with history of severe chronic abdominal pain and question of ampullary mass seen on previous imaging. Previous EGD/EUS revealed no ampullary or pancreatic pathology. Three-month follow-up examination. ABDOMEN:LIVER, BILIARY TRACT: Moderate intrahepatic biliary ductal dilatation, more pronounced on the left side, is similar to the prior study. The common bile duct is prominent in diameter, however, no definite obstructing mass is identified. No suspicious hepatic lesion is seen. The gallbladder is absent.SPLEEN: No significant abnormality noted.PANCREAS: The pancreatic duct is slightly beaded in appearance. The pancreas demonstrates diminished T1 hyperintensity with atrophy of the body and neck compatible with chronic pancreatitis. Scattered subcentimeter cystic foci within the pancreas are compatible with sidebranch IPMNs. No suspicious pancreatic mass or ampullary mass is identified.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: A minimally complex septated right renal cyst is stable. Probable subcentimeter left renal cysts. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: L1 hemangioma. OTHER: No significant abnormality noted.

Output: 1. Stable biliary ductal dilatation without evidence of an obstructing lesion or ampullary mass.2. Scattered cystic pancreatic lesions compatible with sidebranch IPMNs.3. Imaging findings compatible with chronic pancreatitis.


Instruction: Generate impression based on findings.

Input: Lumbar radiculopathy. Right leg pain. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is mild straightening of the lumbar spinal curvature which may be in part positional. Alignment is otherwise within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position.Minimal degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: Minimal disc bulge. No spinal canal or neural foraminal stenosis.L4-L5: Minimal disc bulge with annular fissures involving the foraminal aspects of the disc bilaterally. There is also a small right foraminal disc protrusion best seen on image 12 of sagittal T2 and sagittal STIR sequences. There is mild right neural foraminal stenosis and contact of the exiting L4 nerve root. No clear evidence of impingement however. Otherwise no significant spinal canal or neural foraminal stenosis.L5-S1: Minimal disc bulge. No spinal canal or neural foraminal stenosis.Paraspinous soft tissues are within normal limits.

Output: There is a subtle right foraminal disc protrusion involving the L4-L5 level. There is contact of the exiting right L4 nerve root without clear evidence of impingement and can be correlated with clinical findings. There is otherwise no significant spinal canal or neural foraminal stenosis at any level.


Instruction: Generate impression based on findings.

Input: Clinical question: Brain metastases status post SRS. Evaluate for complete tumor ablation. Signs and symptoms: None. Pre- and post enhanced brain MRI:No diffusion-weighted abnormalities.A previously known enhancing metastatic lesion in high anterior left parietal lobe is again identified and measuring at 7.8 x 7.3 mm in transaxial dimensions and without convincing evidence of interval change since prior study. A approximately 3 mm superficial located posterior temporal-occipital metastatic lesion also demonstrate no significant change in its size or pattern of enhancement since prior exam.None of the lesions demonstrate any appreciable surrounding edema or mass effect. There is also no detectable new parenchymal or meningeal enhancement to suggest additional metastases. The ventricular system remain within normal size and with maintained midline. There are several small foci of FLAIR hyperintensity in the periventricular and subcortical white matter without significant change since prior exam and likely representing mild chronic small vessel ischemic strokes. Unremarkable intracranial contents otherwise.Unremarkable images through calvarium and without abnormal enhancement.Unremarkable images through the orbits and including axial fat sat post enhanced series.Unremarkable images through the paranasal sinuses and mastoid air cells.

Output: 1.No acute intracranial process.2.Stable metastatic lesions in the left parietal (7.8 x 7.3 mm) and right posterior parietal-occipital region (approximately 3 mm) in size, morphology and pattern of enhancement.3.Unremarkable exam otherwise and without evidence of new metastatic lesions.4.Mild chronic small vessel ischemic strokes remain grossly similar to prior exam.


Instruction: Generate impression based on findings.

Input: MRI Brain: There is no evidence of intracranial hemorrhage or mass. A punctate area of apparent restricted diffusion in the right pons was present on the prior MRI and is likely artifactual. There are scattered punctate foci and confluent areas of abnormal T2 hyperintensity within the periventricular and subcortical 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 skull and scalp soft tissues are grossly unremarkable. There is minimal scattered paranasal sinus mucosal thickening. MRI orbits: There is apparent central T2 hyperintensity within the right optic nerve, which appears to be mildly atrophic diffusely. There is staphylomatous deformity of the right globe. There is silicone oil within the left globe and marked diffuse atrophy of the left optic nerve. The extraocular muscles are unremarkable and there is no abnormal intraorbital enhancement or mass within the orbits.

Output: 1. Staphylomatous deformity of the right globe and apparent central signal abnormality in the mildly atrophic right optic nerve may represent artifact or neuropathy, perhaps ischemic in nature, although assessment of acute optic nerve ischemia is otherwise limited.2. Left intraocular silicone oil and marked diffuse optic nerve and chiasm atrophy.3. A punctate area of apparent restricted diffusion in the right pons is likely artifactual.4. Scattered areas of white matter chronic small vessel ischemic disease.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Clinical question: History of right parietal hemorrhagic stroke. Signs and symptoms: Left-sided weakness. Nonenhanced head CT:Subacute old right parietal and posterior stroke is again identified. There is only subtle mass effect of the adjacent cortical sulci in portions of the stroke. No evidence of hemorrhage. The cortical sulci, ventricular system and CSF cisterns are otherwise unremarkable. There is a small focus of increased density measuring 5.8 times 4-mm in size in the AP lateral to the right head of caudate nucleus. Review of prior limited MRI examination (only diffusion weighted images were obtained) reveals no abnormality. This finding may represent a small nonspecific calcification. Possibility of small hemorrhage cannot be ruled out however this is not associated with any edema of adjacent brain parenchyma.

Output: 1.Right posterior frontal -- parietal stroke with no evidence of hemorrhage.2.5.8 times 4-mm focus of high density adjacent to the right caudate nucleus as described.3.Unremarkable exam otherwise.


Instruction: Generate impression based on findings.

Input: Pituitary adenoma 3 year follow up study. There are postoperative findings in the sella. There is no significant change in the appearance of the pituitary gland and infundibulum. There is no mass effect upon the optic apparatus.

Output: No significant interval change in the treated pituitary gland.


Instruction: Generate impression based on findings.

