Instruction: Generate impression based on findings.

Input: Bilateral lower extremity weakness and sensory level There are postsurgical changes related to anterior corpectomy of C5 and anterior fusion of from C4 to C6. There is moderate spinal canal stenosis from the C4-C5 and C5-C6 levels which appears mildly worse since 1/5/2016. Finding may be related to worsening epidural tumor and can be better assessed with dedicated cervical spine study with gadolinium.There is a severe compression fracture at the T5 level which appears worse with associated osseous retropulsion and epidural tumor resulting in deformity of the cord. This finding appears slightly worse compared to 1/5/2016. Tumor infiltration involving the T6 and T8 vertebral bodies again seen. There appears to be increased tumor infiltrating the T8 vertebral body compared to prior with mild pathologic compression fracture but without spinal canal stenosis. No significant spinal canal stenosis in the lower thoracic or lumbar spine is appreciated.

Output: Evidence of osseous metastatic disease in the spine is again seen. There is mild further worsening of moderate to severe spinal canal stenosis and cord deformity at the T5 level and to a slightly lesser degree at the C4-C5 to C5-C6 levels. There is also worsened compression fracture at the T5 level. Please note this examination was performed per screening cord compression protocol and would recommend dedicated cervical and thoracic spine MRI studies with gadolinium for further evaluation.


Instruction: Generate impression based on findings.

Input: Reason: left shoulder pain since April 2015, instability, evaluate for labral tear History: left shoulder pain Several sequences are slightly limited by patient motion artifact.ROTATOR CUFF: The supraspinatus and infraspinatus muscles and tendons appear intact. The subscapularis and teres minor muscles and tendons appear intact.SUPRASPINATUS OUTLET: The acromioclavicular joint is normal in appearance. We see no fluid or gadolinium within the subacromial subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Gadolinium is noted within the glenohumeral joint, however, much of the gadolinium is situated anterior to the subscapularis muscle on this MRI examination, perhaps representing a defect within the anterior capsular structures of the glenohumeral joint or perhaps an anomalous communication of the subscapular recess with the subcoracoid bursa. The glenohumeral joint alignment is within normal limits. The anterior superior labrum appears detached from the underlying glenoid, but this may represent a normal variant sublabral foramen.BICEPS TENDON: The tendon of the long head of the biceps appears intact. ADDITIONAL

Output: 1. Accumulation of contrast anterior to the subscapularis is of uncertain significance; it may represent a defect within the anterior capsular structures of the glenohumeral joint or perhaps an anomalous communication of the subscapular recess with the subcoracoid bursa. We see no rotator cuff tear, however.2. Detachment of the anterior superior labrum from the underlying glenoid which may simply represent a normal variant sublabral foramen.


Instruction: Generate impression based on findings.

Input: Reason: sz History: sz The CSF spaces are appropriate for the patient's stated age with no midline shift. There is encephalomalacia present along the left inferior parietal lobule and posterior left temporal lobe. Smaller foci in T2 and flair signal hyperintensity are present along the cortex of the left middle frontal gyrus, left centrum semiovale and the left superior parietal lobule.No abnormal enhancing mass lesions are appreciated intracranially.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.Foci of encephalomalacia involving left parietal and temporal lobe and small portions of left frontal lobe are suggestive of prior ischemic infarction.


Instruction: Generate impression based on findings.

Input: Reason: meniscus tear? History: right knee pain MENISCI: The medial and lateral meniscus appear intact. There is globular increased signal abnormality within the posterior horn of the medial meniscus which likely represents intrasubstance degeneration.ARTICULAR CARTILAGE AND BONE: The medial and lateral compartment articular cartilage appears intact. There is superficial fraying of the articular cartilage along the lateral facet of the patella. There is a near full-thickness to full-thickness articular cartilage cleft along the lateral facet of the patella. There is a full-thickness articular cartilage cleft along the medial facet of the patella as well.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact. There is an extensive amount of subcutaneous edema along the anterior aspect of the patella and patellar tendon. Some of this edema but becomes confluent along the anterior aspect of the proximal patellar tendon. This is nonspecific but may represent an early prepatellar bursitis.ADDITIONAL

Output: 1. Articular cartilage degeneration most pronounced along the patellofemoral articulation with full thickness articular cartilage clefts as described above.2. Nonspecific subcutaneous edema along the anterior aspect of the patella and patellar tendon which may represent an early prepatellar bursitis.


Instruction: Generate impression based on findings.

Input: Possible rotator cuff tear ROTATOR CUFF: There is a partial full-thickness tear of the anterior fibers of the supraspinatus tendon. There is a partial full-thickness tear of the subscapularis tendon, with some fibers still visible extending to the bicipital groove. The musculature of the rotator cuff is within normal limits for the patient's age.SUPRASPINATUS OUTLET: Moderate osteoarthritis affects the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: No significant abnormality noted.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: 1. Partial full-thickness tears of the right supraspinatus and subscapularis tendons.2. Diffuse fatty atrophy of the rotator cuff musculature of the left shoulder, without rotator cuff tear.


Instruction: Generate impression based on findings.

Input: Brain mets status post multiple courses of SRS. There are multiple unchanged punctate enhancing lesions in the bilateral cerebellar hemispheres and a punctate lesion in the posterior right pons. There also appear to be unchanged punctate foci of enhancement in the right occipital and inferior parietal lobes. There is no discernible left parietal lobe lesion. There is no evidence of intracranial hemorrhage or acute infarct. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Multiple unchanged punctate enhancing metastases in the bilateral cerebellar hemispheres and a punctate lesion in the posterior right pons. Unchanged possible punctate foci of enhancement in the right occipital and inferior parietal lobes. No discernible left parietal lobe metastasis.


Instruction: Generate impression based on findings.

Input: 49-year-old female with concern for bile leak from edge of liver, bilious drain output. Additional clinical history reveals colon cancer with liver metastasis status post right liver resection earlier this year postop day two from a right hemicolectomy which was adhesed to the liver margin and duodenum. ABDOMEN:LIVER, BILIARY TRACT: Status post right hepatectomy and cholecystectomy, small amount of fluid at postoperative site stable to mildly decreased. The common bile duct measures up to 8 mm and appears similar to that seen on the prior CT. No focal discontinuity of the biliary system.Small T2 hyperintense focus in the right hepatic lobe most likely a cyst.SPLEEN: Splenorenal varices are noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right upper pole cyst. No hydronephrosis bilaterally.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is a large right upper quadrant air-fluid collection with a drain terminating within the largest portion of this collection. Small amount of proteinaceous material/blood is noted in the dependent portion of the collection. There is mild wall enhancement of the dependent peritoneal surfaces. Free fluid surrounds the greater curvature of the stomach.The pylorus and D1/D2 segments of the duodenum appears edematous with discontinuous mucosal enhancement that is intimately associated with the large air-fluid collection. Adjacent loops of small bowel also appear edematous. No evidence of small bowel obstruction.BONES, SOFT TISSUES: Body wall edema is present. Amorphous dark signal is noted along the left anterior abdominal wall which may reflect subcutaneous emphysema. Susceptibility artifact from surgical material in the midline anterior abdominal wall.OTHER: Trace bilateral pleural effusions with adjacent atelectasis/consolidation.

Output: 1.Large right upper quadrant air-fluid collection with a drain placed as described above. Intimately associated pylorus and D1/D2 segments of the duodenum appears edematous with discontinuous mucosal enhancement. No biliary duct discontinuity is evident. Provided the large amount of air and intimate association of collection with the duodenum and possible duodenal mucosal discontinuity, findings favor the duodenum as a source of biliary leak. Superimposed infection cannot be entirely excluded. 2.Status post right hepatectomy with postsurgical changes as described above.


Instruction: Generate impression based on findings.

Input: Unspecified disturbances of skin sensation [R20.9], Reason for Study: ^Reason: evaluate for ischemia History: slurred speech, R sided weakness since 9pm 12/1 Brain MRI:No evidence of acute ischemic or hemorrhagic lesion.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.There is about 4.8 mm cerebellar tonsillar ectopia through the foramen magnum.Brain MRA:3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. Mild cerebellar tonsilar ectopia.3. Normal brain MRA


Instruction: Generate impression based on findings.

Input: Progressive glioblastoma. There are postoperative findings related to right pterional craniotomy. There has been slight interval increased in size of the heterogeneously enhancing, infiltrative mass involving the right basal ganglia, insula, temporal lobe, optic chiasm, midbrain, and pons, which measures up to approximately 8 cm. The tumor appears to encase the right posterior cerebral artery. There are numerous scattered punctate foci of susceptibility effect in the mass. There is surrounding infiltrative T2 hyperintensity and evidence of Wallerian degeneration in the right medulla. There is also persistent diffuse bilateral periventricular T2 hyperintensity and an area of subcortical white matter T2 hyperintensity in the inferior left frontal lobe, without associated enhancement. There is no evidence of acute territorial infarction. There is trace midline shift to the left. There is no significant ventricular effacement or enlargement. The orbits are grossly unremarkable.

Output: Slight interval increase in size of extensive tumor involving the right basal ganglia, insula, temporal lobe, optic apparatus, midbrain, and pons. Persistent diffuse bilateral periventricular T2 hyperintensity and an area of subcortical white matter T2 hyperintensity in the inferior left frontal lobe, without associated enhancement are nonspecific.


Instruction: Generate impression based on findings.

