Instruction: Generate impression based on findings.

Input: Reason: prostate cancer s/p prostatectomy with rising PSA.Additional history per electronic medical record:73Yrs old male with adenocarcinoma of the prostate, preop PSA 1.8, s/p radical prostatectomy in 8/2011, pT3aN0, Gleason 4+3=7 (tertiary 5), negative surgical margin with detectable post-operative PSA, maximum 0.05. PELVIS:PROSTATE:Prostate Size: Status post prostatectomy.Peripheral Zone: Status post prostatectomy.Central Gland: Status post prostatectomy.Seminal Vesicles: Status post prostatectomy.Extracapsular Extension: Not applicableBLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy.BONES, SOFT TISSUES: The bone marrow is somewhat heterogeneous, and the bones are more fully evaluated on recent nuclear medicine bone scan.OTHER: No mass lesions or abnormal signal are identified within the prostatectomy bed or at the vesicoureteral anastomosis.Colonic diverticulosis.

Output: No masslesion identified within the prostatectomy bed or other specific evidence of prostate cancer recurrence.


Instruction: Generate impression based on findings.

Input: 53 years Male (DOB:8/17/1962)Reason: anaplastic large cell lymphoma with brain mets, s/p 2 cycles chemotherapy History: see abovePROVIDER/ATTENDING NAME: RYAN S YOUNG JUSTIN P. KLINE There is a nonenhancing heterogeneous lesion present in the right cingulate gyrus and adjacent to right paracentral lobule associated with the foci of susceptibility effect and local volume loss. It is associated with some foci of T1 signal hyperintensity. Axial dimensions of the FLAIR signal abnormality are approximately 54 x 28 mm axial dimensions. On coronal T2 imaging measures approximately 34 x 27 mm coronal dimensions. This is stable since 4/11/2016.Another nonenhancing heterogeneous lesion is present in the right basal ganglia which measures 7x9 axial dimensions and15 mm S.I. length . It is associated with some foci of T1 signal hyperintensity. It is better defined on the current exam relative to the prior but is otherwise not substantially changed.There is a nonenhancing 3 mm T2 hyperintense lesion associated with susceptibility effect located in the left caudate nucleus which remains stable compared to the prior exam. It is associated with T1 signal hyperintensity.A small focus of susceptibility effect is present along the left occipital lobe lingual gyrus adjacent to the calcarine sulcus anteriorly. It is stable compared to the prior exam.A punctate focus of T2 and FLAIR hyperintensity is present in the right thalamus stable. It is associated with susceptibility effect.FLAIR signal hyperintensity at the temporal lobe is suspected to represent artifact as it is not seen on the T2 imaging studies.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.Some of the images are degraded due to patient motion as well as by motion. Many of the imaging sequences were repeated.

Output: 1.Since the prior exam a right cingulate gyrus and paracentral lobule lesion has remained stable. The patient was known to have had an anaplastic large cell lymphoma.2.Since the previous examination a lesion located in the right basal ganglia has become better defined.3.Small lesions in the left caudate nucleus, right thalamus and the left occipital lobe as well as a larger lesion centered in the right cingulate gyrus are stable .


Instruction: Generate impression based on findings.

Input: Female, 76 years old, with low back pain. Trace retrolisthesis of L1 relative to L2 is seen. Spinal alignment is otherwise unremarkable. Vertebral body heights are preserved. Scattered mild endplate degenerative signal abnormality is seen. No concerning marrow replacement or marrow edema is detected.The visualized distal spinal cord, conus and nerve roots of the cauda equina are unremarkable. No epidural abnormality is suspected.T12-L1: Mild bulging disc. No significant spinal canal or foraminal stenosis.L1-2: Facet arthropathy and ligamentum flavum thickening. Bulging disc. Mild generalized spinal canal stenosis. Mild bilateral foraminal narrowing. L2-3: Facet arthropathy and ligamentum flavum thickening. Bulging disc with a superimposed left foraminal protrusion. Mild generalized spinal canal stenosis. Moderate left and mild right foraminal narrowing. L3-4: Facet arthropathy and ligamentum flavum thickening. Bulging disc. No significant spinal canal stenosis. Mild bilateral foraminal narrowing. L4-5: Facet arthropathy and ligamentum flavum thickening. Bulging disc asymmetric to the right. No significant spinal canal stenosis. No significant foraminal narrowing. L5-S1: Facet arthropathy and ligamentum flavum thickening. Prominence of the dorsal and ventral epidural fat. Bulging disc. Mild spinal canal narrowing. Moderate left and mild right foraminal narrowing.

Output: Multilevel disc degeneration is seen causing mild spinal canal stenosis at L1-2 and L2-3. Moderate foraminal narrowing is seen on the left at L2-3 and on the left at L5-S1.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for structural lesions, previous ischemia, previous CEA. Signs and symptoms: Severe tremor. Nonenhanced brain MRI:No acute intracranial process and negative diffusion weighted series.There is a small focus of encephalomalacia in the left occipital lobe consistent with a chronic ischemic stroke. Additionally there are multiple small foci of FLAIR/T2 hyperintensity involving the cortex and subcortical white matter as well as periventricular white matter of bilateral cerebral hemispheres suggestive of multiple prior chronic small vessel ischemic strokes and small cortical strokes. The appearance of the findings could suggest watershed some strokes.There is disproportionate prominence of cortical sulci and to a lesser degree cerebellar and vermin folia patient's stated age of 64. Ventricular system are slightly prominent and with maintained midline.The signal void of major intracranial branches are identified.Unremarkable calvarium and soft tissues of the scalp. Unremarkable images through the orbits.Prostate air cells demonstrate diffuse bilateral patchy nonspecific opacification.Paranasal sinuses demonstrate frontal, sphenoid left greater than right anterior ethmoid sinus disease.

Output: 1.No acute intracranial process and negative diffusion weighted series.2.Multiple small cortical, subcortical and periventricular white matter chronic ischemic strokes of bilateral cerebral hemispheres as detailed above.3.Generalized prominence of cortical sulci, mild prominence of the supratentorial ventricular system and cerebellar- vermian folia for the patient's stated age.4.Chronic sinusitis as detailed.


Instruction: Generate impression based on findings.

Input: Occlusion and stenosis of unspecified carotid artery [I65.29], Reason for Study: ^Reason: 3 t scanner stoke History: ha Brain MRINo evidence of acute ischemic or hemorrhagic lesion.There is a chronic ischemic infarct with encephalomalacia involving left frontal operculum, in particular left inferior frontal gyrus associated with ex focal changes of left lateral ventricle frontal horn. A couple of scattered FLAIR/T2 high signal intensities on the left frontal lobe white matter are likely represent associated small chronic ischemic infarcts. Subtle susceptibility lesions within encephalomalacia indicate focal hemorrhagic conversion.The ventricles, sulci and cisterns are unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The mastoid air cells are clear. Mucosal thickening and retention cyst is seen on the left maxillary sinus.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate nonvisualization of distal left internal carotid artery. Prominent left P-comm artery appears to supply left anterior circulation. However, left MCA and distal MCA branches are diminutive.Right ICA, ACA, and MCA appear to be normal.Left the distal vertebral artery beyond the level of left PICA appears to be hypoplastic. Otherwise, vertebrobasilar system is unremarkable.. Bilateral P-comm as well as a common artery are patent. There is no evidence of intracranial aneurysm. Neck MRA3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate left extracranial internal carotid artery just above the bifurcation is not visualized.Right carotid bulb appears to be irregular however, there is no evidence of significant (more than 50%) luminal stenosis.Right vertebral skin appears to be normal.Left vertebral ostium shows about 20-30% of luminal stenosis.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. Chronic ischemic infarct with encephalomalacia involving left frontal lobe inferior frontal gyrus.3. Nonvisualization of the left internal carotid artery with reconstitution of left MCA fire left posterior communicating artery.4. Nonvisualization of left extracranial internal carotid artery just above the bifurcation of the left common carotid artery.


Instruction: Generate impression based on findings.

Input: Male, 61 years old. Left knee pain MENISCI: There is mild globular intrasubstance degeneration affecting the meniscus, but we see no tear.ARTICULAR CARTILAGE AND BONE: There is heterogeneity of the articular cartilage of the patella indicating mild to moderate degeneration with partial- and full-thickness foci of cartilage loss. Mild heterogeneity of the articular cartilage of the femoral trochlea likely represents minimal degeneration. There is also mild degeneration of the articular cartilage along the lateral femoral condyle anterior to the meniscus. There is a lobulated lesion within the distal femoral metaphysis, representing a benign enchondroma.LIGAMENTS: There is increased intrasubstance signal within the proximal half of the posterior cruciate ligament, likely representing chronic mucoid degeneration or less likely a partial thickness tear. The proximal fibers of the medial collateral ligament appear slightly thickened, which may reflect old injury, but we see no edema to reflect acute injury. The lateral collateral ligament complex is intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1.Cartilage degeneration as described above, particularly affecting the patella.2.Mucoid degeneration of the posterior collateral ligament and other findings as described above, but no meniscal tear is noted.