Input: 76-year-old female with elevated metanephrines ABDOMEN:LIVER, BILIARY TRACT: No focal liver lesions. Cholelithiasis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Heterogeneously enhancing left adrenal gland nodule measures 1.8 x 1.4 cm. No increased T2 signal within the lesion as characteristically expected.KIDNEYS, URETERS: Subcentimeter T2 hyperintense cortical cyst in the right kidney.RETROPERITONEUM, LYMPH NODES: Susceptibility artifact from surgical clips in the right paravertebral space.BOWEL, MESENTERY: Small bowel caliber is within normal limits without evidence of obstruction.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Heterogeneously enhancing left adrenal gland nodule suspicious for a pheochromocytoma given avidity of enhancement and clinical history.


Instruction: Generate impression based on findings.

Input: Reason: spinal epidural abscess, cauda equina syndrome History: bilateral sciatica, possible urinary retention. There is no significant spinal canal stenosis or neural foraminal stenosis in the lumbar spine. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. There are several small foci of increased T1 and T2 signal within the vertebral bodies compatible with benign hemangiomas or focal fat. The vertebral bone marrow signal is otherwise unremarkable. The spinal cord displays normal signal and morphology. The tip of the conus is located at the L1-L2 level. There is trace nonspecific edema within the posterior lumbar subcutaneous soft tissues. There is trace free fluid within the pelvis, which may be physiologic.

Output: 1. No significant spinal canal stenosis or neural foraminal stenosis in the lumbar spine. 2. No evidence of epidural fluid collections, although assessment is limited due to the lack of intravenous contrast.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Multiple sclerosis treated with Tysabri. Brain: There are a few scattered subcortical supratentorial T2 hyperintense white matter lesions. There are also T2 hyperintense lesions in the anterior medulla, left cerebellar hemisphere white matter, and at the junction between the right lateral pons and the middle cerebellar peduncle. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Spine: There are multiple T2 hyperintense lesions within the cervical and thoracic spinal cord, as well as in the conus medullaris region, generally measuring approximately 1 to 2 cm in length. The vertebral column alignment is within normal limits. There is irregularity of the T12 superior endplate associated with a limbus vertebra. The vertebral body and disc space heights are otherwise preserved. The vertebral bone marrow signal is unremarkable. There is a disc-osteophyte complex and bilateral facet hypertrophy at C5-6 that results in mild spinal canal stenosis and moderate-to-severe bilateral neural foramen stenosis. There are also disc-osteophytes at T7-8 and T8-9 that mildly indent the spinal cord, but do not results in neural foraminal stenosis. The paravertebral soft tissues are unremarkable.

Output: 1. Several intracranial and spinal cord lesions may represent demyelinating process, but are incompletely characterized without contrast.2. A disc-osteophyte complex and bilateral facet hypertrophy at C5-6 results in mild spinal canal stenosis and moderate-to-severe bilateral neural foramen stenosis. 3. Disc-osteophytes at T7-8 and T8-9 mildly indent the spinal cord.


Instruction: Generate impression based on findings.

Input: History of recurrent hyperparathyroidism. In the mid to superior pole of the right thyroid lobe, there is an enhancing nodule measuring 1.0 x 0.9 cm, correlating with enhancing abnormality seen on the prior MRI study. The lesion also correlates with abnormal uptake in the prior nuclear parathyroid study, and therefore suggests it most likely represents a parathyroid adenoma. More inferiorly and medially in the right thyroid lobe, there are two additional hypodense lesions with the larger one measuring 0.9 x 0 .7 cm, which has nonspecific imaging appearance, but may represent colloid cysts. There are tiny nodular densities in the visceral space around the thyroid glands, and in the superior mediastinum, which may represent small lymph nodes.There is mild atelectasis in the lungs. There is mild degenerative disease of the cervical spine, with minimal anterolisthesis at C4 over C5 and disc space narrowing at C5 - C6 level.

Output: 1. Enhancing nodule in right thyroid lobe, correlating with previous studies, suggesting it likely represents a parathyroid adenoma. 2. No other suspicious nodules in the neck.


Instruction: Generate impression based on findings.

Input: 65-year-old female with numbness, tingling in the legs. History of myeloma, lumbar polyradiculopathy on the EMG study. 5 lumbar type vertebra are present. Alignment is anatomic. There are no acute fractures or subluxations. Vertebral body heights and disc spaces are maintained. The marrow signal is mildly heterogeneous without evidence of marrow edema. Few scattered areas of subtle STIR hyperintensity, for example within L2 and S1 vertebral bodies, are nonspecific. There are 2 nerve roots (most likely the L4 nerve roots) which, are somewhat thickened and, after originating from the conus, take a position anteriorly within the thecal sac abutting the ventral dura. More inferiorly, these nerve roots return to a more normal dependent position in the thecal sac. There are several additional nerve roots along the cauda equina which appear mildly thickened. L1-2: No significant spinal canal or neuroforaminal stenosis. L2-3: No significant spinal canal or neuroforaminal stenosis. L3-4: Mild disc bulge and ligamentum flavum thickening with associated mild neural foraminal narrowing. No significant spinal canal stenosis. L4-5: Mild to moderate disc bulge, ligamentum flavum thickening, and bilateral facet hypertrophy containing bilateral facet effusions. There is mild bilateral lateral recess and moderate bilateral neural foraminal stenosis. No significant spinal canal stenosis. L5/S1: Mild disc bulge and bilateral facet hypertrophy without significant neural foraminal or spinal canal stenosis.

Output: 1. Apparent adhesion of some nerve roots to the ventral thecal sac and thickening of other nerve roots could represent sequela of prior arachnoiditis though this is nonspecific.2. Heterogeneous marrow signal without evidence of marrow edema, nonspecific.3. Mild degenerative changes of the lumbar spine as described above.


Instruction: Generate impression based on findings.

Input: 17-year-old female with pain in the subtalar joint, evaluate subtalar and ankle joint cysts There is enhancement of the synovium of the anterior and posterior recesses the subtalar joint. Although we see no enhancement of the synovium between the articular cartilage of the joint, there are multiple round foci of abnormal signal intensity and enhancement within the subchondral bone that may represent cysts or erosions, with edema and enhancement of the adjacent marrow. These cysts/erosions appear to communicate with the joint through small articular cartilage defects. Additional foci of subchondral edema and enhancement are noted more anteriorly, just lateral to the medial facet of the subtalar joint. We see no low signal intensity foci to suggest pigmented villonodular synovitis (PVNS) and we see no findings to suggest tarsal coalition.There are foci of susceptibility artifact traversing the medial malleolus obliquely, presumably reflecting prior surgery. This limits evaluation of the bone and cartilage along the medial aspect of the talar dome. There is minimal enhancement of the synovium of the anterior recess of the tibiotalar joint, which is of questionable significance. There are small subchondral foci of abnormal signal intensity within the posteromedial aspect of the talar dome with slight heterogeneity of the overlying articular cartilage, which are of uncertain etiology but may reflect degeneration or prior surgery.An os trigonum is noted with normal signal intensity. The remaining visualized bones appear normal. The talofibular, tibiotalar and calcaneofibular ligaments are intact. The deltoid ligament is intact. The Achilles, flexor, peroneal and extensor tendons are intact.