Input: Diagnosis: Malignant neoplasm of unspecified site of left female breastClinical question: History of brain mets please compare The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.There are punctate foci of susceptibility effect present in the cerebellar hemispheres bilaterally, right frontal lobe, left temporal lobe and the right occipital lobe which have been identified on prior exams and are best seen on the susceptibility weighted images. These are currently not associated with significant enhancement.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 demonstrate scattered opacities in the right mastoid air cells. The visualized portions of the orbits are intact.A focus of marrow replacement associated with some contrast enhancement in the left parietal calvarium is stable. A focus of marrow replacement along the left occipital condyle is also stable

Output: 1.Multiple lesions associated with blood products are present in the brain which are stable since prior exams. These most likely represent treated metastases.2.Calvarial lesions are reidentified and are also stable compared to the prior exam.


Instruction: Generate impression based on findings.

Input: 10-year-old male with history of knee pain from injury. MENISCI: No abnormal signal intensity within the meniscus, and no discrete tear..ARTICULAR CARTILAGE AND BONE: Small area of high T2/low T1 signal intensity within the medial femoral condyle, correlate with history and physical exam as this may represent a bone contusion. No fracture line is seen. The articular cartilage is intact.LIGAMENTS: The cruciate and collateral ligaments are intact. No significant abnormal signal intensity to suggest sprain/strain. EXTENSOR MECHANISM: The extensor mechanism is intact, without abnormal signal intensity.ADDITIONAL

Output: Findings suggestive of medial femoral condyle bone contusion, without fracture or meniscal abnormality.


Instruction: Generate impression based on findings.

Input: Anterolisthesis, radiculopathy symptoms in the lower extremities Examination is moderately motion degraded. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is grade 1 anterolisthesis at L4-L5 on the current images which is worse on the upright recent radiographs indicative of instability. Bone marrow signal is benign. The conus medullaris is normal in position.Multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: Mild disc bulge which is eccentric to the left. Minimal left neural foraminal narrowing. No spinal canal or right neural foraminal stenosis.L3-L4: Mild disc bulge with suggestion of a small right foraminal annular fissure and small protrusion. There is also ligamentum flavum thickening, prominence of the dorsal epidural fat and fairly mild facet arthropathy contributing to mild spinal canal stenosis. There is mild to moderate right and minimal left neural foraminal stenosis.L4-L5: Grade 1 anterolisthesis as described above with disc uncovering,, disc bulge ligamentum flavum thickening, and advanced bilateral facet arthropathy with facet joint distention. These findings contribute to moderate degree of spinal canal stenosis. There is mild disc height loss. There is also mild to moderate right and moderate left neural foraminal stenosis.L5-S1: Disc desiccation with mild bulge. There is a right posterior paracentral annular fissure. Bilateral facet arthropathy. There is tapering of the thecal sac with prominence of the dorsal epidural fat. No high-grade spinal canal stenosis. Neural foramina are also patent.Small multilevel disc bulges in the lower thoracic spine are partially imaged. Paraspinous soft tissues are within normal limits.

Output: 1. Multilevel degenerative changes in the lumbar spine worst at the L4-L5 level where there is grade 1 anterolisthesis on a degenerative basis with advanced facet arthropathy. Recent upright radiographs demonstrate greater degree of anterolisthesis indicating instability. There is moderate spinal canal stenosis at this level as well as moderate left and mild to moderate right neural foraminal stenosis.2. Mild spinal canal stenosis as well as mild to moderate right neural foraminal stenosis at L3-L4. Additional levels as above.3. Motion degraded examination.


Instruction: Generate impression based on findings.

Input: Elevated LFTs after liver transplant. History of cryptogenic cirrhosis. ABDOMEN:LIVER, BILIARY TRACT: Postsurgical changes from an orthotopic liver transplant. The liver is normal in size, morphology, intensity and enhancement. The portal veins are patent. The hepatic artery is suboptimally evaluated due to susceptibility artifact. The intrahepatic branches are opacified. No suspicious liver lesion.There is mild intrahepatic and extrahepatic biliary ductal dilatation including focal narrowing at the level of the anastomosis (series 7/143), similar to prior study. The common bile duct measures approximately 7 mm. There is also smooth focal narrowing near the anastomosis, raising the possibility of ampullary stenosis. No focal mass or stone.SPLEEN: No significant abnormality noted.PANCREAS: Mild pancreatic atrophy. Several small T2-weighted hyperintense cystic foci, some of which appear to communicate with the main pancreatic duct, compatible with side-branch type intraductal pancreatic mucinous neoplasms without suspicious imaging features. The largest is in the pancreatic head measuring 9 mm (series 4/22).ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left renal 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: Stable examination with mild intra and extra-hepatic biliary ductal dilatation. Stable mild narrowing at the biliary anastomosis and findings raising the possibility of ampullary stenosis/benign stricture without a mass or stone. Several pancreatic cystic foci, likely multiple side-branch type IPMNs without suspicious imaging features.


Instruction: Generate impression based on findings.

Input: Male 28 years old with PSC with elevated LFTs and AP. Concerned for a new stricture vs DILI. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in size and smooth in contour. No enhancing liver lesion is identified. The hepatic vasculature appears patent.There is a long segment of stricturing in the distal common duct similar to the previous exam. A short segment stricture is seen in the right hepatic duct and there are scattered short segment intrahepatic strictures, unchanged. There is mild wall thickening in the proximal common duct. No dominant stricture or mass.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is thickening, loss of haustration, restricted effusion and mild enhancement throughout the visualized colon compatible with the history of ulcerative colitis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Scattered intra and extrahepatic biliary ductal strictures are compatible with the history of primary sclerosing cholangitis and not significantly changed since the previous exam.2.No dominant stricture or hepatic lesion.3.Inflammatory changes within the visualized colon compatible with the history of ulcerative colitis.


Instruction: Generate impression based on findings.

Input: Metastatic breast cancer. There is a heterogeneously enhancing, low T1 and T2 signal intensity left temporal region calvarium lesion that measures up to 5 cm in length with epidural extension that measures up to 7 mm in thickness. There is mild mass effect upon the underlying brain parenchyma. There also appears to be mild subgaleal extension of tumor. There is no evidence of intracranial hemorrhage or acute infarct. There is mild nonspecific periventricular cerebral white matter T2 hyperintensity, but no evidence of intraparenchymal enhancing lesions. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable.

Output: Left temporal calvarium region metastasis with epidural extension measuring up to 7 mm in width.


Instruction: Generate impression based on findings.

Input: Invasive rectal adenocarcinoma with acute encephalopathy. Rule out brain metastasis or infarct. The study is significantly limited by patient motion.Brain: There is a centrally T1 and T2 hyperintense lesion in the right frontal middle gyrus that measures up to 1.7 cm, with thin peripheral susceptibility effect and enhancement. There surrounding vasogenic edema, but no midline shift or herniation. There is apparent patchy restricted diffusion in the bilateral thalami and midbrain without corresponding abnormalities on other sequences. There are numerous punctate foci of susceptibility effect scattered in the bilateral cerebral hemispheres. There are patchy areas of cerebral and pontine white matter T2 hyperintensity. This is moderate diffuse cerebral volume loss. The major cerebral flow voids are intact. There is mild mucosal thickening in the ethmoid sinuses. There is fluid within the mastoid air cells bilaterally. There are bilateral lens implants. There is a subcentimeter left parietal bone hemangioma.Neck: There is a T1 and T2 hyperintense lesion in the right aspect of the lower cervical esophagus, which measures up to 2.8 cm in length and 1.1 cm in width. There is also a prominent right supraclavicular lymph node that measures 9 x 14 mm in axial cross-section. Otherwise, there is no evidence of significant cervical lymphadenopathy or other neck soft tissue mass. The parotid glands are mildly prominent diffusely. The submandibular glands are unremarkable. The trachea appears to be intact. There is multilevel degenerative cervical spondylosis.

Output: The examination is significantly limited by patient motion.Brain:1.A cystic right frontal lesion with surrounding vasogenic edema likely represents a metastasis with hemorrhage versus less likely an abscess in this clinical setting. 2.Numerous foci of punctate hemorrhage scattered in the bilateral cerebral hemispheres may represent cerebral amyloid angiopathy.3.Chronic cerebral and pontine chronic microvascular ischemic disease and diffuse cerebral volume loss. Apparent patchy restricted diffusion in the bilateral thalami and midbrain without corresponding abnormalities on other sequences likely represents artifact rather than acute infarction.4.The lesion within the wall of the right lower cervical esophagus may represent a subacute hematoma or hemorrhagic tumor, although the images are markedly limited by patient motion and lack of dedicated sequences with intravenous contrast.5. Nonspecific prominent right supraclavicular lymph node.6. Nonspecific fluid within the mastoid air cells bilaterally.


Instruction: Generate impression based on findings.

Input: 76 are old female with left thalamic intracranial hemorrhage and portion right upper extremity weakness. There is no evidence of intracranial hemorrhage, mass or edema. Bilateral basal ganglia calcifications unchanged. Slight hyperdensity within the left thalamus may be residual calcification of prior hemorrhagic stroke. Diffuse periventricular and subcortical white matter hypodensities consistent with small vessel disease, age indeterminate. If there is concern for acute ischemia, an MRI may be considered.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Small vessel disease, age indeterminate. If there is concern for acute ischemia, an MRI may be considered.


Instruction: Generate impression based on findings.