Instruction: Generate impression based on findings.

Input: 65-year-old woman with history notable for atrial fibrillation s/p prior PVI (9/2012), tachycardia-mediated cardiomyopathy with subsequent LVEF recovery, sinus bradycardia, hypertension, hyperlipidemia, and sleep apnea on CPAP presenting for evaluation prior to possible repeat ablation. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 63%, the LV end diastolic volume index is 80 ml/m2 (normal range: 65+/-11), the LVEDV is 147 ml (normal range 109+/-23), the LV end systolic volume index is 30 ml/m2 (normal range 18+/-5), the LVESV is 55 ml (normal range 31+/-10).There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is severely dilated. The LA volume is 136 ml (indexed to BSA 74 ml/m2).LUPV: 13mm x 10 mmLLPV: 14 mm x 9 mmRUPV: 24 mm x 21 mmRLPV: 15 mm x 13 mmRight VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 63%, the RV end diastolic volume index is 71 ml/m2 (normal range 69+/-14), the RVEDV is 132 ml (normal range 110+/-24), the RV end systolic volume index is 27 ml/m2 (normal range 22+/-8), and the RVESV is 49 ml (normal range 35+/-13). Right AtriumThe right atrium is severely enlarged. 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 trace 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 drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Normal LV size and systolic function. No delayed enhancement.2. Normal RV size and systolic function. 3. Marked bi-atrial enlargement


Instruction: Generate impression based on findings.

Input: Knee pain. MENISCI: The menisci appear intact.ARTICULAR CARTILAGE AND BONE: Near full-thickness cartilage loss involving the medial femoral condyle. Full-thickness cartilage loss involving the lateral patellar facet with underlying subchondral cyst formation. Near full-thickness cartilage loss with associated fissuring involving the medial patellar facet. Focus of reactive subchondral bone marrow edema involving the lateral tibial plateau.LIGAMENTS: The ACL and PCL appear intact. The lateral collateral ligament complex appears intact. Fluid surrounds the medial collateral ligament compatible with a sprain. The fibers of the MCL appear intact.EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: Degenerative arthritic changes most severe at the lateral patellar compartment where there is full-thickness cartilage loss. MCL sprain. Small joint effusion.


Instruction: Generate impression based on findings.

Input: Clinical question to be answered: Hydrocephalus. Signs and symptoms: Mental confusion. No definitive appreciable interval change since prior exam. Limited view of cortical sulci remain similar to what was noted on the prior study. Minimal residual blood within the subarachnoid space in high convexity remains stable. No change in the size of ventricular system. No definitive evidence of new bleed, new area of ischemic change or hydrocephalus. Follow-up with an MRI is recommended if patient's clinical symptoms do not improve.

Output: Stable exam.


Instruction: Generate impression based on findings.

Input: 10-year-old female patient with history of von Willebrand disease presents with soft tissue edema along the distal femur. MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: No significant abnormality noted.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Normal examination.


Instruction: Generate impression based on findings.

Input: Ulcers, leukocytosis Note that the examination is significantly limited secondary to the patient prematurely terminating the study resulting in incomplete sequences, motion artifact, and a lack of gadolinium administration.Left: There is thickening of the skin of the lower extremity with surface irregularity compatible with cellulitis and ulceration. Reticulation of the subcutaneous fat is noted particularly anteromedially and anterolaterally indicative of edema and soft tissue inflammation. There is diffuse fatty atrophy of the calf musculature and increased signal intensity within the muscles distally may reflect more subacute atrophy or additional inflammation. Within the limits of exam, there is no focal fluid collection to suggest abscess and there is no bone marrow signal abnormality to suggest osteomyelitis. Osteoarthritis affects the left knee and there is a small joint effusion.Right: Note that only coronal T1, coronal STIR, and lower axial T1 images were performed. There is skin thickening and subcutaneous edema suggesting cellulitis similar to the left leg. Again, there is no abnormal signal intensity within the tibia or fibula to confirm osteomyelitis. Osteoarthritis affects the knee.

Output: Significantly limited examination demonstrates features of lower extremity cellulitis without definite osteomyelitis or soft tissue abscess.


Instruction: Generate impression based on findings.

Input: Status post T4 laminectomy. Bilateral lower extremity weakness. Assess for hematoma or cord compression. The study is limited by patient motion. There are postoperative findings related to recent T4 decompression. The fluid collection in the posterior paraspinal T4 laminectomy bed has slightly increased in size since the previous examination and now maximally measures on the axial postcontrast images 3.2 cm x 1.4 cm. Otherwise, the height loss and epidural tumor extension at T4 resulting in considerable compression of the thecal sac and spinal cord has not significantly changed since the previous examination. Multiple lesions within the thoracic spine are otherwise unchanged, including the mild epidural tumor that mildly narrowing the spinal canal at the T9 level. There continues to be no definite abnormal signal within the spinal cord. The thoracic vertebral column alignment is unchanged. There appears to be right neck lymphadenopathy.

Output: 1. Slight increase in size of the posterior paraspinal fluid collection associated with the recent T4 decompression and residual epidural tumor extension at this level result in persistent spinal cord compression. 2. Diffuse osseous metastatic disease in the thoracic spine is otherwise unchanged. 3. Apparent right neck lymphadenopathy. Dedicated neck imaging may be useful for further characterization.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Female 54 years old Reason: vaginal cuff tenderness and drainage after TLH @ north shore History: vaginal drainage and vaginal cuff tenderness, exposed suture PELVIS:UTERUS, ADNEXA: Status post hysterectomy.There are postsurgical changes along the superior aspect of the vagina with some delayed enhancement of the vaginal cuff possibly due to granulation tissue. The superior aspect of the vagina area abuts the small bowel however, no discrete fistulous connection.BLADDER: Urinary bladder is unremarkable.LYMPH NODES: No pelvic or inguinal lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Postsurgical changes in the lower abdominal wall.OTHER: No significant abnormality noted.

Output: 1.Postsurgical changes with granulation tissue along superior aspect of the vagina but no discrete fistulous connection or fluid collections.


Instruction: Generate impression based on findings.

Input: Abnormal gait No evidence of acute ischemic or hemorrhagic lesion.There is a focal high signal intensity on FLAIR on the right paracentral lobule and right posterior temporal lobe subcortical white matter which likely indicate chronic ischemic lacune.Minimal small vessel ischemic disease.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.

Output: No evidence of acute ischemic or hemorrhagic lesion.Minimal small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: Left upper extremity weakness and cervicalgia, evaluate for surgical pathology. The vertebral bodies are appropriate in the overall alignment and height. The spinal cord has grossly normal signal characteristics and overall morphology. There is no acute compression of the spinal cord.There is a focal area of high T1 and T2 signal intensity involving the posterior aspect of C4 vertebral body which is unchanged from prior MRI and may represent a hemangioma. There is mild to moderate degenerative changes in the cervical spine including disc osteophyte complexes at C3-C4, C4-C5, C5-C6 and C6-C7 levels resulting in mild indentation on the ventral thecal sac, which has progressed from prior. There is scattered disc space narrowing and disc desiccation in the thoracic spine. There is minimal narrowing of L4-L5 and L5-S1 discs with desiccation.

Output: 1. This is a limited exam specific for the exclusion of cord compression only and does not exclude more subtle lesions such as intrinsic cord abnormalities. No acute cord compression is identified.2. Spondylotic changes throughout the spine as described with interval progression of cervical spine degenerative changes.


Instruction: Generate impression based on findings.

Input: MRI of the brainThere are 2 subcentimeter foci of diffusion restriction present in the right precentral gyrus along its lateral aspect. These display some contrast enhancement.There are punctate foci of signal loss on susceptibility imaging. One located in the right temporal lobe subcortical white matter and one in the right basal ganglia and another located in the right occipital lobe subcortical white matter while another couple are located along the left superior frontal gyrus left and right orbital gyri as well as the left temporal lobe.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.A couple small nodules adjacent to the parotid gland probably represent lymph nodes.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. The posterior communicating arteries are intact. The vertebral arteries are similar in size.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries.