Output: 1.Subchondral cysts/erosions with adjacent marrow edema and synovial enhancement affecting the subtalar joint, suggesting an inflammatory arthritis. There are no specific findings of PVNS.2.Other findings as described above.


Instruction: Generate impression based on findings.

Input: Please note: On the prior exam, the level with the worst degenerative findings was stated to be C4-5, however it is in fact at C3-4. There is mild edema within the C4, C5 and C6 vertebral bodies with mild loss of height as noted before. There is a congenitally narrowed spinal canal with superimposed findings as described below.C2-3: No spinal canal or neural foraminal stenosis.C3-4: Posterior disk osteophyte complex causing persistent focal indentation of the spinal cord without significant change. There is stable focal T2 signal abnormality within the cord, with associated ill-defined long segment T2 signal abnormality within the cord above and below this level and mild expansion of the cord caliber without significant change. However, there is more conspicuous predominantly peripheral enhancement along the spinal cord at this level. There is mild bilateral neural foraminal compromise.C4-5: Posterior disk osteophyte complex causing mild/moderate spinal canal stenosis, and mild bilateral neural foraminal compromise. No significant change in T2 signal abnormality within the cord at this level. No significant enhancement within the cord at this level.C5-6: Posterior disk osteophyte complex causing mild spinal canal stenosis and severe left neural foraminal stenosis. No significant change in T2 signal abnormality within the cord at this level. No significant enhancement within the cord at this level.C6-7: Posterior disk osteophyte complex with no significant spinal canal stenosis, and mild right neural foraminal stenosis. No significant change in T2 signal abnormality within the cord at this level. No significant enhancement within the cord at this level.C7-T1: No spinal canal or neural foraminal stenosis. No significant change in T2 signal abnormality within the cord at this level. No significant enhancement within the cord at this level.

Output: 1.Persistent cervical myelopathy most pronounced at C3-4 level where there is focal impingement of the cord from a posterior disk osteophyte complex. Compared to the prior study, there is more conspicuous peripheral enhancement at this level which does not appear masslike. Differential diagnosis includes reactive changes secondary to chronic spondylotic impingement of the cord, demyelination, non-infections inflammation, and less likely a chronic infection. Neoplasm is felt to be unlikely given the imaging characteristics.2.Persistent degenerative changes in the cervical spine contributing to multilevel cervical spinal canal and neural foraminal stenoses, without significant change.


Instruction: Generate impression based on findings.

Input: 52 year old female patient with dizziness, abnormal VNG. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are a few scattered foci of white matter T2 hyperintensity which are non-specific. Otherwise, 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 with a fetal origin of the left posterior cerebral artery. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

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


Instruction: Generate impression based on findings.

Input: Brain: There is a subdural collection over the left posterior occipitoparietal area that extends over the posterior right occipital lobe and is near CSF signal on T1 and T2 weighted imaging; finding are favored to represent chronic subdural hemorrhages. The septum pellucidum is present anteriorly with thinning/absence in the midportion, which may be due to prior hydrocephalus. No hydrocephalus is seen on the current examination. The lateral ventricles are mildly dysmorphic and there is diminished supratentorial white matter in the parietooccipital lobes bilaterally. A developmental venous anomaly is noted in the right parietal lobe. There is no midline shift or mass effect. No evidence of heterotropia. There is minimal diffuse dural enhancement, which may be reactive to the subdural collections. There is no diffusion abnormality. Pituitary: Dedicated images through the sella demonstrate a grossly unremarkable pituitary gland with normal T1 shortening of the posterior pituitary and normal diffuse homogenous enhancement. There is no obvious hypoplasia of the optic nerve or chiasm. There is mild calvarial deformity involving the posterior planum sphenoidale, which appears mildly depressed without evidence of platybasia.

Output: 1.The pituitary is within normal limits for age without findings to suggest hypoplasia or adenoma. No evidence of heterotopia as questioned. 2.Dysmorphic lateral ventricles with septum pellucidum present anteriorly and very thin/deficient in its midportion, finding which may be related to prior hydrocephalus. Priors may be helpful for confirmation if available. No findings to suggest hydrocephalus on the current study.3.Bilateral subdural fluid collections are nonspecific but favored to represent chronic subdural hematomas.4.Diminished white matter in the parieto-occipital region.5.Focal calvarial deformity involving the posterior planum sphenoidale which is angulated inferiorly. No evidence of platybasia.


Instruction: Generate impression based on findings.

Input: Diagnosis: Hemangioma of intracranial structuresClinical question: CCM Protocol, 3T Scanner, s/p resection,Signs and Symptoms: S/p resection on 7/20Comments: Asthma, 3T Scanner | The CSF spaces are appropriate for the patient's stated age with no midline shift. The patient is status post left frontal craniotomy for left frontal lobe surgery and the left left frontal lobe cavernoma. There are some dural thickening and enhancement at the craniotomy site. There is a cystic cavity associated with susceptibility effect at the surgical site within the left frontal lobe.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.There is partial opacification of the maxillary sinuses with air-fluid levels which were also present in the July exam. There are also scattered opacities in the ethmoid air cells which were also present in the July exam. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: Status post left frontal lobe surgery for removal of a left frontal lobe lesion. There are postoperative changes present.


Instruction: Generate impression based on findings.

Input: Acute cerebellar hemorrhage Redemonstration of large cerebellar hemorrhage with mass effect against for centrical weight ventricular enlargement.The degree of ventricular enlargement comparing to prior CT scan does not show any significant interval change. However, there are evidence of intraventricular hemorrhage especially on bilateral lateral ventricle occipital horns, indicating extension of hemorrhage into the ventricular system.There are linear and nodular areas of the restricted diffusion especially inferior vermis and cerebellar sulci indicating the possibility of hemorrhagic transformation from underlying ischemic infarct.There is no evidence of abnormal enhancement on the scan.Multifocal scattered small susceptibility lesions on gradient echo images on bilateral hemisphere and brainstem indicate chronic petechial hemorrhage.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. Extension of hemorrhages into the ventricular system which is now more evidence comparing to prior scan. No change of ventricle size.2. The size and mass effect of right cerebellar ICH do not show significant interval change.3. Subtle restriction diffusion areas within the hemorrhage may provide clue for the possibility of hemorrhagic transformation from ischemic infarction.4. No evidence of abnormal enhancement.