Input: 67-year-old female with posterior fossa meningioma. Evaluate for mass change. Heterogeneous mass within the left posterior fossa extending into the upper cervical spine is seen. There is mass effect on the left cerebellar hemisphere and fourth ventricle with surrounding vasogenic edema corresponding to recent MRI. There is no significant hydrocephalus. The basal cisterns are normal in size and configuration. There is no evidence of intracranial hemorrhage. Extensive of subcortical lucencies consistent with small vessel ischemic disease is unchanged.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. No acute change in left posterior fossa meningioma with no evidence of hydrocephalus2. Extensive small vessel ischemic disease of indeterminate age.


Instruction: Generate impression based on findings.

Input: 58-year-old male patient with history of prostate cancer status post prostatectomy with rising PSA. Evaluate for local recurrence. PELVIS:PROSTATE:Prostate Size: Status post prostatectomy.Peripheral Zone: Surgically absent.Central Gland: Surgically absent.Seminal Vesicles: Surgically absent.Extracapsular Extension: None.BLADDER: No significant abnormality noted.LYMPH NODES: There is a 6 mm lymph node in the left perirectal area (series 801 image 28), not seen on prior exam.BONES, SOFT TISSUES: There is an abnormal focus of enhancement with washout in the right periurethral area that measures 9 x 7 mm (series 1401 image 415).OTHER: No significant abnormality noted.

Output: 1.Abnormal focus of enhancement in the right periurethral area is concerning for a focus or recurrent or residual disease.2.New mildly enlarged left perirectal lymph node.


Instruction: Generate impression based on findings.

Input: 56-year-old male with history of renal cancer and pelvic mass. Please compare with previous MRI done 4/2016. ABDOMEN:LIVER, BILIARY TRACT: No focal lesion or biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Status post left nephrectomy. Again noted are several enhancing soft tissue nodules in the left dorsal lateral retroperitoneal space (axial series 14 images 142, 137, 134).The largest nodule measures 3 x 1 cm (axial series 15 image 50), unchanged.Another discrete nodule more inferiorly measures 0.8 cm (axial series 15 image 39), unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Interval enlargement of the previously described peripherally enhancing lesion anterior to the spleen in the left upper quadrant measuring 4.1 x 4 cm (axial series 14 image 259), previously measured as 2.1 x 1.9 cm.BONES, SOFT TISSUES: Similar appearing 2 x 1 cm enhancing nodularity of the lower left lateral abdominal wall musculature (axial series 14 image 200).OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Minimal persistent wedge-shaped focus of enhancement within the left lateral gluteus maximus muscle (axial series 4 image 76). No evidence for pelvic mass.OTHER: No significant abnormality noted.

Output: 1.Increased size of the rim-enhancing mesenteric lesion anterior to the spleen measuring 4.1 x 4 cm (prior 2.1 x 1.9 cm) and is again highly suspicious for a necrotic metastatic focus.2.Status post left nephrectomy with similar appearing enhancing soft tissue nodularity in the left retroperitoneum suspicious for residual/recurrent disease. Not significantly changed.3.Additional nonspecific enhancing soft tissue nodule in the left lateral abdominal wall musculature is also not significantly changed and may represent another site of metastatic disease.


Instruction: Generate impression based on findings.

Input: 37 year old with history of ischemic cardiomyopathy referred to assess burden of scar and LV ejection fraction. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. There is a large territory of akinesis involving the basal anteroseptal wall, mid anterior, anteroseptal, and inferoseptal walls, and the apical anterior, septum, and inferior walls. The overall LV ejection fraction is 24%, the LV end diastolic volume index is 152 ml/m2 (normal range: 74+/-15), the LVEDV is 277 ml (normal range 142+/-34), the LV end systolic volume index is 116 ml/m2 (normal range 25+/-9), the LVESV is 212 ml (normal range 47+/-19), the LV mass index is 48 g/m2 (normal range 85+/-15), and the LV mass is 88 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is a large transmural region of late gadolinium enhancement in a myocardial infarction pattern involving the basal anteroseptal wall, mid anterior, anteroseptal, and inferoseptal walls, and the apical anterior, septum, and inferior walls. These segments are not viable. The remainder of the myocardium is free of myocardial infarction and is viable. Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 46%, the RV end diastolic volume index is 99 ml/m2 (normal range 82+/-16), the RVEDV is 181 ml (normal range 142+/-31), the RV end systolic volume index is 54 ml/m2 (normal range 31+/-9), and the RVESV is 98 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Severe LV dilation with severely reduced systolic function (LVEF 24%). There is a large wall motion abnormality with associated scar involving most of the LAD territory. This territory is unlikely to be viable. The remainder of the myocardium (including the territory of a likely large diagonal artery or a ramus intermedius artery) is free of myocardial infarction and likely to be viable.2. Normal RV size with mildly reduced systolic function (RVEF 46%). 3. Severe left atrial dilation.


Instruction: Generate impression based on findings.

Input: Pilocytic astrocytoma status post laser ablation on 8/12/14. There are postoperative findings related to recent laser ablation of a hypothalamic region tumor, which appears to have decreased slightly in size, now measuring up to 12 mm, previously 14 mm. There is perhaps slightly decreased dilatation of the lateral ventricles as well. The optic apparatus appears grossly intact. There is no evidence of territorial infarction or acute intracranial hemorrhage. There is no midline shift or herniation. The skull and extracranial soft tissues are unchanged.

Output: Postoperative findings related to recent laser ablation of a hypothalamic region pilocytic astrocytoma, which appears to have decreased slightly in size.


Instruction: Generate impression based on findings.

Input: Dysphagia. There are areas of encephalomalacia in the left inferior frontal and parietal lobes with associated susceptibility effect. There is a punctate focus of encephalomalacia in the left thalamus as well. There is also a nonspecific punctate focus of susceptibility effect in the right frontal lobe and mild scattered areas of high T2 signal in the bilateral cerebral hemisphere white matter without restricted diffusion. 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 are grossly unremarkable. There is a focus of arrested pneumatization of the right sphenoid sinus.

Output: 1. Chronic infarcts with associated chronic hemorrhage in the left inferior frontal and parietal lobes, left thalamus chronic lacunar infarct, and a background of probable chronic small vessel ischemic disease.2. No evidence of acute intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: 48-year-old female with anaplastic thyroid cancer: evaluate for metastases. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is a punctate focus of faint enhancement and susceptibility effect in the right paramedian pons. There is also a small developmental venous anomaly in the left superior frontal gyrus. 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 a right maxillary sinus retention cyst.

Output: Punctate probable capillary telangiectasia in the right pons and a small developmental venous anomaly in the left superior frontal gyrus. Otherwise, no evidence of intracranial metastases.


Instruction: Generate impression based on findings.

Input: Clinical question: Hypoxic encephalopathy. Signs and symptoms: Cardiac arrest. Non-infused CT of brain.Examination again demonstrates a hematoma in the left thalamic region. Poorly defined borders of hematoma are consistent with breakdown. The overall size of this hematoma remains similar to prior exam of 24 hours earlier. Very extensive surrounding vasogenic edema with associated mass effect is again identified and with no appreciable change. Edema appears to extend inferiorly from the thalamus into the left cerebral peduncle. Mass effect on the third ventricle and midline shift remains similar to prior exam. Mild guided patient of lateral ventricles remains similar. Minimal amount of blood within bilateral occipital horns remain stable. Extensive periventricular and subcortical foci of low-attenuation although nonspecific however there are concerning for small vessel disease of indeterminate age.Further follow-up with an MRI is recommended.

Output: Overall stable exam since prior study.


Instruction: Generate impression based on findings.

Input: History of multiple pancreatic cysts. Evaluate for suspicious imaging characteristics. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology and size, measuring 15 cm in craniocaudal dimension. No focal suspicious lesion, biliary ductal dilatation or vascular abnormality.SPLEEN: The spleen is normal in size without a focal lesion.PANCREAS: The pancreas is mildly atrophic. It is normal in signal intensity. The main pancreatic duct appears to drain into the major papilla. There is an additional dilated tubular structure in the pancreatic head/uncinate process (series 9/23) which appears to drain into the major papilla, slightly more prominent than previously but seen dating back to 2008. This may represent a dilated side-branch versus variant ductal anatomy. Several subcentimeter cystic lesions are noted in the pancreas parenchyma the largest being in the body measuring 9 x 6 mm (series 10/15), essentially unchanged. It appears to communicate with a normal caliber main pancreatic duct.No suspicious enhancement characteristics.Additional subcentimeter cystic pancreatic foci are too small to characterize, unchanged.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Stable small cystic pancreatic body lesion likely represents a sidebranch IPMN without suspicious imaging characteristics.2. Dilated side-branch versus variant ductal anatomy appearing essentially unchanged dating back to 2008.


Instruction: Generate impression based on findings.

Input: 72-year-old male with abnormal CT findings. Evaluate for an ampullary lesion. ABDOMEN:LIVER, BILIARY TRACT: No suspicious hepatic lesion. The common bile duct is mildly dilated to approximately 8 mm.SPLEEN: No significant abnormality noted.PANCREAS: No evidence of a pancreatic mass. The pancreatic duct is mildly dilated.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts with the largest measuring up to 2 cm.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.Mild common bile duct and pancreatic ductal prominence. Findings are nonspecific but may represent a benign ampullary stricture. 2.No pancreatic mass.


Instruction: Generate impression based on findings.