Output: 1.Foci of diffusion restriction are present in the right precentral gyrus laterally compatible with subacute foci of infarction.2.There multiple subcortical punctate foci of susceptibility effect which correspond to calcifications on a CT of the head. They are nonspecific suggestive of cysticercosis in the appropriate clinical setting. Please note that punctate calcifications can also be seen with other entities as well3.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: 74 years, Female, right weakness, history of breast cancer with metastasis to brain and seizures . Additional history per chart, patient is status post CyberKnife treatment for brain metastasis 5 months ago. Examination is obtained per treatment planning protocol and limited to 3-D T2 and 3D T1 sequences. There appears to be lack of contrast on the 3-D T1 sequence, which may be in part related to the low dose administered or timing. Fiducial markers are in place.There is a 15 x 17 mm lesion centered on the left precentral gyrus with extensive surrounding vasogenic edema. There is low T2 signal within the lesion which may reflect small amount of blood products or mineralization. There is mild effacement of the left lateral ventricle. No midline shift or herniation. Additional scattered foci of T2/FLAIR hyperintensity in the periventricular and subcortical white matter as well as the pons are compatible with small vessel ischemic disease. No hydrocephalus. Major flow-voids are preserved.

Output: 1. Examination for operative planning demonstrating a 15 x 17 mm lesion in the left precentral gyrus consistent with known metastatic disease. 2. Note there appears to be lack of contrast on the 3-D T1 sequence and would suggest obtaining prior outside complete brain MRI with gadolinium to better assess for additional metastases.


Instruction: Generate impression based on findings.

Input: History of 2 negative for prior TRUS guided prostate biopsies. PELVIS:PROSTATE:Prostate Size: 4.0 x 6.0 x 6.3 cmPeripheral Zone: The peripheral zone is diffusely thinned without a discrete lesion.Central Gland: Significantly enlarged with changes of benign prostatic hyperplasia without a discrete suspicious lesion.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: No evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Colonic diverticulosis without diverticulitis.

Output: No focal suspicious lesion. BPH.


Instruction: Generate impression based on findings.

Input: Hyperreflexia. Evaluate for cervical spine stenosis. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained. Bone marrow signal is within normal limits. Axial images of the cervical spine are significantly degraded. There is however no convincing signal abnormality in the cervical cord on the sagittal sequences. Minimal degenerative changes are seen including small disc bulge at C3-C4, with no significant spinal canal stenosis at any level in the cervical spine. There is uncovertebral hypertrophy at the left C2-C3 and left C3-C4 levels which along with facet arthropathy contribute to mild narrowing of the left neural foramina. The neural foramina in the remainder of the cervical spine are patent. Bilateral pontine lacunar infarcts are noted and better assessed on recent brain MRI. There is nonspecific opacification of the bilateral mastoid air cells as seen previously.

Output: 1. Please note patient could not tolerate the full requested pre and postcontrast exam and only noncontrast sequences were obtained. There is no evidence of spinal canal stenosis at any level in the cervical spine. No gross cord signal abnormality within the limits of the study.2. Bilateral chronic pontine lacunar infarcts are partially imaged and better assessed on prior brain MRI.


Instruction: Generate impression based on findings.

Input: 57-year-old male with elevated PSA. Evaluate prostate. PELVIS:PROSTATE:Prostate Size: 4.6 x 2.6 x 3.9 cm.Peripheral Zone: There is abnormal T2 hypointensity with corresponding low ADC signal in the left anterior apex measuring approximately 1.6 x 0.7 cm (series 603, image 184). This region demonstrates enhancement. Central Gland: Central gland is heterogeneous in appearance, consistent with benign prostatic hypertrophy.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: No evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Lesion in the left anterior apex suspicious for carcinoma.


Instruction: Generate impression based on findings.

Input: Female, 16 years old, history of mediastinal lymphoma and extradural soft tissue mass at T5-6, 6 months off therapy. Cervical:The spinal cord is morphologically normal. No pathologic intrathecal or epidural enhancement is seen. Alignment of the cervical spine is straightened, similar to prior and likely secondary to positioning. Vertebral body morphology and marrow signal characteristics are normal.Thoracic:The spinal cord is morphologically normal. No evidence of any residual pathologic epidural or foraminal enhancement is seen. No pathologic intrathecal enhancement is detected. Alignment is anatomic. Vertebral body morphology and marrow signal characteristics are normal. Lumbar:The conus and cauda equina are normal. No pathologic intrathecal or epidural enhancement is detected. Alignment is anatomic. Vertebral body morphology and marrow signal characteristics are normal.

Output: No evidence of residual or recurrent tumor in the spine.


Instruction: Generate impression based on findings.

Input: 67-year-old female with severe hip pain and mild abnormalities on radiographs. There are areas of full-thickness cartilage loss along the posteromedial aspect of the hip, indicating osteoarthritis. There is also abnormal signal intensity within the labrum indicating intrasubstance degeneration as well as degenerative tearing involving the anterosuperior and posterior labrum. There is a small amount of fluid within the joint, but no large effusion is evident. The ligamentum teres appears intact. We see no trochanteric bursitis. The muscles of the hip appear normal for age. Mild osteoarthritis affects the left hip as seen on the large field-of-view images. The bone marrow signal intensity is otherwise within normal limits. Mild osteoarthritis affects the sacroiliac joints. Mild degenerative joint disease affects the pubic symphysis. Degenerative disc disease and facet joint osteoarthritis affects the lower lumbar spine.

Output: 1. Osteoarthritis of the right hip with degeneration and degenerative tearing of the acetabular labrum.2. Additional osteoarthritis/degenerative arthritic changes as described above, including the lower lumbar spine.


Instruction: Generate impression based on findings.

Input: History of bulging disc 2 year ago: back pain - radicular to both legs to thigh - worse on left. There is a persistent eccentric right disc extrusion with annular fissuring that narrows the right lateral recess at the L5-S1 level, where nerve roots are compressed. There is minimal facet hypertrophy and ligamentum flavum thickening at this level. There are small bilateral neural foraminal perineural cysts at L5-S1. There is also a new small eccentric right disc protrusion with annular fissuring at the L3-4 level without significant spinal canal or neural foraminal narrowing. There is no significant degenerative spondylosis at T12-L1, L1-2, L2-3, and L4-5. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: 1. Persistent eccentric right disc extrusion with annular fissuring that narrows the right lateral recess at the L5-S1 level, where nerve roots are compressed.2. New small eccentric right disc protrusion with annular fissuring at the L3-4 level without significant spinal canal or neural foraminal narrowing.


Instruction: Generate impression based on findings.

Input: MRI Brain:There are multiple areas of restricted diffusion involving the bilateral occipital lobes, bilateral cerebellar hemispheres, cerebellar vermis, the pons, midbrain and left anteromedial thalamus. There is also prominent T2/FLAIR signal abnormality in these regions indicating more acute to subacute infarcts. There is no evidence of frank hemorrhage, midline shift or herniation. There is no evidence of hydrocephalus or basilar cistern effacement.There is encephalomalacia and hemosiderin staining involving the left occipital region, precentral gyrus and inferomedial left frontal lobe, compatible with prior infarcts. Additional moderate periventricular and subcortical white matter T2/FLAIR hyperintensity is nonspecific but likely related to small vessel ischemic disease.Postsurgical changes are again seen in the region of the sphenoid bone and sella, which appear stable from prior studies. The third ventricle appears distorted but is unchanged. The pituitary gland is not identified. There is some signal loss on the susceptibility weighted images involving the right midbrain and right sella which appears similar to the prior exam from 2010. The right middle cerebral peduncle is distorted and narrowed which was present in 2010. The optic chiasm is distorted. There is mild mucosal thickening involving the ethmoid air cells.MRA Brain: There is occlusion of much of the posterior circulation including the bilateral V4 segments just distal to the PICA origins and involving the entire basilar artery. In addition, AICA, SCA and PCA arteries are non-visualized. The bilateral PComAs are also not visualized. The right A1 segment is hypoplastic. There is atherosclerotic irregularity of the cavernous portion of the right greater than left internal carotid arteries.MRA neck:Redemonstrated is high grade stenosis of the left vertebral artery at its origin which is unchanged compared to the prior exam. There is also some mild irregularity of the cervical portion of the left vertebral artery. There is origin of the left common carotid artery from the brachiocephalic artery. There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There are atherosclerotic calcifications of the origins of the vertebral arteries bilaterally. Additional atherosclerotic calcifications are seen involving the aorta and its proximal branches. There is a small left pleural effusion and nonspecific ground glass opacity versus motion artifact in the bilateral lung apices.