Instruction: Generate impression based on findings.

Input: 20 year old female with perinatal stroke, right hemiparesis, and intractable localization related epilepsy: seizures. There is encephalomalacia and gliosis in the left inferior frontal lobe, insula, and portions of the basal ganglia, with evidence of Wallerian degeneration. There is associated ex vacuo dilatation of the left lateral ventricle. There is no evidence of acute infarct. There is no abnormal intracranial enhancement. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There are secretions and mucosal thickening throughout the left maxillary sinus and adjacent anterior ethmoid air cells.

Output: 1. Findings related to remote infarction of the left inferior frontal lobe, insula, and portions of the basal ganglia.2. Chronic left-sided sinusitis.


Instruction: Generate impression based on findings.

Input: Female, 35 years old. Reason: Palpable mass to right midback Markers were placed on the skin surface on the back to the right of midline presumably denoting the site of the patient's palpable mass. Between the markers there is a mass of predominantly fat signal intensity that lies between the lateral margin of the trapezius and the medial margin of the right scapula. The mass lies superficial to the rhomboid major and does not appear to contact the ribs. It measures approximately 6.5 x 1.5 cm in greatest transverse dimension and just over 7 cm in craniocaudal dimension. Thin bandlike septae of nonadipose tissue are noted within the mass, but we see no dominant nodular nonadipose elements. There is no frank enhancement of the mass following contrast administration.

Output: Findings compatible with a lipoma as described above.


Instruction: Generate impression based on findings.

Input: Clinical question: 70-year-old with ovarian carcinoma and history of hemorrhagic stroke. Altered mental status. Nonenhanced CT of brain:There is a large area of encephalomalacia in the right posterior temporal -- occipital region with ex vacuo dilatation of adjacent cortical sulci and ventricle. There was a large acute hemorrhagic stroke on this side on prior study.There is a subtle area of cortical and subcortical low attenuation in high convexity of the left posterior frontal and precentral stroke post which may represent a small cortical stroke of indeterminate age. This finding was not present on prior exam. Please correlate with history and follow up with an MRI is recommended. There is no evidence of hemorrhage. No midline shift is detected.

Output: 1.A very subtle small left precentral sulcus low-attenuation of cortex and subcortical white matter which is too small to determine the age however it is a new finding since prior examination. Correlate with history and follow-up with an MRI for acute ischemic stroke.2.Previously noted large area of hemorrhage in the right posterior temporal -- occipital junction has evolved into a large area of encephalomalacia and minimal demineralization. Unremarkable exam otherwise.


Instruction: Generate impression based on findings.

Input: 40 year-old female with chronic posterior and adductor pain. ACETABULAR LABRUM: There is a small tear of the anterosuperior labrum (series 901, image 13) with an associated paralabral ganglion.ARTICULAR CARTILAGE AND BONE: No significant abnormality noted.SOFT TISSUES: Increased fluid signal within the right hamstring near its origin on the ischial tuberosity. Given that the hamstring is not retracted, findings are compatible with a partial tear. ADDITIONAL

Output: 1.Partial tear of the right hamstring near its origin on the ischial tuberosity.2.Small anterosuperior labral tear with associated paralabral ganglion.


Instruction: Generate impression based on findings.

Input: 26 year old male status post olecranon osteotomy for osteochondral defect, compare cartilage surface with previous exams. Review of the patient's first mri examinations reveals a subchondral lesion within the distal humerus centrally compatible with a "trochlear osteochondral defect," which has since undergone surgery (bone grafting). The majority of the defect is now filled with signal intensity similar to normal bone marrow with exception of a 5-mm subchondral focus of low signal intensity centrally that appears identical to prior. Irregularity of overlying articular surface with overlying cartilage loss also appears similar to prior. There is a small focus of abnormal signal intensity within the trochlear groove of the olecranon in the approximate location of the trochlear ridge that was not seen on prior examination. This could represent a small degenerative subchondral cyst. There is also mild focal edema-type signal within the medial aspect of the olecranon process and the posterior aspect of the medial humeral condyle with small osteophytes, suggesting a degenerative etiology, which may be associated with overlying focal cartilage loss.No loose bodies in the joint. No joint effusion.Low signal intensity within the posterolateral aspect of the radiocapitellar articulation may represent a prominent radiohumeral plica, which can be associated with "synovial fringe syndrome" in the correct clinical context (posterolateral pain and/or mechanical symptoms).Remainder of the soft tissue structures are normal.

Output: 1.Postoperative changes of distal humeral trochlear osteochondral defect bone grafting, appearing similar to prior.2.New small foci of signal abnormality within the trochlear groove of the olecranon and along the medial aspect of the ulnohumeral articulation, which could be degenerative in etiology.3.Findings suggestive of a prominent radiohumeral plica, which can be associated with "synovial fringe syndrome" in the correct clinical context (posterolateral pain and/or mechanical symptoms).


Instruction: Generate impression based on findings.

Input: Evaluate for focus of seizures, pre-MRI for surgical candidacy: periventricular heterotopia and left temporal lobe seizures. There are numerous bilateral periventricular nodules with signal characteristics of grey matter. There is no evidence of intracranial hemorrhage or acute infarct. There is no abnormal intracranial enhancement. The lateral ventricles are enlarged and dysmorphic and there is deficiency of the septum pellucidum. There is a retrocerebellar arachnoid cyst that measures up to 25 mm in width. 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: Extensive bilateral periventricular heterotopia and enlarged lateral ventricles.


Instruction: Generate impression based on findings.

Input: Malignant neoplasm of unspecified site of right female breast [C50.911] / Secondary and unspecified malignant neoplasm of axilla and upper limb lymph nodes [C77.3] / Malignant neoplasm of unspecified site of right female breast [C50.911], Multiple bone marrow replacing lesions involving T4, T6 and T7 vertebrae are again seen and show interval increase of extent of involvement.At the level of T4, the right pedicle and right side transverse process show enhancement and T2 high and T1 low signal intensity indicating metastatic lesion, progressed since prior scan.The vertebral body lesions involving both T6 and T7 also appear to be increased in extent of inhomogenous enhancement, however, there is no paravertebral soft tissue mass formation.There is no evidence of spinal canal stenosis or neuroforaminal stenosis.There is no other bone marrow replacing lesion seen. There is normal thoracic kyphosis.The spine alignment is anatomic. The vertebral body height is preserved. The signal of the visualized cord is normal. The conus medullaris terminates at the T12-L1 level. The intervertebral discs demonstrate normal T2 intensity and height with no evidence of disc herniation. The paraspinal soft tissues are unremarkable.