Input: 41 year old female with history of left lumpectomy for IDC in 04/2010. Patient is status post radiation. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.Postsurgical changes including scarring are seen in the left axillary tail. No abnormal enhancement is identified in this region. A few benign-appearing enhancing foci are again seen in the right breastNo abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Known cavernoma patient, follow-up. Headache, blurred vision No evidence of acute ischemic lesion on this scan.There is a lesion at the left parieto-temporal lobe trigone with susceptibility artifact consistent with cavernous malformation. The lesion appears to be located on the periventricular white matter with possibly the hemosiderin deposition on the left lateral ventricular wall. There is no evidence of associated DVA. There is no evidence of surrounding edema.There is no evidence of abnormal Gad enhancement.Above described findings do not show any significant interval change since prior exam. 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: Re-demonstration of cavernous malformation on the left parieto-temporal lobe trigone area as described above. No change since prior exam.No evidence of new acute ischemic or hemorrhagic lesion on this scan.


Instruction: Generate impression based on findings.

Input: Progressive and congenital hearing loss. Internal Auditory Canal: The bilateral cranial nerve 7 and 8 complexes are intact. There is no evidence of mass lesions. The inner ear structures, including the cochlea, vestibule, endolymphatic duct, and semicircular canals, appear unremarkable. There is scattered fluid signal in the right mastoid air cells and middle ear. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are terminal zones of myelination in the bilateral parietal lobes. The brain parenchyma otherwise appears unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. No evidence of cochlear nerve deficiency of gross inner ear anomalies.2. No evidence of acute intracranial hemorrhage, mass, or acute infarct.3. Scattered fluid signal in the right mastoid air cells and middle ear likely represents sequela of recent otomastoiditis.


Instruction: Generate impression based on findings.

Input: Evaluate parotid gland enlargement. Possible sarcoidosis. None in views CT of soft tissues of neck:Limited value exam due to lack of intravenous contrast. This study was performed without the benefit of contrast as it was requested by clinical service.Images through the skull base, paranasal sinuses and bilateral petrous bones are unremarkable.Examination demonstrates normal low attenuation of parotid glands bilaterally. The left parotid gland appears a slightly larger than the right however with similar normal appearing density. Very small nodes within the left parotid measuring approximately 5 mm in size are identified. These findings were observed on prior MRI examination and show no change. The fascial planes surrounding the parotid glands remain within normal limits.Images through the rest of the neck demonstrate no evidence of a mass or any pathologic adenopathy.

Output: Essentially unremarkable CT of soft tissues of neck and without enhancement. Minimally larger left parotid gland however the normal density and morphology. Very small sub-centimeter lymph node in the left parotid is noted.


Instruction: Generate impression based on findings.

Input: Low back pain, new. For this study I will designate five lumbar vertebrae with small hypoplastic ribs at L1. Vertebral body heights and intervertebral disc spaces appear normal. Facet joints appear normal. Alignment is within normal limits. There are tiny osteophytes projecting from the anterior aspects of L3. Sclerosis within the iliac wings along the sacroiliac joints likely represents chronic bone infarction, as suggested on an MRI exam of the hip from 2010. Surgical clips are noted in the right upper quadrant.

Output: Sclerosis along the sacroiliac joints may represent osteonecrosis, but I otherwise see no specific findings to account for the patient's back pain.


Instruction: Generate impression based on findings.

Input: Spinal cavernous malformation, yearly surveillance. Again seen is a hemorrhagic spinal cord lesion at the T10 vertebral body level predominantly involving the left aspect of the cord and measuring approximately 8 x 7 mm in the axial plane, which is unchanged. Hemosiderin staining extending slightly superiorly and inferiorly is also unchanged. There is no new surrounding edema appreciated on the current exam. The thoracic vertebral bodies are appropriate in the overall alignment and height. There is disc desiccation at the T9-T10 level with a right-sided disc protrusion which effaces the right lateral aspect of the thecal sac at this level. The disc protrusion is minimally increased in the interval. No significant spinal canal or neural foraminal stenosis at this level or elsewhere in this thoracic spine.

Output: 1. Compared to 11/24/2014 and 11/25/2013, there is no significant change in hemorrhagic intramedullary lesion centered at the left T10 level consistent with cavernous malformation.2. Small disc protrusion at the right T9-T10 level is minimally increased in the interval but without significant associated spinal canal stenosis.


Instruction: Generate impression based on findings.

Input: Male 57 years old Reason: 57M with high risk prostate cancer, pre-operative imaging for surgical planning. PELVIS:PROSTATE:Prostate Size: 4.7 x 5.3 x 4.6 cmPeripheral Zone: The peripheral zone at the base, mid gland and apex, right greater than left, as well as much of the central gland is replaced by abnormal T2 hypointense signal which is also dark on the ADC map. A representative measurement of signal abnormality at the midline measures 4.7 x 4.5 cm.Central Gland: Please see above.Seminal Vesicles: There is loss of normal T2 hyperintense signal within the medial aspect of the seminal vesicles bilaterally and the appearance is suspicious for seminal vesicle invasion.Extracapsular Extension: The prostate gland is diffusely enlarged and abuts the anterior wall of the rectum at the apex. Rectal invasion is not excluded.BLADDER: Foley catheter within the bladder, deviated in course secondary to prostatic tumor invasion.LYMPH NODES: Enlarged right common iliac node measures 1.3 x 0.9 cm (series 1003, image 119). Additional subcentimeter pelvic side wall and mesorectal nodes are also noted. A reference right perirectal node measures 0.8 x 0.5 cm.BONES, SOFT TISSUES: Left hip prosthesis causes significant artifact which significantly limits evaluation of the left hemipelvis and the adjacent osseous structures. Enhancing right hip joint effusion is suspicious for right hip synovitis which is incompletely assessed on this nondedicated study.OTHER: No significant abnormality noted.

Output: 1.Signal abnormality replacing much of the normal prostate gland with suspicion for extracapsular extension and seminal vesicle invasion. Invasion of the anterior rectal wall is not excluded. Enlarged right common iliac lymph node and subcentimeter perirectal and pelvic sidewall lymph nodes are noted.2.Suspicion for right hip synovitis.


Instruction: Generate impression based on findings.

Input: 46-year-old man with right knee pain. MENISCI: The lateral meniscus appears normal. There is increased signal intensity within the root of the posterior horn of the medial meniscus, which may reflect focal degeneration. There is also focal signal abnormality in the underlying tibia. ARTICULAR CARTILAGE AND BONE: There is mild focal degeneration of the articular cartilage of the patella at the median eminence. The remaining articular cartilage of the knee appears normal. The remaining bone marrow signal intensity is within normal limits.LIGAMENTS: The ACL and PCL appear intact. The MCL and LCL complex appear intact. There is mild edema between the iliotibial band and lateral femoral condyle. There is additional mild edema within the subcutaneous fat along the anterolateral aspect of the tibia.EXTENSOR MECHANISM: The quadriceps and patellar tendons appear intact. There is mild edema in the subcutaneous fat anterior to the patella and patellar tendon, which is nonspecific. ADDITIONAL

Output: 1.Normal appearance of the lateral meniscus.2.Increased signal intensity within the root of the posterior horn of the medial meniscus suggesting degeneration.3.Mild subcutaneous edema as described above. Mild edema deep to the iliotibial band could reflect a "friction syndrome."4.Other findings as above.


Instruction: Generate impression based on findings.

Input: Male 18 years old with left knee pain and swelling, evaluate for acl tear, patellar fracture, contusion MENISCI: The menisci are normal in appearance.ARTICULAR CARTILAGE AND BONE: Increased T2 signal along the lateral condyle and medial patellar facet consistent with osseous contusions. No evidence of acute fracture.LIGAMENTS: Increased signal abnormality within the medial patellofemoral ligament with subtle fragmentation at the very edge of the articular cartilage of the medial patellar facet (901/23-24). Fluid surrounds the LCL complex without evidence of disruption. The ACL, PCL, and MCL are intact. EXTENSOR MECHANISM: Intact.ADDITIONAL

Output: 1. Possible transient patellar dislocation with a partial patellofemoral ligament tear.2. Moderate joint effusion is present.


Instruction: Generate impression based on findings.

Input: Forgetfulness and inattention. Cognitive impairments. There is global parenchymal volume loss, mildly prominent for age. There are extensive scattered and confluent areas of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, which are nonspecific, but most consistent with extensive chronic small vessel ischemic changes. There is no evidence of intracranial hemorrhage, mass effect, or acute infarct. No hydrocephalus or extra-axial collections. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable.

Output: 1. Global parenchymal volume loss with extensive chronic small vessel ischemic changes. 2. No evidence of intracranial hemorrhage, mass effect, or acute infarct.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 33 years, Female, Reason: surveillance s/p trachelectomy History: none. PELVIS: FemaleUTERUS, ADNEXA: Postsurgical changes of trachelectomy and myomectomy. The residual uterus measures 3.6 x 3.5 x 4.4 cm. There is an exophytic small focus of tissue along the anterior aspect of the anastomosis which is likely postsurgical. No evidence of local recurrence.BLADDER: No significant abnormality notedLYMPH NODES: No lymphadenopathy.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: No evidence of recurrent disease or lymphadenopathy.


Instruction: Generate impression based on findings.