Output: 1.Large posterior circulation infarctions involving the bilateral cerebellar and occipital regions with sulcal effacement and edema indicating a more subacute character to the infarcts. There are infarcts also involving the pons, midbrain and left basal ganglia.2.On MRA, there is complete occlusion of the bilateral V4 segments beyond the PICA arteries as well as the entire basilar artery. The AICA, SCA, PCA and PComAa are also non-visualized.3.Moderate chronic likely small vessel ischemic disease and chronic left pre-central gyrus, left anteromedial inferior frontal lobe, and left occipital lobe infarcts.


Instruction: Generate impression based on findings.

Input: Shoulder pain ROTATOR CUFF: No significant abnormality noted.SUPRASPINATUS OUTLET: An os acromiale is noted but without abnormal marrow signal.GLENOHUMERAL JOINT AND GLENOID LABRUM: No significant abnormality noted.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: Normal MRI of the left shoulder.


Instruction: Generate impression based on findings.

Input: 53-year-old male with a history of small enhancement in the pons on the previous MRI Brain. Evaluate for interval change. Brain CCM:The ventricles and sulci are prominent, consistent with mild age-related volume loss. The basal cisterns remain patent. There is no midline shift or mass effect. There are multiple nonspecific scattered punctate foci of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter. There is redemonstration of foci of ill-defined enhancement within the central pons with a smaller focus in the right paramedian pons just cranially which is unchanged. These demonstrate stable ill-defined susceptibility. There is no diffusion abnormality. No extra-axial fluid collection is identified. The midline structures and craniocervical junction are within normal limits. There is a small mucosal retention cyst in the right maxillary sinus. Brain MRA:There is no detectable vascularity within the pons. There is an incidental finding of a 2 x 3 mm outpouching off of the left supraclinoid ICA projecting inferiorly compatible with a small aneurysm. The intracranial internal carotid arteries are otherwise normal in course and caliber. The middle and anterior cerebral arteries are unremarkable. The vertebral arteries, basilar artery, and posterior cerebral arteries are normal in course and caliber. There is no evidence of flow-limiting stenosis.

Output: 1.Stable likely incidental capillary telangiectasias in the central pons.2.Scattered unchanged nonspecific punctate foci of T2/FLAIR hyperintensity within the subcortical and periventricular white matter.3.Incidental 2 x 3 mm inferiorly directed left supraclinoid ICA aneurysm.


Instruction: Generate impression based on findings.

Input: 82-year-old female with metastatic cancer. Rule out brain metastases prior to anticoagulation. There is no evidence of intracranial hemorrhage, edema, or midline shift. Patchy areas of subcortical and periventricular white matter hypodensity likely represent extensive small vessel ischemic disease, age indeterminate by CT. Calcifications are noted in the basal ganglia bilaterally. Two foci of dystrophic calcification are noted in the right cerebellar hemisphere with a surrounding area of focal low attenuation. Though this could represent microangiopathic changes with dystrophic calcification, a neoplastic lesion cannot be ruled out an MRI with intravenous contrast is recommended for further evaluation.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.These findings were communicated to the clinical service at the time of interpretation.

Output: Extensive small vessel ischemic disease, age indeterminate. An area of low attenuation with foci of calcification in the right cerebellar hemisphere may represent microangiopathic changes, but a neoplastic lesion cannot be ruled out. MRI with intravenous contrast is recommended for further evaluation.


Instruction: Generate impression based on findings.

Input: 26-year-old female with possible Crohn's disease of the upper GI tract. Motion artifact mildly limits examination. Within this limitation, the following observations are made.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No evidence of inflammatory bowel disease. On coronal postcontrast images, there is a distal small bowel loop in the right lower quadrant with apparent wall thickening; this finding is most likely due to peristalsis with no corresponding abnormality seen on T2 and diffusion-weighted images.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: 2.3 cm right ovarian simple cyst. Small amount of endometrial fluid, likely physiologic.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: As above.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Mild pelvic free fluid, likely physiologic.

Output: No evidence of inflammatory bowel disease.


Instruction: Generate impression based on findings.

Input: 4-5 months of persistent ankle pain and limp. Wearing boot and intermittent crutch use. History of talus fracture 9 mm. Evaluate for ATFL tear and healing of talus fracture versus new injury. TENDONS: No significant abnormality noted.LIGAMENTS: The ligaments of the ankle are intact including the anterior talofibular ligament.ARTICULAR SURFACES AND BONE: There is a focus of increased T2 signal along the posterior aspect of the talus compatible with bone marrow edema without evidence of overlying chondral injury. There is minimal bone marrow edema of the anterior cuboid near the 5th metatarsal articulation without underlying fracture. ADDITIONAL

Output: 1. Intact anterior talofibular ligament.2. Minimal edema in the posterior talus and anterior cuboid, which is likely reactive, without underlying fracture.


Instruction: Generate impression based on findings.

Input: MRI brain: There are no areas of abnormal signal. There is no diffusion abnormality. The ventricles and sulci are within normal limits. The basal cisterns remain patent. There is no midline shift or mass effect. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. The cerebellar tonsils are normal in position. No evidence of Chiari malformation. The CSF flow studies demonstrates normal biphasic flow ventrally and dorsally.MRI spine: There are 7 cervical, 12 thoracic, and 5 lumbar vertebral bodies. The spine is in normal alignment. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal. The distal spinal cord and conus are within normal limits with the conus terminating at the mid L1 level. There is no evidence of tethered cord. No evidence of filar lipoma or other lesions within the spinal canal.There is trace prominence of the central canal throughout the cervical cord, approximately measuring up to 1-2 mm. There is a thoracic syringohydromyelia which extends from upper T5 up to lower T8 levels, measuring up to 4.7 x 5.5 mm in the axial plane at the T6 level. There is trace prominence of central canal in the more distal cord. There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the spine.Urinary bladder is grossly distended, which is nonspecific.

Output: 1. There is syringomyelia involving the thoracic cord extending from upper T5 to the lower T8 levels. There is mild prominence of central canal more superiorly and inferiorly.2. MRI of the brain appears within normal limits. Cerebellar tonsils are normal in position with preserved biphasic CSF flow at the foramen magnum. No findings to suggest Chiari I malformation.3. No evidence of tethered cord.


Instruction: Generate impression based on findings.

Input: Male, 60 years old, with hypertension and presyncope, brain cystic lesion seen on CT. A 9 mm nodule is evident within the anterior superior third ventricle situated at the level of the foramina of Monro. The nodule is isoattenuating relative to brain on T1 weighted images and hypoattenuating on T2 weighted images.The right lateral ventricle is significantly dilated with bowing of the septum pellucidum across the midline up to 10 mm. The left lateral ventricle is partially effaced by this encroachment from the right lateral ventricle. The third and fourth ventricles are normal in size.Mild T2 hyperintensity rimming both frontal horns is seen. A small area of T2 hyperintensity is evident in the right frontal subcortical white matter. Scattered T2 hyperintense lesions are evident within the left basal ganglia.Elsewhere, no significant focal parenchymal lesions or parenchymal edema is detected. No restricted diffusion is seen. No evidence to suggest acute intracranial hemorrhage.

Output: Findings compatible with a third ventricular colloid cyst with associated obstruction of the right foramen of Monro and dilatation of the right lateral ventricle.Scattered T2 hyperintense foci may reflect areas of chronic ischemic injury. Lesions in the left basal ganglia could represent accommodation of chronic lacunar infarcts and/or dilated perivascular spaces.


Instruction: Generate impression based on findings.

Input: 57 years Male (DOB:6/9/1958)Reason: MRI treatment planning prior to stereotactic radiosurgery History: nonePROVIDER/ATTENDING NAME: STEVEN J CHMURA STEVEN J CHMURA The CSF spaces are appropriate for the patient's stated age with no midline shift. Since the prior exam a right frontal LASER ablation probe has been removed.There is a heterogeneous and round mass present in the right frontal lobe periventricular white matter which measures approximately 22 x 20 mm axial dimensions. Enhancement predominantly occurs along the periphery. There are foci of susceptibility long the periphery of the lesion. There is redemonstration of a lesion centered in the left posterior pons associated with susceptibility effect measuring approximately 6 x 7 mm axial dimensions which is also associated with a ring enhancement pattern.There are periventricular and subcortical confluent hyperintense white matter lesions present identified on the FLAIR and T2 images. This is not substantially changed relative to prior examsThere are multiple punctate subcortical foci of signal loss identified on susceptibility imaging located in both hemispheres as well as the cerebellum. Some of these are associated with contrast enhancementNormal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate some mucosal thickening.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.There is redemonstration of a right periventricular frontal partially hemorrhagic mass. This patient is known to have metastatic disease from RCC. Most likely this represents metastasis.2.There is redemonstration of a left pontine hemorrhagic mass. This patient is known to have metastatic disease from RCC. Most likely this represents metastasis.3.There are multiple microhemorrhages scattered in both hemispheres as well as in the cerebellum. Some of these are associated with contrast enhancement and some are not. It is suspected that these represent metastatic disease.4.There are periventricular confluent white matter signal changes which could be treatment related.