Output: 1. Interval increase of size of T4, T6 and T7 bone marrow replacing lesions since prior scan which are consistent with metastatic lesions.2. No evidence of spinal stenosis or neuroforaminal stenosis.3. Spinal cord signal intensity is normal.


Instruction: Generate impression based on findings.

Input: Diagnosis: Unspecified abnormalities of gait and mobilityClinical question: gait disorder, falls. Assess for cervical lesion.Signs and Symptoms: Unsteady gait Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology.No abnormal enhancing lesions are appreciated in the cervical spine. Overall there is no significant change since the prior exam from 1/20/2010At C2-3 there is no significant compromise to the spinal canal or neural foramina. There is bilateral facet hypertrophy right more than left this level.At C3-4 there is no significant compromise to the spinal canal . There are small uncovertebral osteophytes present in bilateral facet hypertrophy at this level. There is a mild disc bulge present at this level. There is encroachment of the exiting nerve roots within the neural foramina bilaterally (right worse than left) at this level as a result of facet hypertrophy and uncovertebral osteophyte formation.At C4-5 there is no significant compromise to the spinal canal . There are small uncovertebral osteophytes present in bilateral facet hypertrophy at this level. There is encroachment of the exiting nerve roots within the neural foramina bilaterally (right worse than left) at this level as a result of facet hypertrophy and uncovertebral osteophyte formation.At C5-6 there is no significant compromise to the spinal canal . There are small uncovertebral osteophytes on the right side present and bilateral facet hypertrophy (right worse than left) at this level. There is mild encroachment of the exiting nerve roots within the right neural foramen at this level as a result of facet hypertrophy and uncovertebral osteophyte formation.At C6-7 there is no significant compromise to the spinal canal or neural foramina. There is bilateral facet hypertrophy present at this level. There is a couple millimeters anterior subluxation of C6 on C7.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.MRI thoracic spine:The thoracic vertebral bodies are appropriate in the overall alignment and height. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots. No abnormal enhancing lesions are appreciated in the thoracic spine.

Output: 1.There are multilevel degenerative changes present in the cervical spine with some encroachment of the right-sided exiting nerve roots at C3-4 and C4-5 and narrowing of neural foramina elsewhere. These findings have not changed substantially since 2010 exam. There is no evidence for cervical spinal cord compromise.2.There is no compromise of thoracic spinal cord or exiting nerve roots appreciated.


Instruction: Generate impression based on findings.

Input: Right renal tumor. Evaluate for right vein involvement and lymphadenopathy. Small left renal mass. ABDOMEN:LIVER, BILIARY TRACT: Several hepatic cysts. No suspicious liver lesion. Normally distended gallbladder without gallstones. No biliary ductal dilatation or vascular abnormality.SPLEEN: The spleen is normal in size without a focal lesion.PANCREAS: Moderate fatty filtration of the pancreatic head. No pancreatic ductal dilatation or focal lesion.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Lobular complex partially exophytic mass involving the superior half of the right kidney measuring 7.6 x 6.8 x 7.1 cm. No macroscopic fat. The lesion is peripherally isointense to the renal cortex on T2-weighted imaging with central nonenhancing probable necrosis. The lesion extends into the superior collecting system. It abuts the inferior aspect of the liver and extends into the pararenal fat. It abuts the renal vein without evidence of renal vein invasion. No enlarged locoregional lymphadenopathy.Mildly T2 hypointense enhancing endophytic lesion in the left interpolar region measures 2.9 x 2.4 x 2.4 cm. Few subcentimeter foci are too small to characterize, likely cysts. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.7.6 cm right exophytic and 2.9 cm left renal endophytic heterogeneous masses compatible with renal cell carcinoma. The right renal mass extends into the collecting system. It abuts the renal vein without evidence of invasion. No locoregional enlarged lymphadenopathy. The bilateral renal masses raises the possibility of Birt-Hogg-Dube Syndrome, particularly in patients with lung cysts. 2.Hepatic cysts.


Instruction: Generate impression based on findings.

Input: Status post L4 intradural mass resection, prelim pathology of schwannoma, evaluate extent of resection. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is mild endplate irregularity involving the superior L5 and inferior L4 endplates which is on a degenerative basis. Alignment is grossly maintained. Bone marrow signal is benign. The conus medullaris is normal in position.There are postsurgical changes of laminectomy at the L4-L5 level for resection of intradural mass which demonstrated partial cystic and enhancing solid components. There is no definite evidence of residual tumor. There is enhancement involving the L4-L5 level along the dura and epidural space compatible with postoperative change. There is a postoperative fluid collection in the laminectomy bed including blood products which contributes to moderate to severe effacement of the thecal sac from the upper L4 to the lower L5 levels. There is clumping of the cauda equina nerve roots at these levels. There is a 5 mm focus of T1 hyperintensity involving the left lateral epidural space at the L4-5 level likely related to blood products.Multilevel degenerative changes are present including mild disc bulges at the L2-L3 to L5-S1 levels. There is a left paracentral disc extrusion at the L4-L5 level with mild inferior migration. There is mild bilateral L4-L5 and L3-L4 neural foraminal stenosis. No high-grade neural foraminal stenosis is present. Spinal canal at L3-L4 and more superiorly is preserved. There is also mild multilevel facet arthropathy, relatively worse at the L4-L5 level.There are small bilateral renal cysts.

Output: 1. Postoperative changes related to resection of previously seen cystic and solid mass at the L4 to L5 levels. There is no definite evidence of residual tumor.2. Moderate to severe effacement of the thecal sac at the upper L4 to lower L5 levels with clumping of the cauda equina nerve roots, which may reflect combination arachnoiditis and extrinsic compression from postoperative fluid collection in the laminectomy bed. Bony spinal canal is surgically decompressed at this level.3. Mild degenerative changes as above including a disc extrusion at the L4-L5 level.


Instruction: Generate impression based on findings.