Input: Right arm weakness/deficits status post septic shock and VA-ECMO (now decannulated). There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is mild fluid in the right nasal cavity, possibly with nasogastric tube. There is minimal opacification of the right mastoid air cells. There is a small left maxillary sinus retention cyst. The orbits, skull, and scalp soft tissues are grossly unremarkable. However, there is a nodular lesion in the left cheek subcutaneous tissue that measures up to 15 mm.

Output: 1. No evidence of acute intracranial hemorrhage, mass, or acute infarct.2. A nodular lesion in the left cheek subcutaneous tissue that measures up to 15 mm may represent an inclusion cyst, for example, but is nonspecific.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Reason: evaluate kyphosis History: kyphosis - status post hemilaminectomy for aneurysmal bone cystVIEWS: Thoracolumbar spine lateral (1 views) 06/18/15 at 09:21 Overlying brace is noted. A surgical clip overlies T8. The thoracic kyphosis measured between T4 and T10 is 50 degrees.

Output: 50 degrees of kyphosis between T4 and T10.


Instruction: Generate impression based on findings.

Input: 25-year-old female with a history of recurrent acute pancreatitis. MRI/MRCP without contrast was negative for choledocholithiasis and showed a moderately distended gallbladder. Rule out sphincter of Oddi dysfunction. ABDOMEN:LIVER, BILIARY TRACT: No intra-or extrahepatic biliary ductal dilation. No focal mass lesions are identified. No gallstones are seen.SPLEEN: No significant abnormality noted.PANCREAS: There is restricted diffusion and decreased signal abnormality in the distal body and tail of the pancreas which has a "sausage" shaped appearance with loss of its normal fatty invaginations. There is also faint peripheral enhancement on post contrast sequences. There is a dampened response to secretin after augmentation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No evidence of lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Nonspecific findings which are suggestive of autoimmune pancreatitis, as detailed above. Correlation with IgG4 levels could be considered for further evaluation.


Instruction: Generate impression based on findings.

Input: 54-year-old male with headache; evaluate for possible bleed There is no evidence of acute intracranial hemorrhage, mass or edema. Patchy nonspecific areas of hypoattenuation are seen in the subcortical white matter which may represent small vessel ischemic disease of indeterminate age. Please correlate with patient history and symptoms. No acute cortical infarct is identified. If high clinical concern for ischemia, MRI may be obtained. Bilateral basal ganglia calcifications.The ventricles and basal cisterns are normal in size and configuration.Sequelae of an old left orbital blowout fracture of the lamina papyracea is noted. Otherwise, the calvaria and skull base are radiographically normal. The visualized paranasal sinuses, mastoid air cells and middle ear cavities are normally pneumatized.

Output: 1. No acute intracranial hemorrhage or acute cortical infarct. 2. Likely small vessel ischemic disease of indeterminate age.


Instruction: Generate impression based on findings.

Input: Evaluate for chronic pancreatitis. History of recurrent acute pancreatitis. Daily abdominal pain nausea and vomiting. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology and size. There is loss of signal intensity on in phase imaging suggesting iron deposition. Status post cholecystectomy. No intra or extrahepatic biliary ductal dilatation. The vessels are patent. No focal suspicious lesion.The vessels are patent.Perfusional anomaly in segment 4B, benign.SPLEEN: The spleen is normal in morphology and size without a focal lesion. Small splenule adjacent to splenic hilum.PANCREAS: The pancreas is normal in morphology. The main pancreatic duct is at the upper limits of normal measuring approximately 3 to 4 mm in maximal caliber. It is relatively smooth without focal stricture or dilatation. Following secretin administration there is a prompt excretion of pancreatic fluid with mild increase in main pancreatic duct caliber. No side-branch ectasia.The pancreas demonstrates decreased intrinsic T1 weighted signal intensity suggesting parenchymal dysfunction. It demonstrates homogeneous parenchymal enhancement. No peripancreatic inflammatory changes to suggest acute pancreatitis. No focal lesion.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No evidence of acute pancreatitis. Decreased intrinsic T1-weighted signal intensity and mild prominence of the main pancreatic duct can be seen in the setting of mild chronic pancreatitis. Normal secretin response. No focal pancreatic lesion or significant duct stricture.


Instruction: Generate impression based on findings.

Input: The study is motion degraded. Multiple repeated sequences were attempted. Fast scan sequences were also attempted. Given these caveats:The marrow signal is benign. The cervical and upper thoracic cord is normal in signal without abnormal enhancement. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are grossly unremarkable.Cervical spondylosis is present throughout, notable from C3/4 through C6/7. At these levels there are likely degrees of central and neural foraminal stenosis, without cord compression or intrinsic cord signal abnormality. Additionally there is anterolisthesis of C7 on T1 secondary to facet disease.

Output: 1.Severe motion degradation limits diagnostic evaluation.2.No gross abnormal enhancement to suggest the presence of metastatic disease.3.Cervical spondylosis with probable central and neural foraminal stenoses as described in detail above. Further characterization of the degree of stenosis would require a diagnostic exam, which may require sedation.


Instruction: Generate impression based on findings.

Input: Female 57 years old Reason: HCC screening History: PBC ABDOMEN:LIVER, BILIARY TRACT: The patient status post cholecystectomy. There is persistent mild intrahepatic biliary ductal dilatation. Single punctate focus of arterial enhancement in the right hepatic lobe (series 10/40) is nonspecific, and not seen on any other sequence-type or phase of contrast enhancement. The portal vasculature is patent. There is persistent mild intrahepatic biliary ductal dilatation, not substantially changed for multiple prior studies.SPLEEN: The spleen measures 13 cm in length and there are numerous perisplenic varices related to a splenorenal shunt.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Additional T2 hyperintense lesion in the superior pole of the left kidney is too small to characterize but presumably benign. There is no hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No ascites.

Output: 1.Nonspecific punctate arterial hyperenhancement in the right lobe of the liver is not present on any other sequence. Continued imaging surveillance for hepatocellular carcinoma is suggested in this high-risk patient.2.Mild intrahepatic biliary ductal dilatation, unchanged.3.Splenomegaly with perisplenic varices related to a splenorenal shunt unchanged.4.No ascites.


Instruction: Generate impression based on findings.

Input: Female, 63 years old, with psychomotor slowness and right-sided hyperreflexia. Scattered Brain:Relatively proportional prominence of the lateral and third ventricles and the cerebral sulci is seen likely reflecting underlying parenchymal volume loss. The temporal horns of the lateral ventricles are not dilated. The fourth ventricle is within normal limits.Minimal periventricular T2 hyperintensity is seen which can be a normal finding in this age group. No evidence of any focal parenchymal lesion, edema or mass effect is observed. No diffusion restriction is seen. No findings to suggest acute intracranial hemorrhage or any abnormal extra-axial fluid collection are detected.C-spine:Exaggeration of the cervical lordosis is seen. A trace anterolisthesis of C6 relative to C7 is noted. Sagittal alignment is otherwise unremarkable.Vertebral body height and morphology are within normal limits. No evidence of marrow replacement or marrow edema is seen.The visualized spinal cord shows normal signal intensity and morphology throughout. No epidural abnormalities are suspected.The left thyroid lobe is questionably somewhat nodular. The paraspinal soft tissues are otherwise unremarkable.C2-3: No spinal canal stenosis or neuroforaminal narrowing. C3-4: Left facet arthropathy. No significant spinal canal stenosis or neuroforaminal narrowing. C4-5: Facet arthropathy. Loss of disc height and minimal posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Moderate left foraminal narrowing. C5-6: Left greater than right facet arthropathy. No significant spinal canal stenosis. Moderate left foraminal narrowing. C6-7: Facet arthropathy. Minimal posterior disc-osteophyte complex formation. No spinal canal stenosis. Moderate left foraminal narrowing C7-T1: No spinal canal stenosis or neuroforaminal narrowing.

Output: 1.Proportionate prominence of the supratentorial ventricles and cerebral sulci is demonstrated most likely representing generalized parenchymal atrophy. No focal or acute intracranial lesions are detected.2.Relatively mild degenerative findings are seen in the cervical spine. No areas of high-grade spinal canal stenosis or spinal cord impingement are seen. At most, moderate foraminal narrowing is evident at several levels on the left.


Instruction: Generate impression based on findings.

Input: Clinical question: Progressive bilateral lower extremity weakness and paresthesias of her feet, hands and tongue. Rule out multiple sclerosis. Signs and symptoms: As above. Pre and post enhanced brain MRI:Negative diffusion weighted series.Examination demonstrate periventricular, subcortical, corpus callosum, midbrain, bilateral middle cerebellar peduncles and medullary foci of FLAIR hyperintensity without associated mass effect or hemorrhagic changes and without detectable abnormal enhancement. The morphology, distribution and signal intensity of the findings are highly suggestive of chronic demyelinating disease of moderate degree. Postcontrast images demonstrate a tiny left inferior frontal developmental venous anomaly of no clinical significance.There is mild prominence of cortical sulci mostly in the parietal region for patient of stated age. The ventricles remain within normal size and with maintained midline.The signal void of major intracranial arterial branches are identified.Unremarkable calvarium, soft tissues of the scalp, orbits and paranasal sinuses.Pre- and post enhanced cervical MRI:Examination demonstrates diffuse patchy foci of T2/T2 STIR hyperintensity throughout the cervical spine and medulla without abnormal enhancement or change in the cord caliber. Findings are consistent with chronic demyelinating disease of moderate to advanced degree. Mild degenerative changes throughout the cervical spine is noted however without significant central spinal stenosis at any level.Pre and post enhanced thoracic MRI:This examination also demonstrate mild diffuse findings of demyelinating disease throughout the thoracic cord which is best appreciated on axial T2 series. There is short segmental decreased cord caliber in the lower thoracic cord secondary to demyelinating disease.There is no detectable abnormal enhancement of the cord or the leptomeninges.Mild to moderate degenerative changes of the discs and hypertrophic changes of the ligamentum flavum posteriorly are noted. There is however no evidence of central spinal stenosis at any level.