Instruction: Generate impression based on findings.

Input: 40-year-old female with metastatic non-small cell lung carcinoma. Note is made of heterogeneous bone marrow signal which likely represents residual islands of red marrow. The foci of decreased bone marrow signal abnormality on T1 weighted images are hyperintense to skeletal muscle. No enhancing mass lesions are identified. The imaged musculature of the pelvis appears normal. Linear focus of signal void within the vagina consistent with a tampon. 4.3 cm right adnexal cystic lesion is likely physiologic in a menstruating patient of this age. Facet joint osteoarthritis affects the lower lumbar spine. Mild degenerative disc disease affects the imaged portion of the lower lumbar spine.

Output: No evidence of osseous metastatic disease affecting the sacrum, as clinically questioned. The patient was called back for this additional imaging and will not be billed for this examination.


Instruction: Generate impression based on findings.

Input: Reason: rule out structural abnormalities History: seizure There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are a few scattered periventricular T2 hyperintensities as well as a small T2 hyperintensity in the head of the left caudate without diffusion restriction. This is nonspecific but likely suggests mild chronic small vessel ischemic disease. Hippocampi are symmetric without evidence of atrophy or abnormal signal. No heterotopic gray matter is identified. 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. The paranasal sinuses are unremarkable.

Output: 1.No mass or other findings to explain patient's seizures.2.Mild chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: Disorder of brain, unspecified [G93.9] / Vomiting, unspecified [R11.10] / Headache [R51], Reason for Study: ^Reason: Evaluate for brainstem lesion History: HA, vomiting There is no evidence of acute ischemic or hemorrhagic lesion.Previously described left pontine lesion is not shown on today's scan.There is no abnormal enhancement except a developmental venous anomaly on the right posterior basal ganglia.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, 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.

Output: 1. Previously shown left pontine lesion is not shown on this scan. It was not demonstrated on immediate prior scan either.2. No evidence of acute ischemic or hemorrhagic lesion. No abnormal enhancing lesion.3. No change of right basal ganglia DVA.


Instruction: Generate impression based on findings.

Input: headache, left side. No evidence of acute ischemic or hemorrhagic lesion on this scan.Scattered foci of high signal intensities on FLAIR images are again demonstrated, no change since prior exam.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, 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.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal bilateral ICAs, MCAs and ACAs. The left PCA is fetal origin and the vertebrobasilar system appears to be normal.There is no evidence of intracranial arterial aneurysm or stenosis.

Output: No evidence of acute ischemic or hemorrhagic lesion on this scan.No interval change of minimal small vessel disease since prior exam.Normal brain MRA.


Instruction: Generate impression based on findings.

Input: 44-year-old female with history of stage IIB cervical cancer s/p chemoradiation. Evaluate disease status. CHEST:LUNG BASES: Stable diffuse right posterior basilar pleural thickening. No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is no evidence of obstruction or intraperitoneal free fluid. Thickening of the rectosigmoid with surrounding submucosal fatty infiltration of the rectum is again seen, consistent with post-radiation changes.The visualized appendix is filled with contrast. Mild thickening of the appendiceal wall is noted at the distal tip of the appendix. However, in the absence of periappendiceal inflammatory changes and complete opacification of the appendix with contrast, appendicitis is very unlikely. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No other significant abnormality noted.PELVIS:UTERUS, ADNEXAE: Nodular masses in the uterus are again noted and unchanged, likely leiomyomas. Heterogeneous appearance of the cervix is again noted.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy noted.BOWEL, MESENTERY: Thickening of the rectosigmoid with surrounding submucosal fatty infiltration of the rectum is again seen, consistent with post-radiation changes. The prerectal collection seen on the 12/21/2010 MRI exam has resolved. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No other significant abnormality noted.

Output: Interval resolution of pre-rectal collection. No local recurrence or metastatic disease.


Instruction: Generate impression based on findings.

Input: Shoulder pain ROTATOR CUFF: There is increased signal and thickening of tendons of the the distal supraspinatus and anterior infraspinatus reflecting tendinosis although no discrete fluid-filled tear is identified. The teres minor and subscapularis tendons are intact. There is mild atrophy of the supra and infraspinatus muscles. The humeral head is slightly high riding.SUPRASPINATUS OUTLET: There is moderate arthrosis of the acromioclavicular joint. A trace amount of fluid is noted in the subacromial subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is mild thinning of the articular cartilage of the glenohumeral joint. There is also abnormal contour and signal of the glenoid labrum suggesting tearing and degeneration although no full-thickness detachment is appreciated.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: Rotator cuff tendinopathy without evidence of discrete full-thickness tear.


Instruction: Generate impression based on findings.

Input: Abdominal pain with history of abdominal schwannoma ABDOMEN:LIVER, BILIARY TRACT: Small bilobar hepatic cysts. Status post cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: No lymphadenopathy. See pelvis report.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Status post hysterectomy.BLADDER: No significant abnormality noted.LYMPH NODES: No lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Lobulated peripherally enhancing T2 hyperintense mass anterior to the L5 vertebral body measures approximately 3.2 x 5.7 x 5.6 cm (AP x TR x CC). The mass arises at the level of the aortic bifurcation and surrounds the right common iliac artery and vein.

Output: 1. Peripherally enhancing cystic mass anterior to the L5 vertebral body surrounds the right common iliac artery and vein. Given the time course, a postoperative collection should be considered although residual and/or recurrent schwannoma can not be excluded.


Instruction: Generate impression based on findings.

Input: Evaluate for ischemic lesion or change since initial intracranial hemorrhage. There is a new punctate focus of diffusion restriction in the left cerebellar hemisphere.There are postoperative findings with track related to placement and removal of a prior right frontal approach catheter. There is interval decrease in the size of the right thalamic and posterior basal ganglia hematoma, which measures 3.1 x 3.0 x 2.9 cm (AP x TR x CC), previously 3.5 x 4.2 x 4.3 cm on 6/7/2015. There is surrounding edema with stable mass effect on the frontal and posterior horn of the right lateral ventricle. There is right to left midline shift measuring 7 mm, previously 8 mm. There is a trace subdural collection along the right frontal lobe with trace layering blood products measuring 4 mm in width, unchanged from CT head of 6/10/2015. A small amount of subarachnoid hemorrhage in the left posterior temporal-parietal region is again noted. There are trace bilateral layering intraventricular hemorrhages. The ventricular size and morphology is unchanged. There is susceptibility effect compatible with chronic microhemorrhage involving the left basal ganglia and thalamus. There are scattered patchy foci of T2 hyperintensity throughout the supratentorial and infratentorial white matter that are most compatible with chronic small vessel ischemic disease. Mild asymmetric T2 hyperintensity within left dentate nucleus is nonspecific but may also represent chronic small vessel ischemic disease. There is mild ectasia of the distal right internal carotid artery. The major cerebral flow voids are intact. There is trace scattered mucosal thickening of the paranasal sinuses. There is fluid within the nasopharynx. There is increased partial opacification of the bilateral mastoid air cells.

Output: 1. New punctate focus of diffusion restriction in the left cerebellar hemisphere, consistent with a microinfarct.2. Interval decrease in size of the right thalamic and posterior basal ganglia hematoma with similar appearance of the surrounding edema, mass effect and midline shift towards the left. 3. Stable small amount of subarachnoid hemorrhage in the left posterior temporal-parietal region.4. Stable trace bilateral layering intraventricular hemorrhages.5. Stable trace subdural collection along the right frontal lobe.6. Evidence of remote hemorrhages involving the left thalamus and basal ganglia again seen. Distribution favors a hypertensive etiology. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: No current breast related complaints. There is scattered fibroglandular tissue in both breasts. Minimal parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Confusion, lethargy, and dysarthria. History of cecal cancer and multiple myeloma. There are a few supratentorial and infratentorial punctate foci of high T2 signal and enhancement, including within the cerebellar vermis, right cerebellar tonsil, and right occipital lobe, right parietal lobe, and left insula. which appear to be new. Otherwise, scattered foci of high T2 signal in the supratentorial and infratentorial white matter are unchanged. There is no evidence of intracranial hemorrhage. There is diffuse mild thickening and prominent enhancement of the dura. The ventricles and basal cisterns are unchanged in size and configuration. There is a partially empty sella. There is no midline shift or herniation. There is mild vertebrobasilar dolichoectasia. There is an unchanged prominent left occipital lymph node. The orbits, skull, and paranasal sinuses are grossly unremarkable.