Input: Chronic low back pain, symptoms of spinal stenosis, new onset bowel/bladder control problems since 2 months Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is mild exaggeration of lumbar lordosis, levoscoliosis of the mid to lower lumbar spine, and grade 1 anterolisthesis of L4 and L5. These findings were present on prior study and can be further assessed with upright radiographs. Bone marrow signal is benign. The conus medullaris is normal in position.Multilevel degenerative changes are again seen with multilevel disc bulges and disc height loss which is severe at the L3-4 level, similar to prior. Additional details as below:L1-L2: Mild disc bulge with small right central protrusion as before. Minimal right neural foraminal narrowing. No spinal canal or left neural foraminal stenosis.L2-L3: Disc bulge eccentric to the right with effacement of the right lateral recess as before. Mild to moderate right neural foraminal stenosis. Left neural foramen is patent.L3-L4: There is moderate to severe spinal canal stenosis at this level related to combination of disc bulge which is eccentric to the right, moderate degree of bilateral facet arthropathy, and prominence of the dorsal epidural fat. Degree of stenosis is minimally worse in the interval. There is effacement of the bilateral lateral recesses. There is moderate right-sided neural foraminal stenosis. Left neural foramen is patent.L4-L5: There is severe spinal canal stenosis at this level related to combination of disc bulge, grade 1 anterolisthesis, advanced bilateral facet arthropathy, and ligamentum flavum thickening. There is effacement of the lateral recesses. There is moderate to severe left neural foraminal stenosis and mild right neural foraminal narrowing similar to prior. L5-S1: Mild disc bulge and bilateral facet arthropathy, severe on the left. There is no significant spinal canal or neural foraminal stenosis. Paraspinous soft tissues are within normal limits.

Output: 1. Multilevel degenerative changes in the lumbar spine with severe L4-L5 and moderate to severe L3-L4 spinal canal stenoses which is stable to minimally worse since 11/28/2014. Additional details including neural foraminal stenoses as above, relatively worse at the left L4-L5 and right L3-L4 levels.2. Degenerative grade 1 anterolisthesis at L4-L5 as well as levoscoliosis of the lumbar spine can be further assessed with upright radiographs as clinically indicated.


Instruction: Generate impression based on findings.

Input: Fusion Rod and screw stabilization hardware is present in the cervical and thoracic spine, with pedicular screws at C4, C5, C6, C7, T5, T6, T7, and T8. The T2, T3, and T4 vertebral bodies are wedged with increased density, likely representing pathological fractures. There is no radiographic evidence of hardware complication. There is moderate degenerative disk disease of the cervical and thoracic spine. Multifocal lytic lesions are better seen on CT and MRI.

Output: Post-surgical changes of a cervicothoracic stabilization without evidence ofhardware complication.


Instruction: Generate impression based on findings.

Input: Diagnosis: CervicalgiaClinical question: SUSPICION FOR NUEROVASCULR COMPRESSIONSigns and Symptoms: NECK PAIN The cervical vertebral bodies are appropriate in overall alignment and height. The patient is status post anterior fusion of C4-C7 with anterior plate and screws from C4 to C7anterior vertebral bodies. and bone graft placement along the C4-C6 vertebral bodies and partial vertebrectomies of C4 and C5. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal enhancing lesions are identified in the cervical spine.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is diffuse disk bulge, disk dessication and posterior ligamentous hypertrophy associated with spinal stenosis and bilateral neural foramen encroachment of exiting nerve roots. This is new since the prior examAt C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal . There is encroachment of exiting nerve roots on the right side due to uncovertebral osteophytes. This was also present in the 2009 exam.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.Status post anterior cervical spine surgery as described above from C4 to C7.2.Spinal stenosis and neural foramen encroachment of exiting nerve roots at C3-4 due to degenerative changes.3.Encroachment of right sided exiting nerve roots at C6-7 due to degenerative changes.


Instruction: Generate impression based on findings.

Input: A 66 year old male with paroxysmal atrial fibrillation, increased CPK extra-cardiac sarcoidosis with suspected cardiac involvement from previous cardiac MRI in 2009. Referred now to cardiac MRI for follow up. Left VentricleThe left ventricle remains normal in size and systolic function. The overall LV ejection fraction is 58%. There are no regional wall motion abnormalities present. The previous left ventricular ejection fraction was 59%. There is mild progression of basal anteroseptal hypertrophy measuring up to 14 mm. The LV end diastolic volume index is 84 ml/m2 (normal range: 74+/-15), the LVEDV is 185 ml (normal range 142+/-34), the LV end systolic volume index is 35 ml/m2 (normal range 25+/-9), the LVESV is 77 ml (normal range 47+/-19), the LV mass index is 43 g/m2 (normal range 85+/-15), and the LV mass is 93 g (normal range 164+/-36). There is late gadolinium enhancement in the basal infero-lateral segment in a mid myocardial distribution, similar in extent to the cardiac MRI of 2009. The late gadolinium enhancement spares the endocardium. Given the clinical history, this is suggestive of myocardial sarcoidosis. No thrombus is present.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 51%, the RV end diastolic volume index is 96 ml/m2 (normal range 82+/-16), the RVEDV is 210 ml (normal range 142+/-31), the RV end systolic volume index is 47 ml/m2 (normal range 31+/-9), and the RVESV is 102 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation. There is mild chordal systolic anterior motion during systole secondary to anterobasal septal hypertrophy.Pulmonic ValveThe pulmonic valve opens widely. There is mild pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is tricuspid regurgitation which visually appears mild. Dedicated imaging was not performed.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no pericardial effusion.Extracardiac FindingsMild bilateral hilar lymphadenopathy.

Output: 1. Well-preserved left ventricular function with an LVEF of 58%.2. Enhancement at the basal infero-lateral segment similar to cardiac MRI of 2009. This spares the endocardium and is not likely to represent a prior myocardial infarction. Given the clinical history, this is suggestive of cardiac sarcoidosis. There is no significant changes compared to 2009.3. The right ventricle is normal in size and systolic function, the RVEF is 51%. 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 hyperprolactinemia and migraines. Evaluate for macroadenoma. MRI brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. MRI pituitary:Dedicated images through the sella demonstrate a normal height of the pituitary gland. A tiny 2 mm oval lesion seen on sagittal imaging along the posterior inferior portion of the anterior pituitary gland and abuts the T1 bright spot is hypointense on T1, and is either nonenhancing or hypoenhancing on postcontrast images. Further evaluation is somewhat limited since all of the other sequences skip over the lesion. No additional focal abnormal signal intensity or mass is seen within the pituitary gland. The pituitary stalk deviates slightly to the left which may be within normal variation. Suprasellar cistern, optic chiasm, cavernous sinuses and intracranial portions of the optic nerves appear unremarkable.