Output: 1.Pre and postcontrast enhanced brain MRI demonstrates findings consistent with moderate chronic demyelinating disease as detailed.2.Pre and post contrast cervical MRI demonstrate diffuse findings of chronic migraine headache and disease without significant change in cord caliber.3.Pre- and post enhanced thoracic MRI demonstrates findings of demyelinating disease of the thoracic cord without detectable abnormal enhancement. There is a focal segmental decreased cord caliber in the lower thoracic cord and unremarkable thoracic cord caliber otherwise.


Instruction: Generate impression based on findings.

Input: Cirrhosis with HCC status post TACE/RFA. Segment 8 1.6 cm lesion. ABDOMEN:LIVER, BILIARY TRACT: Nodular cirrhotic liver morphology.The segment 8 ablation cavity measures approximately 1.8 x 1.3 cm, compared to 2.2 x 1.7 cm previously with internal T1-weighted hyperintense debris. There is a punctate nodular focus of arterial enhancement along the anterior and caudal aspect of the ablation cavity without definite washout. Otherwise minimal thin enhancement around the ablation cavity is unchanged.There is plaque-like enhancing focus at the gallbladder fundus measuring 1.2 x 0.5 cm, unchanged dating back to 1/6/2015, with associated T2-weighted cystic intensity, likely focal adenomyomatosis. Cholelithiasis without cholecystitis. Recanalized umbilical vein. The common hepatic artery originates from the aorta. The vessels are patent.SPLEEN: Stable mild splenomegaly, measuring 14 cm in length.PANCREAS: Lobular cystic focus in the pancreatic head measuring approximately 1.3 cm is unchanged, likely communicates with a normal caliber pancreatic duct. No suspicious postcontrast imaging features.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Simple appearing renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Small fat-containing umbilical hernia.OTHER: No significant abnormality noted.

Output: 1.Punctate nodular enhancement along the anterior and caudal aspect of the segment 8 ablation cavity may be posttreatment changes, however attention to this on follow-up imaging is recommended.2.No new suspicious liver lesion.3.Stable cystic lesion in head may represent a side branch IPMN without suspicious imaging features.


Instruction: Generate impression based on findings.

Input: Evaluate for demyelinating disease: paresthesias. There is faint patchy T2 hyperintensity in the cervical and upper thoracic spinal cord at multiple levels, particularly at C2 through C4. There is a left middle cerebellar peduncle T2 hyperintense lesion. There is no evidence of mass lesions. The vertebral column alignment is mildly straightened in the sagittal plane and there is mild degenerative spondylosis at C4 though C6, but there is no significant spinal canal stenosis. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. The paravertebral soft tissues are unremarkable.

Output: Findings compatible with demyelinating lesions in the cervical and upper thoracic spinal cord at multiple levels, although these are incompletely characterized without intravenous contrast. Refer to the previous brain MRI regarding additional intracranial lesions.


Instruction: Generate impression based on findings.

Input: 10-year-old female with arachnoid cyst experiencing dizziness Redemonstrated is an approximately 32 x 27 mm extra-axial cystic lesion interposed between the left frontal lobe and frontal calvarium. The lesion does not enhance and follows CSF signal characteristics on all sequences. The lesion exerts mass effect on the adjacent frontal lobe which is compressed and displaced posteriorly. The parenchyma surrounding this lesion, however, is free of any pathologic signal alteration, edema, or enhancement.No additional abnormality is detected. The remainder of the brain demonstrates normal morphology and signal characteristics. Diffusion weighted images are unremarkable. No pathologic parenchymal or extra-axial enhancement is seen. There is no evidence of intracranial hemorrhage. The ventricle system is normal in size and morphology.

Output: Stable left frontal arachnoid cyst exerting mass effect on the adjacent frontal lobe. The brain parenchyma, however, is free of pathologic signal alteration.


Instruction: Generate impression based on findings.

Input: Reason: Evaluate lateral meniscus, s/p lateral menisectomy with continued pain and Baker's cyst, 3 years ago. History: Right knee pain MENISCI: There is blunting of the posterior horn of the lateral meniscus likely representing a combination of degeneration and postsurgical change. No fluid filled tear is identified. The anterior horn appears intact. There is blunting of the free edge of the body of the medial meniscus which likely represents superficial fraying/degenerative tearing. No fluid-filled tear is evident.ARTICULAR CARTILAGE AND BONE: Note is made of focal full-thickness articular cartilage degeneration along the weightbearing portion of the medial femoral condyle above the body of the meniscus measuring approximately 7 mm in the transverse dimension (image 14; series 1001).LIGAMENTS: There is thickening and intermediate signal intensity within the proximal fibers of the PCL which may represent mucoid degeneration or prior tearing. There is cyst formation within the distal femur at the insertion of the PCL. The ACL, MCL and LCL appear intact.EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Blunting of the medial and lateral menisci as described above likely represents a combination of degeneration and possibly postsurgical change. No fluid-filled tear/unstable tear is identified.2. Focal full-thickness articular cartilage degeneration with delamination along the weightbearing surface of the medial femoral condyle.3. Large Baker's cyst. 4. Thickening and intermediate signal intensity within the proximal fibers of the PCL may reflect prior sprain versus mucoid degeneration.


Instruction: Generate impression based on findings.

Input: A-year-old male with history of recurrent pancreatitis. ABDOMEN:LIVER, BILIARY TRACT: No intrahepatic biliary ductal dilation. No suspicious masses. The common bile duct measures 3 mm.SPLEEN: No significant abnormality noted.PANCREAS: There is increased T2 signal abnormality with associated restricted diffusion throughout the pancreas compatible with acute pancreatitis. There is no evidence of pseudocyst or vascular complication.The main pancreatic duct is diffusely irregular, particularly in the pancreatic head, however it is not abnormally dilated. Small hypointense filling defect near the proximal pancreatic duct may represent a stone or calcification.Mild pancreatic atrophy. Pancreatic exocrine function is diminished.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Findings compatible with acute on chronic pancreatitis with a diffusely irregular main pancreatic duct, worse near the pancreatic head. Intraductal hypointense lesion near pancreatic head may represent a stone or calcification. Moderately diminished pancreatic exocrine function.


Instruction: Generate impression based on findings.

Input: Chronic knee pain Due to the patient's body habitus, the high-definition knee MRI coil was not able to be used. An alternate coil was used, which limits image quality and evaluation.MENISCI: There is poorly-defined increased signal at the inner edge fibers of the body of the lateral meniscus, likely reflecting mild degenerative fraying. We see no findings to suggest an unstable tear. The medial meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is focal increased signal intensity within the articular cartilage of the medial patellar facet with slight prominence of the cartilage, reflecting partial-thickness focal degeneration (blistering). The medial and lateral tibiofemoral compartments appear normal.LIGAMENTS: The cruciate and collateral ligaments are intact.EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Focal degeneration of the articular cartilage of the medial patellar facet.2. Mild degenerative fraying of the free edge of the body of the lateral meniscus. We see no findings to suggest an unstable tear.


Instruction: Generate impression based on findings.

Input: Clinical question: Stenosis. Signs and symptoms: Sciatica. CT of lumbar spine:The alignment of the vertebral column is anatomical.T12 -- L1.Minimal degenerative changes and unremarkable otherwise.L1 -- 2.Minimal degenerative changes and unremarkable otherwise.L2 -- L3.Minimal degenerative changes and unremarkable otherwise.L3 -- L4.There is mild degenerative disk disease and minimal hypertrophic changes of posterior elements.There is asymmetric midline and leftward disk protrusion with resultant mass effect and posterior displacement of thecal sac. No convincing evidence of central trauma stenosis however mild lateral recess compromise bilaterally is noted. Minimal bilateral neural foraminal compromise is also present.L4 -- L5.Advanced degenerative disk disease with significant loss of disk height and mild hypertrophic changes of posterior elements are present. There is shallow broad based bulge of disk slightly more prominent on the right. No central spinal stenosis. Very minimal bilateral neural foramina (right greater than left) is present.L5 -- S1.Minimal degenerative changes. No central spinal stenosis. Minute bilateral neural foraminal compromise secondary to hypertrophied changes of ligamentum flavum present.

Output: 1.No convincing evidence of central spinal stenosis at any level.2.Broad base disk protrusion in the midline and to the left however at L3--L4 results in subtle mass effect on the thecal sac at this level.3.Advanced degenerative disk disease at L4 -- L5 level and mild disk disease at other levels.4.Minimal bilateral neural foraminal compromise at L3 -- L4, L4 -- L5 (right greater than left) and L5 -- S1 levels are present.


Instruction: Generate impression based on findings.

Input: Female, 30 years old, with migraines and seizure. The cerebral and cerebellar hemispheres and brainstem show normal signal intensity and morphology. No restricted diffusion is seen. The medial temporal lobes structures are symmetric and free of signal abnormality.No evidence of parenchymal edema, mass, or mass effect is seen. There is no evidence of intracranial hemorrhage or abnormal extra-axial fluid. The ventricular system is normal in caliber and morphology.