Output: 1. Punctate enhancing supratentorial and infratentorial lesions appear to be new and may represent metastases or perhaps an inflammatory process. Otherwise, scattered foci of high T2 signal in the supratentorial and infratentorial white matter are unchanged and may represent chronic small vessel ischemic disease and there is no evidence of acute infarction. 2. Diffuse mild thickening and prominent enhancement of the dura may be due to intracranial hypotension or recent lumbar puncture.


Instruction: Generate impression based on findings.

Input: 56 year old female with brain mass, most likely meningioma. Rule out systemic involvement. Expressive aphasia. CHEST:LUNGS AND PLEURA: Atelectasis at the right lung base. MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Right breast mass with macrocalcification at image 30 of series 5 measures 2 cm in diameter. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Laparoscopic band at gastroesophageal junction is in the expected position. Normal appendix in the right lower quadrant. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Status post hysterectomy.BLADDER: Foley catheter in decompressed bladder. 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. Right breast mass.2. Lap band at GE junction.3. No occult malignancy was found.


Instruction: Generate impression based on findings.

Input: Female, 56 years old, falls, left sided weakness. Evaluate for lumbar radiculopathy. For the purposes of numbering, the inferiormost well formed disc is designated L5-S1. There is transitional anatomy at the right L5-S1 level. The vertebral column alignment is within normal limits. The vertebral body heights are preserved. There is disc desiccation at L2-L3, L3-L4 and L4-L5. There is mild loss of disc height at L3-L4, L4-L5 and moderate loss of disc height at L5-S1. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. There is minimal nonspecific enhancement of the left L3-L4 interspinous soft tissue.T12-L1: Mild bilateral facet degeneration. No significant disc bulge, spinal canal or foraminal stenosis. L1-L2: Mild bilateral facet degeneration. No significant disc bulge, spinal canal or foraminal stenosis. L2-L3: Disc bulge, thickening of the ligamentum flavum and bilateral facet degeneration. No significant spinal canal or foraminal stenosis. L3-L4: Disc bulge, thickening of the ligamentum flavum and bilateral facet degeneration, contributing to mild left L3-L4 foraminal stenosis. No significant spinal canal or right foraminal stenosis. L4-L5: Disc bulge, thickening of the ligamentum flavum and progression of bilateral facet degeneration, contributing to minimal left L4-L5 foraminal stenosis. No significant spinal canal or right foraminal stenosis. L5-S1: Bilateral facet degeneration. No significant disc bulge, spinal canal or foraminal stenosis.

Output: 1. Mild degenerative changes of the lumbar spine, without significant spinal canal stenosis. Minimal to mild left foraminal stenosis at L3-L4 and L4-L5.2. Minimal nonspecific enhancement of the left L3-L4 interspinous soft tissue, which may be vascular in etiology versus represent mild interspinous bursitis.3. Transitional anatomy at the right L5-S1 level.


Instruction: Generate impression based on findings.

Input: Myalgias Soft tissues: There is diffusely increased T2 signal within the anterior compartment of the left thigh specifically involving the vastus lateralis, intermedius, and medius. This also involves the rectus for more subtle but to a lesser degree. Additionally, on the coronal STIR sequence, similar although less severe findings are noted in the contralateral leg. There is no evidence of a focal fluid collection.Osseous structures: Marrow signal of the femora is normal.

Output: Diffuse muscle edema involving the anterior compartment of the left femur consistent with myositis. This is most notable within the vastus lateralis. Similar although less severe findings are noted in the contralateral leg as well. Although evaluation is limited by lack of intravenous contrast, there is no evidence of focal fluid collection.


Instruction: Generate impression based on findings.

Input: Paresthesia of skin [R20.2], Reason for Study: ^Reason: stroke/ History: stroke? There is no evidence of acute ischemic or hemorrhagic lesion.Previously seen left frontal lobe precentral gyrus ischemic infarct with hemorrhagic transformation is again seen, demonstrate interval encephalomalacia.Various sized tissue defects involving bilateral basal ganglia and right thalamus indicating chronic lacunar infarctions.Underlying brain shows patchy FLAIR/T2 high signal intensity lesions on bilateral periventricular white matter and centrum semiovale indicating nonspecific small vessel ischemic disease, unchanged.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.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. Interval development of minimal encephalomalacia on previously diagnosed as acute ischemic infarct involving the left frontal lobe frontal operculum (precentral gyrus) with evidence of prior hemorrhagic conversion.3. Nonspecific small vessel ischemic disease, unchanged since prior scan.4. Multiple lacunar infarctions involving bilateral basal ganglia and right thalamus, unchanged since prior scan.


Instruction: Generate impression based on findings.

Input: Female, 55 years old, history of lymphoma with lower back pain. Alignment is anatomic. Vertebral body morphology is normal. No concerning marrow replacement or pathologic marrow enhancement is seen.The visualized spinal cord, conus and cauda equina are unremarkable. No pathologic intrathecal enhancement is seen.Mild loss of disc height and T2 signal is evident at T11-12, L3-4, L4-5 and L5-S1. Additional level specific findings are as follows:L1-2: Unremarkable. L2-3: Unremarkable. L3-4: Mild facet hypertrophy and ligamentum flavum thickening. Mild bulging disc with a small superimposed central disc protrusion. Annular fissuring seen previously is less conspicuous, but the size of the protrusion is unchanged. No significant spinal canal or neuroforaminal stenosis. L4-5: Moderate facet hypertrophy and ligamentum flavum thickening. Mild bulging disc with small superimposed central disc protrusion, unchanged. Moderate generalized spinal canal stenosis, mild bilateral foraminal narrowing, unchanged. L5-S1: Moderate facet hypertrophy and ligamentum flavum thickening. Mild bulging disc with a superimposed small central disc protrusion and annular fissure, unchanged. No significant spinal canal or foraminal stenosis, though the bulging disc does abut the S1 nerve sheaths bilaterally.

Output: 1.Stable mild disc bulging and central protrusions at L3-4, L4-5 and L5-S1.2.Stable moderate generalized spinal canal stenosis at L4-5.


Instruction: Generate impression based on findings.

Input: The patient submitted outside mammogram dated 6/2/2014, outside ultrasound dated 6/2/2014, and MRI dated 9/9/2014, from UICMC. Submitted outside study was compared to the current mammogram dated 7/23/2015.Interval increase in a circumscribed mass in the right breast at the 5:00 to 6:00 position from 10 to 18 mm; this area mostly corresponds to a clustered cyst seen on ultrasound dated 6/2/2014 with atypical blood flow. No abnormal enhancement is seen on MRI. A few cysts are noted in the right breast with the largest measuring 8 mm.

Output: Clustered cyst in the right breast with atypical blood flow on outside ultrasound, which is increased in size; this area needs further evaluation with ultrasound.BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: EB - Additional Mammo/Ultrasound Workup Required.


Instruction: Generate impression based on findings.

Input: 48-year-old female with CF, status-post bilateral lung transplant, with worsening hypoxia, lethargy. Please evaluate for intracranial fungal infection or other potential etiologies of encephalopathy. Limited examination secondary to motion artifact and the use of portable scanner. Interval placement of nasoenteric tube and endotracheal tube.The ventricles, sulci, and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass effect, edema, midline shift, intra- or extra-axial fluid collection or acute hemorrhage. The calvaria and skull base are radiographically normal. The visualized paranasal sinuses again demonstrate partial opacification in the maxillary sinuses, ethmoid air cells, and hypoplastic frontal sinuses and sphenoid sinuses. This appears increased compared to prior CT examination. Opacification of the right mastoid air cells also appears increased compared to prior CT examination, although similar to prior MRI brain. The visualized left mastoid air cells are clear.Atherosclerotic calcification again identified along the distal left acute artery and the distal internal carotid arteries.

Output: 1. Limited examination secondary to motion artifact and the use of portable scanner. Within this limitation, there is no evidence of acute intracranial abnormality. 2. Increased opacification of the right mastoid air cells and paranasal sinuses.


Instruction: Generate impression based on findings.

Input: 50-year-old female with strong family history of breast cancer presents for MRI breast for screening. There is scattered fibroglandular tissue in both breasts.Minimal parenchymal enhancement is noted bilaterally.No significant interval change of the enhancing focus within the right nipple, which was characterized as a papilloma on the prior ultrasound.No additional abnormal enhancement is seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.