Output: No pituitary macroadenoma. Tiny 2 mm pituitary lesion, with location most suggestive of a tiny pars intermedia cyst along the posterior inferior portion of the anterior pituitary gland.


Instruction: Generate impression based on findings.

Input: Please note, the postcontrast 3-D T1 images were inadvertently not acquired. There is unchanged extra-axial dural based mass along the greater right sphenoid wing with enhancement measuring 44 ML x 36 CC x 42 AP mm on series 1201 image 14 and series 1101 image 12. There is central heterogeneity. The predominant portion of the mass is centered along the skull base of the right middle cranial fossa, although some portion extends along the anterior clinoid process into the right anterior cranial fossa. The mass intimately abuts the right cavernous sinus and the right supraclinoid internal carotid artery, as well as the right M1 segment causing superior deviation of the right M1 segment which appears to be draping over the mass, as noted on the prior exams. There are also unchanged serpiginous linear flow voids posteriorly along the border of the mass best seen on axial T2 images, which probably represent displaced vascular structures which are outlined due to presence of edema.The mass shows T1 isointense and mild T1 hyperintense signal relative to white matter with mild increased DWI signal. As noted on the prior exam, there may be mild thickening of the right anterior clinoid process and greater sphenoid wing suggesting hyperostosis. There is a thin cleft of CSF signal separating this lesion from the adjacent temporal lobe which is again compressed with persistent leftward uncal herniation causing compression and leftward deviation of the mid brain, unchanged. There is vasogenic edema within the right temporal lobe tracking superiorly into the right parietal lobe and basal ganglia. There is persistent mass effect with near effacement of the right lateral ventricle, and midline shift to the left of 9 mm without change. There is an enlarged left lateral ventricle again seen with a prominent left occipital horn, suggesting entrapment. The third and fourth ventricles are unchanged in caliber and not dilated. There is no acute infarct.

Output: 1. Stable enhancing extra-axial mass centered at the right greater sphenoid wing and right anterior clinoid process causing extensive right temporal lobe vasogenic edema, mass effect with midline shift, right uncal herniation, effacement of the right lateral ventricle, as well as stable dilation of the left lateral ventricle suggesting entrapment. This most likely represents a meningioma.2. Mass abuts the right cavernous sinus, and is in close proximity with the right distal internal carotid artery and M1 segment.


Instruction: Generate impression based on findings.

Input: Evaluate for structural abnormality, hydrocephalus: AM vomiting, abnormal movements, autism, and behavioral issues. There is a prominent cerebrospinal fluid intensity space overlying the anterior left frontal lobe that measures up to 8 mm in width, which is compatible with an arachnoid cyst. Otherwise, there is no evidence of intracranial hemorrhage, soft tissue 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, and scalp soft tissues are grossly unremarkable. There is scattered paranasal sinus mucosal thickening.

Output: Small left frontal convexity arachnoid cyst, but no evidence of ventriculomegaly, acute intracranial hemorrhage, solid mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: Male 2 years old Reason: Concern for abuse History: right forearm swelling, possible healing fracture, concern for cigarette burnsEXAMINATION: Skull AP/lateral, cervical spine AP/lateral, thoracolumbar spine AP/lateral, right humerus AP, left humerus AP, right forearm AP, left forearm AP, right hand PA, left hand PA, chest AP, ribs right oblique/left oblique, pelvis AP, right femur AP, left femur AP, right tibia fibula AP, left tibia fibula AP, right foot AP, left foot AP (24 views) 10/12/2015, 1347 Hypoplastic pedicle of C1 is noted. No cervical, thoracic, or lumbar spinal fracture. Cortical thickening and soft tissue mass about the right mid radius, please refer to MRI right forearm. Linear focus of subcutaneous emphysema on the left arm. Medial cortex of the left femur is thickened, with bowing deformity, and the left femur appears slightly shorter than the right. The medial cortex of the left tibia is thickened as well, with minimal bowing deformity. No bone destruction from Langerhans cell histiocytosis is present.Cardiothymic silhouette is normal. Lungs appear normal with no focal airspace opacity, pleural effusion or pneumothorax.

Output: 1.Cortical thickening and bowing deformity of the left femur and tibia, most likely congenital in etiology, although there are other possibilities. 2.Subcutaneous emphysema in the left arm of unclear etiology.3.Right forearm soft tissue mass, please refer to MRI right forearm.


Instruction: Generate impression based on findings.

Input: 31-year-old woman with right femur Ewing's R, with retroperitoneal metastasis. Pain in lower extremity. There is a mass within the anterior compartment musculature of the proximal right thigh, predominantly involving the vastus intermedius muscle deep to the vastus lateralis. It is approximately 5 x 3 cm in transverse dimension and approximately 10 cm in craniocaudal dimension, representing a decrease in size when compared with the prior study. The mass is isointense to skeletal muscle on T1-weighted images, heterogeneously hyperintense to skeletal muscle on T2-weighted images, and shows diffuse but slightly heterogeneous enhancement following intervenous administration of gadolinium. There is focal atrophy of the vastus medialis muscle immediately distal to the mass. The mass abuts the lateral cortex of the proximal femoral diaphysis. Although I see no frank destruction of the underlying cortex, there is abnormal signal intensity and enhancement of the medullary bone of the underlying femur likely representing neoplastic involvement that has also decreased in extent when compared with the prior study. Patchy intermediate signal intensity within the remaining femoral diaphyses bilaterally likely reflects reconverted red marrow. Enhancing inguinal lymph nodes have overall decreased in size.

Output: Decrease in size of Ewing sarcoma.


Instruction: Generate impression based on findings.

Input: 76-year-old male with prostate cancer. Rule out metastatic disease. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Multiple, small nonenlarged retroperitoneal lymph nodes. A reference left para-aortic lymph node measures 10 x 7 mm image number 58, series number 3.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Focal enhancing nodule in the right base of the prostate is suspicious for patient's known prostate cancer. Bilateral seminal vesicles are enlarged. The local staging is clinically critical, MRI of the prostate may be helpful for further evaluation.BLADDER: 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: Small retroperitoneal lymph nodes. No evidence of definite metastatic disease in the abdomen or pelvis.


Instruction: Generate impression based on findings.

Input: Acute disseminated encephalitis and encephalomyelitis, with worsening headache. There are postsurgical findings related to right frontal approach stereotactic biopsy of the pontine enhancing lesions. There is significant interval improvement in the foci of enhancement within the pons. There are no new enhancing lesions. There are unchanged mild scattered nonspecific punctate foci of T2 hyperintensity in the cerebral white matter. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable.

Output: Interval improvement of the pontine lesions, status post biopsy.