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


Instruction: Generate impression based on findings.

Input: Female, 36 years old, with MS, f/u progression. Numerous lesions are redemonstrated involving the corpus callosum, periventricular and subcortical white matter both supra- and infratentorially. These show a morphology consistent with demyelination.Since the prior examination, a prominent lesion within the left cerebellum/middle cerebellar peduncle has decreased in size. A prior lesion within the left parietal subcortical white matter is also decreased in size. However, some lesions have increased in size or are new including one in the left frontal subcortical white matter (image 19 series 801), and two within the right cerebellum (image 8 series 8 a one). Most of the numerous additional lesions are unchanged.The corpus callosum is mildly thinned but brain parenchymal morphology is otherwise unremarkable. No evidence of significant mass effect is seen. No intracranial hemorrhage is suspected. There are no abnormal extra-axial collections and the ventricles are normal in size and morphology.

Output: Most of the numerous white matter lesions, compatible with the history of multiple sclerosis, are unchanged. However, at least two lesions seen on the prior examination have improved in terms of size and conspicuity, and three lesions are either new or increased in size.


Instruction: Generate impression based on findings.

Input: Reason: Rule out osteosynovitis History: redness, swelling, pain There is a moderate joint effusion with synovial enhancement, indicating mild synovitis. There is no bone marrow edema to suggest osteomyelitis. There is mild edema of the subcutaneous fat anteriorly. Focal increased signal intensity within the articular cartilage of the patella just medial to the median eminence likely reflects full thickness degeneration with an underlying degenerative cyst. There is linear signal within the anterior horn of the lateral meniscus with extension to the tibial surface, which may represent a small undersurface tear but is of questionable significance. There is mild intrasubstance degeneration of the medial meniscus but no tear is seen. The cruciate and collateral ligaments are intact. The extensor mechanism is intact.

Output: Joint effusion and mild synovitis. We see no radiographic findings to suggest osteomyelitis. Other findings as described above.


Instruction: Generate impression based on findings.

Input: There is no evidence of spinal cord lesions. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no abnormal enhancement. There are minimal posterior disc-osteophyte complexes at C4-5, C5-6, and C6-7 levels without spinal canal or neural foraminal stenosis. There is a left thyroid nodule that partially enhances and measures up to approximately 10 mm.

Output: 1. No evidence for demyelinating disease of the cervical or thoracic spinal cord.2. Minimal degenerative spondylosis of the cervical spine without spinal canal or neural foraminal stenosis.3. Nonspecific left thyroid nodule that measures up to approximately 10 mm. Thyroid ultrasound may be useful for further evaluation.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Male, 55 years old, with left-sided weakness. Assess brain lesions. Enhancing lesions are redemonstrated along the body of the right lateral ventricle, within the right ventricular atrium, occipital horn and temporal horn, and within the right cerebellum. All lesions show interval reduction in size of enhancement and degree of associated parenchymal edema. A previously noted small lesion within the left occipital lobe is no longer discretely identified. No new intracranial lesions are seen. No significant generalized mass effect is detected, though there is still mild edema related effacement of the right ventricular atrium. A few additional scattered small foci of white matter T2 hyperintensity are unchanged and nonspecific. The ventricular system is otherwise normal in size and morphology. The calvarial marrow demonstrates heterogeneous fat signal but no pathologic enhancement.

Output: Continued interval decrease in the enhancement and associated edema related to multiple parenchymal and intraventricular lesions.


Instruction: Generate impression based on findings.

Input: New diagnosis of prostate cancer, GS 6, T1c, PSA 9 PELVIS:PROSTATE: Prostate Size: 2.7 x 4.8 x 4.0 cm (AP x TR x CC)Peripheral Zone: Patchy T1 hyperintensity involving the peripheral zone bilaterally consistent with hemorrhage. There is T2 hypointense bandlike signal abnormality involving predominantly the right gland with a focal T2 hypointense lesion in the right mid gland / base.Central Gland: BPH nodules.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: No evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No lymphadenopathy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Findings are suggestive of a small focus of carcinoma involving the right mid gland / base superimposed on a background of prostatitis and hemorrhage.


Instruction: Generate impression based on findings.

Input: MRI head: There is no diffusion abnormality to indicate acute infarction. There are scattered punctate foci and confluent areas of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter as well as in the pons, consistent with extensive chronic small vessel ischemic changes, and minimally progressed from prior. Scattered supratentorial lacunar infarcts also seen such as in the right temporal white matter, thalami and right caudate head. There are also small lacunar infarcts in the bilateral cerebellar hemispheres.Again seen is a lipoma measuring about 13 x 11 mm abutting the pontomedullary junction without significant mass effect and unchanged. There is susceptibility associated with the lipoma compatible with mineralization.The ventricles and sulci are mildly prominent and unchanged from the previous exam. There is no midline shift or mass effect. The basal cisterns remain patent. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. There is diffuse opacification of the right sphenoid sinus better seen on prior CT as well as trace mucosal thickening elsewhere.MRA head: The intracranial internal carotid arteries are normal in course and caliber. The middle and anterior cerebral arteries are unremarkable. There are patent bilateral posterior communicating arteries, larger on the left. The right vertebral artery is dominant. Basilar artery, and posterior cerebral arteries are normal in course and caliber. There is no evidence of flow-limiting stenosis or aneurysm.

Output: 1. No evidence of acute ischemia.2. Extensive chronic small vessel ischemic disease, minimally progressed since 4/19/2013.3. Unchanged lipoma at the pontomedullary junction without mass effect, not significantly changed.4. No evidence of high-grade stenosis or occlusion in the anterior or posterior intracranial circulation.


Instruction: Generate impression based on findings.

Input: Personal history of right breast cancer. The patient has had a right mastectomy and prophylactic left mastectomy. The patient is status post bilateral mastectomies with implant placements. No abnormal enhancement is seen in the chest wall. Enhancement with the nipples is within normal limits. No abnormal lymph nodes are identified in either axillary region.High T2 hepatic lesion compatible with a cyst again noted.

Output: No MRI evidence for malignancy. Given that the patient has had bilateral mastectomies, clinical follow up is recommended. BIRADS: 1 - Negative.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: A patient submitted outside study for review. Submitted for review is breast MRI (June 11, 2014) performed at Silver Cross Hospital. No other additional studies were submitted for comparison. Bilateral breast MRI was performed without and with gadolinium as per outside hospital protocol.At the 12 o'clock position of the left breast there is an irregular, enhancing mass measuring 1.9 x 2.2 x 2.1 cm, which contains susceptibility artifact from a biopsy clip, compatible with malignancy. Multiple additional masses are noted anterolateral and posterior to the index lesion. Total extent of enhancing masses in the left breast is 7.9 cm AP x 2.7 cm transverse x 4.0 cm CC. A single enhancing, irregular mass is present at the approximate 11 o'clock position of the right breast measuring 1.1 x 0.6 x 1.1 cm. a 0.4-cm enhancing focus is noted 2.3 cm anterior to the index lesion on the right, with intervening mild non-mass enhancement. Total enhancement in the right breast is 3.8 cm AP x 0.7 cm transverse x 1.1 cm CC.Prominent but symmetric lymph nodes are present in both axillary and subpectoral regions. All of the visualized lymph nodes maintain their normal fatty hilum.There is incidental node of cholelithiasis on included, limited images of the upper abdomen.

Output: 1.Multiple enhancing masses within the left breast. Index lesion measures 2.2 cm in greatest dimension. Total extent of enhancement in the left breast is 7.9 cm anterior to posterior.2. Irregular 1.1-cm enhancing mass within the right breast with a 4-mm enhancing focus anterior to the index lesion, with intervening non-mass enhancement. Total extent of right breast enhancement is 3.8 cm anterior to posterior.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Anatomic alignment of the cervical spine appears to be normal. Vertebral body heights were preserved. No fracture or infiltrative marrow process. Signal characteristics and morphology of the cord and canal are within normal limits. Cervical level specific findings : C2-3: Focal central protrusion at this of disc which abuts thecal sac. No evidence of spinal canal stenosis or neural foraminal stenosis..C3-4: Central protrusion of disc which abuts thecal sac results minimal to moderate spinal canal stenosis. No evidence of neural foraminal stenosis..C4-5: Diffuse bulging of disc with bilateral ligamentum flavum thickening result minimal to mild spinal canal stenosis..C5-6: Diffuse bulging of disc associated with broad-based central to right lateral disc protrusion results mild to moderate spinal canal stenosis as well as right lateral recess stenosis..C6-7: Diffuse bulging of disc results mild to moderate spinal canal stenosis..C7-T1: No significant abnormality noted.

Output: 1. Degenerative spondylosis with multilevel various degree spinal canal stenosis.2. Disc protrusion at the level of C23, C45 and C56.3. Various degree spinal canal stenosis at the level of C4-5, C5-6, and C67.4. Spinal cord signal intensity appears to be normal.


Instruction: Generate impression based on findings.