Output: 1. No MRI evidence for malignancy. 2. Stable enhancing focus in the right nipple likely represents a benign papilloma.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: 70 year-old female. Clinical question to be answered is stroke. Left arm and left leg numbness. No evidence of hemorrhage, edema, mass-effect, midline shift or hydrocephalus. Cortical sulci, ventricular system and all CSF cisterns remain within normal. This examination demonstrates no interval change since prior normal CT of brain from 5 -- 19 -- 2009. Follow up with an MRI is recommended considering the two consecutive negative CTs of brain and presenting clinical symptoms.

Output: Negative CT of brain and stable since prior study.


Instruction: Generate impression based on findings.

Input: Follow up after laser ablation of the left hippocampal lesion. There is unchanged T2 hyperintensity, susceptibility effect and volume loss within the left hippocampus and parahippocampal gyrus, where laser ablation has been performed. The posterior hippocampus still demonstrates asymmetrically increased T2 signal. There is no evidence of acute intracranial hemorrhage or acute infarct. The ventricles are unchanged in size and configuration. There is no midline shift or herniation. Left frontal and parietal skull burr holes are again noted. The skull is otherwise unremarkable. The visualized portions of the paranasal sinuses and mastoid air cells are clear.There are unchanged numerous punctate foci of high T2 signal within the right parotid gland, which may again represent sequelae of an inflammatory process.

Output: Unchanged expected findings related to laser ablation in the left medial temporal lobe.


Instruction: Generate impression based on findings.

Input: Patient has depth electrodes placed for intracranial EEG monitoring on 10/8/15. Evaluate for depth electrode position. There are two left transfrontal electrodes that extend to the left anterior cingulate and left orbitofrontal regions. There are also bilateral transparietal electrodes that extend to the bilateral medial temporal lobes. There is a small amount of pneumoventricle. The ventricular system is otherwise unchanged in size. There is a small amount of high T1 signal in the right parietal sulci adjacent to the electrode, which may represent postoperative enhancement or hemorrhage. There is no midline shift or herniation. There is mild scalp swelling surrounding the electrode insertion sites.

Output: Two left transfrontal electrodes that extend to the left anterior cingulate and left orbitofrontal regions and bilateral transparietal electrodes that extend to the bilateral medial temporal lobes.


Instruction: Generate impression based on findings.

Input: 17 year old male with schwannomas in leg and groin area. Beading of the left femoral nerve and sciatic nerve is similar in appearance to the prior exam. The schwannoma/neurofibroma of the proximal tibial nerve is similar in appearance and has a maximum diameter of 1.2 cm, 1.2 cm previously. Subtle beading is again noted in the distal tibial nerve. No new lesions are identified.

Output: No significant change in neurofibromas/schwannomas since prior exam.


Instruction: Generate impression based on findings.

Input: 67-year-old female status post fall with traumatic subarachnoid hemorrhage and small subdural/epidural. Reidentified along the right high parietal convexity, is a high density focus within the cortex with additional focus of high density seen on image 19/28 which is mostly resolved. These findings remain consistent with cortical hemorrhage given the history. No new areas of hemorrhage or associated extra-axial hemorrhage. Otherwise, there is no evidence of mass or edema. Bifrontal prominence of the subdural space within the high convexity appears slightly more dense than expected and may represent chronic bifrontal subdural hematomas or prominent extra-axial space. MRI may be considered for further evaluation as clinically warranted.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. Resolving hematomas as described above.2. Prominence of the bifrontal extra axial space may represent chronic subdural hematomas or prominent extra-axial space. MRI may be considered for further evaluation as clinically warranted.


Instruction: Generate impression based on findings.

Input: 64-year-old male with elevating PSA, history of prior prostate biopsies with negative results. PELVIS:PROSTATE:Prostate Size: 5.0 x 6.1 x 4.8 cm.Peripheral Zone: The base of the left peripheral zone adjacent to the transitional zone is T2 hypointensity with an area of corresponding restricted diffusion measuring 2.2 x 0.8 cm. There is no corresponding early arterial enhancement.Central Gland: Severe degree benign prostatic hypertrophy.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: No extracapsular extension is evident.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.T2 hypointensity with corresponding restricted diffusion in the left base peripheral zone.


Instruction: Generate impression based on findings.

Input: Brain MRI:Redemonstrated is diffuse cortical thickening and T2/FLAIR hyperintensity involving the right frontal lobe including the right precentral gyrus, most conspicuous along the right parasylvian cortex and laterally along the right frontal lobe. There is also involvement of the right insula, the right cingulate gyrus, right mesial temporal lobe, and the right thalamus. There is also mild possible increased signal within the right basal ganglia and caudate without enlargement. There is no associated diffusion restriction or associated enhancement. There is associated subtle right cerebral sulcal effacement in areas of abnormality. There are new expected changes secondary to right frontal approach biopsy with a tract extending to the right thalamus.The ventricles and sulci are otherwise within normal limits. The cisterns remain patent. There is no midline shift. 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. Brain perfusion and spectroscopy:Pertinent spectroscopic peak heights are as follows:Thalami:*NAA 0.090 right, 0.107 left*Choline 0.092 right, 0.066 left*Creatine 0.121 right, 0.088 leftInsula:*NAA 0.124 right, 0.160 left*Choline 0.134 right, 0.087 left*Creatine 0.171 right, 0.125 leftThe in NAA/Cr ratio is distinctly abnormal in the right thalamus and insula. However, the Choline/Cr ratio is not. However, when comparing metabolite peak heights on the involved right interrogated sites compared to left contralateral controls, there is an overall increase in both right-sided choline voxels suggesting an increase in cellular membrane density. Additionally, the creatine "standard" is elevated within both right-sided voxels, suggesting an increase in overall right-sided interrogated metabolic rate, which would thus skew ratio analysis due to variability of this internal control. There are no peaks demonstrating lactate or lipid. The overall metabolic profile appears the same for both the interrogated right thalamus and right insula.Corrected rCBV demonstrates a very subtle and diffuse increase within the involved right sided hemispheric structures, primarily demonstrated within the adjacent white matter rather than the thickened gyri.Complete spine MRI:Alignment is normal. The marrow signal is benign. The spinal cord is normal in signal without abnormal enhancement. The cervicomedullary junction is normal. Redemonstrated is diffuse The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable. There are no osseous dysplasias or stenoses.

Output: 1.Redemonstrated is diffuse cortical thickening and T2/FLAIR hyperintensity involving the right frontal lobe including the right precentral gyrus, most conspicuous along the right parasylvian cortex and laterally along the right frontal lobe. There is also involvement of the right insula, the right cingulate gyrus, right mesial temporal lobe, and the right thalamus. There is also mild possible increased signal within the right basal ganglia and caudate without enlargement. There is no associated diffusion restriction or associated enhancement. There is associated subtle right cerebral sulcal effacement in areas of abnormality. These findings are overall stable in appearance. However, there are new expected changes secondary to right frontal approach biopsy with a tract extending to the right thalamus.2.Perfusion and spectroscopic analysis suggests elevated metabolism and an increase in membrane density within interrogated voxels of both the right thalamus and right insula. The overall metabolic profile appears the same for both the interrogated right thalamus and right insula locations.3.Negative complete spine with contrast. Specifically, there is no abnormal enhancement of intrathecal contents.


Instruction: Generate impression based on findings.

Input: Reason: Fall, L knee pain, eval for ligamentous injury History: see above MENISCI: There is linear signal abnormality traversing the posterior horn of the medial meniscus extending to both the tibial and femoral articular surfaces. There is blunting of the posterior horn of the meniscus on the sagittal images. These findings likely represent a small radial tear which extends to involve the body of the meniscus. The anterior horn appears intact. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is near full-thickness articular cartilage degeneration along the lateral facet of the patella with near full-thickness articular cartilage loss. There is superficial fraying of the articular cartilage of the lateral facet of the femoral trochlea. There is relative sparing of the medial and lateral compartment cartilage.LIGAMENTS: The collateral ligaments appear intact. There is complete disruption of the ACL, although the lack of surrounding edema may indicate that this is chronic in etiology. The PCL appears intact.EXTENSOR MECHANISM: The extensor mechanism appears intact. The Insall Salvati ratio measures 1.4, indicating patella alta.ADDITIONAL

Output: 1. Small radial tear of the medial meniscus as described above.2. Complete disruption of the ACL, which may be chronic in etiology.3. Articular cartilage degeneration and cartilage fissuring affecting the patellofemoral articulation with edema in the superolateral aspect of Hoffa's fat pad, patella alta, and a borderline elevated tibial tubercle to the trochlear groove distance. These findings can be seen in patellofemoral instability.


Instruction: Generate impression based on findings.