Instruction: Generate impression based on findings.

Input: 30-year-old female with ulcerative colitis and recurrent pancreatitis. MRCP with secretin to rule out a pancreatic ductal stricture. Limited exam due to the lack of intravenous contrast.ABDOMEN:LIVER, BILIARY TRACT: Small cyst of hepatic segment 6. Otherwise, unremarkable hepatic parenchyma. No intra or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: Normal bright T1 noncontrast signal intensity of the pancreatic parenchyma. Appropriate fluid distention of the duodenum on the post-secretin series. Stricture of the mid pancreatic body with upstream dilatation. The lack of intravenous contrast limits evaluation for an underlying neoplasm. Mild increased DWI signal intensity of the pancreatic body and tail is also suggestive of pancreatitis.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Mildly enlarged lymph nodes tracking along the transverse colon.BOWEL, MESENTERY: Wall thickening and edema of the visualized colon with enlarged adjacent lymph nodes compatible with history of ulcerative colitis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Stricture of the mid pancreatic body with mild upstream ductal dilatation and increased diffusion signal intensity of the body and tail suggestive of pancreatitis. The lack of intravenous contrast limits the evaluation for an underlying neoplasm.2.Wall thickening and edema of the visualized colon with adjacent mildly enlarged lymph nodes compatible with the history of ulcerative colitis.


Instruction: Generate impression based on findings.

Input: Female, 59 years old, with chronic low back pain radiating to the feet, unrelieved by physical therapy. A slight levocurvature of the lumbar spine is seen which may be positional. Sagittal alignment is unremarkable. Vertebral body height and morphology are within normal limits. No concerning marrow replacement or marrow edema is seen.The visualized distal spinal cord and conus demonstrate normal morphology and signal characteristics. The conus tip terminates at the L2 level which is within normal limits. Fatty infiltration of the filum terminale is demonstrated. No epidural abnormalities are suspected.L1-2: Unremarkable. L2-3: Mild facet arthropathy. Minimal disc bulging. No significant spinal canal stenosis. Mild left foraminal narrowing. L3-4: Facet arthropathy and ligamentum flavum thickening, right greater than left. Mild disc bulging with a small superimposed left foraminal protrusion which does not impinge on the exiting nerve root. Mild generalized spinal canal narrowing to which prominent dorsal epidural fat contributes. Moderate right and mild left foraminal narrowing. L4-5: Marked right facet arthropathy. Moderate left facet arthropathy. Ligamentum flavum thickening. Mild bulging disc. Mild to moderate generalized spinal canal narrowing with some degree of crowding of the cauda equina. Mild bilateral foraminal narrowing. L5-S1: Moderate bilateral facet arthropathy. Ligamentum flavum thickening. Disc bulging. Moderate generalized spinal canal narrowing. Severe left foraminal narrowing with probable nerve root impingement. Mild right foraminal narrowing.

Output: Multilevel disc and posterior element degeneration is seen. A mild narrowing of the spinal canal is present at L3-4, with moderate narrowing and some degree of cauda equina crowding at L4-5.Moderate right foraminal narrowing is seen at L3-4. Severe left foraminal narrowing with probable nerve root impingement is seen at L4-5. Marked facet arthropathy is evident on the right at L4-5.Fatty infiltration of the filum terminale is seen. This can be an incidental finding in adults, particularly in the absence of additional imaging and clinical evidence of tethered cord.


Instruction: Generate impression based on findings.

Input: Abdominal pain and stool changes. Evaluate for chronic pancreatitis. ABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy. No biliary ductal dilatation. The liver is normal in morphology, size, signal intensity and enhancement without a focal lesion. The vessels are patent.SPLEEN: The spleen is normal in size without a focal lesion.PANCREAS: The pancreas is normal in T1-weighted signal intensity with mild atrophy of the pancreatic body. No peripancreatic inflammatory changes. The parenchyma demonstrates normal postcontrast enhancement without a focal lesion. The main pancreatic duct is normal in caliber. Normal variant pancreaticobiliary anatomy.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter right renal hyperintensity is too small to characterize, likely a simple cyst. 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: Mild pancreatic body atrophy. Otherwise no specific evidence of acute or chronic pancreatitis. No specific findings to account for the patient's abdominal pain.


Instruction: Generate impression based on findings.

Input: Previous history of focal seizure activity left frontal, behavior challenges. There is a linear area of high T2 signal in the white matter of the anterior left superior frontal gyrus. There is no evidence of intracranial hemorrhage, mass, or encephalomalacia. The hippocampi are 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, mastoid air cells, and scalp soft tissues are grossly unremarkable. There is a small right maxillary sinus retention cyst.

Output: Nonspecific linear T2 hyperintensity in the white matter of the anterior left superior frontal gyrus may potentially be related to cortical malformation.


Instruction: Generate impression based on findings.

Input: Right shoulder pain The examination is limited by motion artifact and the inability to optimally position the patient. There are scattered foci of signal void identified superiorly relating to prior shoulder arthroscopy.ROTATOR CUFF: There is increased signal intensity within the supraspinatus tendon reflecting tendinopathy. Additional areas of higher signal intensity are identified within the intrasubstance of the tendon at the level of the distal acromium suggesting intrasubstance tearing as well as a focus of fluid signal intensity along the articular insertional fibers likely representing a small partial-thickness tear. The tendinopathy seen within the supraspinatus tendon extends posteriorly to involve portions of the infraspinatus tendon which otherwise appears relatively intact. There is increased signal intensity within the insertional fibers of the subscapularis tendon which likely reflect insertional tendinosis or mild interstitial tearing. The teres minor tendon is intact. There is mild atrophy of the supraspinatus, infraspinatus, and subscapularis muscles.SUPRASPINATUS OUTLET: Moderate osteoarthritis affects the acromioclavicular joint. There is evidence of prior distal acromial resection. A trace amount of fluid is noted within the subacromial subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Alignment of the glenohumeral joint is normal. Mild osteoarthritis affects the glenohumeral joint and there is degenerative fraying and tearing of the superior labrum. There is a small amount of fluid present within the subcoracoid recess.BICEPS TENDON: The biceps tendon is absent within the bicipital groove relating to prior tenotomy. ADDITIONAL

Output: 1. Small partial articular surface tearing of the insertional fibers of the supraspinatus tendon with additional rotator cuff tendinopathy detailed above. There is no evidence of a full-thickness tear.2. Surgical changes of prior acromioclavicular decompression and biceps tenotomy.3. Moderate osteoarthritis of the acromioclavicular joint.