Input: Pain and numbness. Evaluate lipomyelomeningocele. For the purposes of numbering, the most inferior well-defined disc space is labelled L5-S1. Again seen is a severe compression fracture involving the L3 vertebral body with near complete height loss involving the anterior mid aspect of the vertebral body similar to prior. Previously seen edema involving the L3 vertebral body is no longer present. Evidence of cement augmentation at the L3 vertebral body is again seen. No significant osseous retropulsion.Remainder of the vertebral body heights are normal. Alignment is grossly maintained in the lumbar spine. There are diminished posterior osseous elements from L3-L4 to the sacrum reflecting combination of prior laminectomies and dysplasia. Abnormal T2 signal likely reflecting myelomalacia in the spinal cord at the L2-L3 level again seen. The spinal cord remains low-lying with the distal neural tissue/conus extending to the L5 level. Septations/adhesions are again again noted in the thecal sac from the L5 to S1 levels similar to prior. Lipoma within the thecal sac at the right lateral S1 level is again seen as well as along the distal aspect of the filum in the midline at the S2 level. Degenerative changes are specified by the intervertebral level as follows and unchanged since 3/31/2016:T12-L1: No spinal canal or neural foraminal stenosis.L1-L2: There is bilateral facet hypertrophy and ligamentum flavum thickening. There is minimal disc bulge. There is unchanged mild central canal stenosis and bilateral mild to moderate neural foraminal stenosis.L2-L3: There is bilateral facet hypertrophy and ligamentum flavum thickening. There is diffuse disc bulge with central protrusion component without significant change in moderate to severe spinal canal stenosis and moderate bilateral foraminal stenosis. L3-L4: There is bilateral facet hypertrophy and ligamentum flavum thickening. There is also mild disc bulge with unchanged mild to moderate spinal canal stenosis and mild to moderate bilateral foraminal stenosis.L4-L5: There is bilateral facet hypertrophy. There is central disc protrusion. No significant spinal canal stenosis. There is unchanged mild bilateral foraminal narrowing, relatively worse on the left.L5-S1: There is bilateral facet hypertrophy without neuroforaminal narrowing or spinal stenosis.Fatty atrophy involving the paraspinous musculature again seen, which is predominantly on the right. Left renal cysts again seen.

Output: 1. Compared to 3/31/2016, there is no significant change in moderate to severe spinal canal stenosis at the L2-L3 level. Unchanged T2 hyperintensity within the cord and volume loss at the L2-L3 level consistent with myelomalacia.2. Severe chronic compression fracture of the L3 vertebral body with evidence of cement augmentation again seen. Previously seen edema within the vertebral body is no longer present.3. Unchanged appearance of the low-lying conus which extends to the L5 level with adhesions within the distal thecal sac as well as residual lipoma involving the right lateral aspect of the thecal sac at the S1 level and to a minimal degree along the distal filum terminale at the S2 level. Re-tethering can be considered in the appropriate clinical setting. 4. Degenerative changes at additional levels as detailed above which are also not appreciably changed in the interval.


Instruction: Generate impression based on findings.

Input: Multinodular goiter RIGHT LOBE MEASUREMENTS: 6 x 2.7 x 2.9 cmLEFT LOBE MEASUREMENTS: 5.7 x 1.8 x 1.9 cmISTHMUS MEASUREMENTS: 4-mmRIGHT LOBE: Previous described right lower lobe solid nodule is grossly unchanged measuring 2.7 x 2.1 x 1.9 cm.LEFT LOBE: Previous described left lower lobe solid nodule is also grossly unchanged measuring 0.9 x 1 x 1.4 cm.ISTHMUS: A new solid nodule measuring 1.1 x 0.8 cm in the isthmus.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Bilateral multiple lymph nodes are again noted. Largest lymph node on the right measures 2.1 x 1 cm inferiorly and largest lymph node on the left measures 1 x 1.2 cm superiorly. The etiology of the lymph nodes is unknown.OTHER: No significant abnormality noted.

Output: Multinodular goiter with no significant change in the right and left lobe nodules and a new isthmic nodule. Bilateral multiple lymph nodes in the neck are again noted and are nonspecific.


Instruction: Generate impression based on findings.

Input: Recurrent thyroid cancer status post re-excision and radiation therapy. There are interval post-treatment findings for locoregional recurrent left thyroid cancer superimposed upon prior thyroidectomy and neck dissection with diffuse edema in the left visceral space soft tissues, although a small amount of residual tumor is not excluded. There is no evidence of cervical lymphadenopathy. The salivary glands appear unchanged. There are scattered patchy cerebral white matter T2 hyperintense lesions, which may represent chronic small vessel ischemic disease. The osseous structures are unchanged. There is fluid in the bilateral maxillary sinuses. There are bilateral lens implants.

Output: 1. Interval post-treatment findings for locoregional recurrent left thyroid cancer superimposed upon prior thyroidectomy and neck dissection with diffuse edema in the left visceral space soft tissues, although a small amount of residual tumor is not excluded.2. Findings suggestive of acute sinusitis.


Instruction: Generate impression based on findings.

Input: A 60 year old male with history of coronary artery disease, CABG in 2012 (LIMA to LAD, SVG to RPDA, SVG to OM1/OM2/LPDA). On 8/2015 he was diagnosed with non-ST elevation myocardial infarction, a left catheterization was performed and 2 stents were implanted (at anastomosis of LIMA to LAD and on native LAD). Now he is hospitalized because of chest pain with no evidence of infarction. Referred to stress CMR for further evaluation.MEDICATIONS: aspirin, bisoprolol, eplerenone, insulin, ticagrelor, lisinopril, rosuvastatin. First Pass PerfusionDuring hyperemia, a perfusion defects was noted in the base-mid and apical segments of the inferior and infero-septum walls. Viability/ Myocardial ScarThere is late gadolinium enhancement in the anterior wall at the base and mid segments and in the infero-lateral wall at the mid segment only. Both enhancements are less than 50% of the wall thickness and thus considered to be non-transmural myocardial infarctions. The rest the myocardium is viable.Left VentricleThe left ventricle is normal in size with mildly reduced systolic function. The overall LV ejection fraction is 47%, the LV end diastolic volume index is 92 ml/m2 (normal range: 74+/-15), the LVEDV is 221 ml (normal range 142+/-34), the LV end systolic volume index is 49 ml/m2 (normal range 25+/-9), the LVESV is 117 ml (normal range 47+/-19), the LV mass index is 55 g/m2, and the LV mass is 133 g. There is hypokinesis of the mid and apical segments of the inferior wall . Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 52%, the RV end diastolic volume index is 97 ml/m2 (normal range 82+/-16), the RVEDV is 233 ml (normal range 142+/-31), the RV end systolic volume index is 46 ml/m2 (normal range 31+/-9), and the RVESV is 111 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve has three leaflets, opens widely and there is acceleration of the flow compatible with mild-moderate aortic stenosis.Mitral ValveThe mitral valve opens widely and there is trace mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is trace tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThere is azygous lobe. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. A perfusion defects was noted in the base-mid and apical segments of the inferior and infero-septum walls. 2. There is late gadolinium enhancement in the anterior wall at the base and mid segments and in the infero-lateral wall at the mid segment only. Both enhancements are less than 50% of the wall thickness and thus considered to be non-transmural myocardial infarctions. The rest the myocardium is viable.3. Normal LV size and systolic function (LVEF 47%).4. Normal RV size and systolic function (RVEF 52%).5. Mild to moderate aortic stenosis.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 30 year-old female status post MPC. MPC, as provided by the clinical history, is most likely an error as other reports indicate history of MVC which is understood to mean motor vehicle collision. BRAIN: There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized. Minimal opacification is present in few sided ethmoid air cells.CERVICAL SPINE: There is minimal straightening of the visualized cervical spine secondary to positioning for the examination. Cervical spine alignment is within normal limits without evidence of spondylolysis or spondylolisthesis. Vertebral body heights and intervertebral disk spaces are within normal limits. The pre-and paravertebral soft tissues are within normal limits. The airway is patent.Within the limits of CT scanning, the thecal sac and spinal cord are preserved with no evidence of spinal canal stenosis. If there is clinical concern for spinal cord or ligamentous injury, an MRI may be considered.The lung apices are clear bilaterally.

Output: 1. Normal brain CT.2. Normal cervical spine without evidence of fracture or malalignment.


Instruction: Generate impression based on findings.

Input: Osteopetrosis, pre-transplant workup recommended to detect narrowing of nerve channels, neuropathic changes, and hydrocephalus. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The degree of myelination appears to be appropriate for age. The ventricles and basal cisterns are normal in size and configuration. However, there is prominence of the bilateral anterior frontal and temporal convexity subarachnoid spaces. There is a mega cisterna magna. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, paranasal sinuses, and scalp soft tissues are grossly unremarkable. Osseous findings related to osteopetrosis are better depicted on CT.

Output: 1. No evidence of acute intracranial hemorrhage, mass, cerebral infarction, or ventriculomegaly.2. Prominence of the bilateral anterior frontal and temporal convexity subarachnoid spaces, which represents external hydrocephalus.3. Refer to the concurrent CT regarding findings related to osteopetrosis.


Instruction: Generate impression based on findings.

Input: Migraine with aura, not intractable, without status migrainosus [G43.109] / Benign paroxysmal vertigo, left ear [H81.12], Reason for Study: ^Reason: intracerebral abnormality? History: vertigo No evidence of acute ischemic or hemorrhagic lesion.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. 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.Bilateral IACs appear to be normal in configuration and MR signal characteristics.

Output: No evidence of acute ischemic or hemorrhagic lesion.No evidence of abnormal signal intensity on bilateral IAC.