Input: Personal history of infections of the central nervous system. History of Meningitis, questionable head CT. BRAINThe 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.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate minor opacity in the right maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.There are several subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. These are likely of little clinical significance given the small number. They are not unusual at this age.IACCorrelation with CT temporal bones from 4/4/15, on the left side no distinct cochlear semicircular canals are appreciated. On the right side the superior semicircular canal is identified but no distinct cochleae is identified. The left external auditory canal isn't prominent well-formed. The left facial nerve canal can be identified.Correlation with CT temporal bones, the right internal auditory canal is wide, however, distinct cochlear nerve is not readily appreciated. The right facial nerve is identified. There appears to be a vestibular nerve along the inferior posterior aspect of the right internal auditory canal.The right middle ear and mastoid air cells appear to be opacified.No abnormal enhancing lesions are appreciated at the cerebellopontine angle cisterns nor the internal auditory canals.

Output: 1.There is opacification of the right middle ear and mastoid air cells. This was also present on the recent temporal bone CT there are no obvious signs of active infection appreciated.2.The inner ear structures bilaterally are severely malformed. There is no distinct cochlear appreciated on either side. The semicircular canals on the left side are also not identified. The right superior semicircular canal is identified. There are bilateral facial nerves present probably a vestibular division of the right eighth nerve. The rest of the distal fibula cochlear nerves are not readily appreciated.3.There is no MR evidence for intracranial infection appreciated at this time.


Instruction: Generate impression based on findings.

Input: 53 years Female (DOB:10/2/1962)Reason: hx Lumbar schwannoma. eval for change in size History: back pain., left leg painPROVIDER/ATTENDING NAME: EDWIN RAMOS EDWIN RAMOS Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is a mild disc bulge at this level.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is a left lateral disc protrusion at this level which narrows the left neural foramen and displaces the left-sided exiting nerve roots after they exit the neural foramen.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is a left far lateral disc protrusion at this level which abuts the left-sided exiting nerve root as it exits the neural foramen. There are some mild enhancement present within this disc protrusion at the left far lateral zone and adjacent the left neural foramenAt L2-3 there is no significant compromise to spinal canal or neural foramina. There is a left far lateral disc protrusion at this level which encroaches on the left-sided exiting nerve root after it exits the neural foramen. There is effacement of fat planes adjacent to this left far lateral disc protrusion expected location of the nerve roots. There is associated enhancement along the left-sided exiting nerve root after it exits the neural foramen.At L1-2 there is no significant compromise to spinal canal or neural foramina. There is a broad-based left lateral recess disc protrusion present at this level without compromise to spinal canal or exiting nerve roots.

Output: 1.There is a left far lateral disc protrusion present at L2-3 which displaces the left-sided exiting nerve root as it exits the neural foramen. This is associated with some infiltration adjacent to it. This infiltration could represent inflammation or an alternative type of infiltrating lesion. Please correlate with clinical symptoms.2.There are infiltrative changes are also associated with left lateral disc protrusion at L3-4 and the left far lateral zone which are less prominent than at L2-3. Involve the adjacent exiting nerve root as it exits the neural foramen. This could also represent inflammation or an alternative type of infiltrating lesion.


Instruction: Generate impression based on findings.

Input: Ms. Ulman is a 55 year old female with a personal history of right breast lumpectomy for IDC in 2004 followed by chemotherapy and radiation therapy. She is BRCA1 positive. She presents for routine MRI screening. There is scattered fibroglandular tissue in both breasts. Minimal parenchymal enhancement is noted bilaterally.Stable postsurgical changes are identified in the right inferior breast and right axillary region. No abnormal enhancement is seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Postmenopausal bleeding PELVIS:UTERUS, ADNEXA: Small amount of fluid in the endometrial canal, which is deviated by a low signal intensity broad-based submucosal mass along the posterior fundus with an enhancement pattern similar to the uterus. Overall, the mass measures 1.8 x 1.7 x 3.5 cm (series 7, image 25; series 6, image 21). There are no T2 cystic changes or T1 hyperintense foci to suggest adenomyosis.BLADDER: No significant abnormality noted.LYMPH NODES: No lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: Broad-based submucosal mass along the posterior fundus of the uterus; differential considerations include leiomyoma; adenomyoma is considered less likely.


Instruction: Generate impression based on findings.

Input: Pain and swelling MENISCI: Poorly defined intermediate signal intensity within the posterior horn of the medial meniscus extends toward the femoral articular surface, but I see no frank disruption of the meniscal surface to confirm a tear. The remainder of the medial meniscus appears normal. The lateral meniscus appears normal.ARTICULAR CARTILAGE AND BONE: There is a well-defined full-thickness defect of the articular cartilage of the lateral femoral condyle above the posterior horn of the lateral meniscus. This defect measures just over 1 cm in AP dimension and approximately 5 mm in mediolateral dimension. There is additional delamination of the articular cartilage immediately posterior to this defect. There is also a tiny partial-thickness defect more anteriorly within the articular cartilage of the lateral tibial plateau. The articular cartilage of the medial tibiofemoral compartment appears relatively intact. The articular cartilage of the patellofemoral compartment likewise appears intact.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The quadriceps and patellar tendon appear intact. There is slight lateral translation of the patella relative to the center of the femoral trochlea, with a borderline tibial tubercle to trochlear groove distance of 18 mm. There is a small joint effusion.

Output: Full-thickness defect of the articular cartilage of the lateral femoral condyle with adjacent cartilage delamination. Other findings as above.


Instruction: Generate impression based on findings.

Input: There are stable postsurgical findings related right parietal craniotomy with encephalomalacia along the surgical approach extending to the ventricle and bifrontal ventricular catheter tracks. The glomus of the right lateral ventricle choroid plexus is absent and there is no abnormal enhancement to suggest residual or recurrent tumor. The lateral and third ventricles appear to be unchanged in size. There is a small amount of unchanged minimal residual chronic blood products within the occipital horns. There is unchanged encephalomalacia within the posterior right basal ganglia. There are unchanged small cystic areas left peritrigonal white matter. There is no evidence of acute infarct. The major cerebral flow voids are grossly intact. There is persistent mucosal thickening within the bilateral maxillary and ethmoid sinuses. The extracranial structures are unchanged.

Output: 1.Stable postsurgical findings related to right lateral ventricle choroid plexus tumor removal without evidence of gross residual or recurrent tumor.2.Unchanged small cystic areas in the left peritrigonal region may represent prominent perivascular spaces. 3.Right posterior basal ganglia encephalomalacia is unchanged.


Instruction: Generate impression based on findings.

Input: Headache [R51], Reason for Study: ^Reason: evaluate for structural abnormality History: severe intermittent headache and extended periods of unresponsiveness in former 26 week infant with heroin/cocaine exposure Brain MRINo 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, 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.Brain MRV3D MRV brain without-gadolinium enhancement with maximum intensity projections of the superficial/deep intracranial venous drainage demonstrate normal flow enhancement in the superior sagittal sinus, transverse sinuses, sigmoid sinuses, internal cerebral veins, vein of Galen and straight sinus. There is however intra sinus linear signal voids especially at the level of distal superior sagittal sinus indicating intra-sinus fibrous strand which are normal findings.

Output: 1. Normal brain MRI2. Normal brain MRV


Instruction: Generate impression based on findings.

Input: 68-year-old male, history of liver transplant with back pain, rule out lumbosacral impingement For the purposes of numbering, there are 5 lumbar type vertebral bodies with lumbarization of S1. Lumbar alignment is maintained without spondylolysis or spondylolisthesis. Diffusely mottled low signal of the bone marrow which is nonspecific; no focal suspicious osseous lesions. The conus is in normal position. L1/2: No significant neuroforaminal narrowing or spinal canal stenosis.L2/3: No significant neuroforaminal narrowing or spinal canal stenosis.L3/4: Mild asymmetric hypertrophy of the right posterior facet without significant neuroforaminal narrowing or spinal canal stenosisL4/5: Posterior facet hypertrophy and small right facet joint effusion with mild bilateral neuroforaminal narrowing, but no significant spinal canal stenosis.L5/S1: Moderate degenerative disease and disk bulge and left greater than right facet hypertrophy, with moderate left and mild right neuroforaminal narrowing. No central canal stenosis.

Output: 1. Spondylosis and disk bulge at L5/S1 with moderate left and mild right neuroforaminal narrowing. Additional degenerative changes at described above.2. Heterogenous marrow signal which is nonspecific. No convincing evidence of metastatic disease in the lumbar spine. 2. Please note for the purposes of numbering, there are 5 lumbar type vertebral bodies with lumbarization of S1.


Instruction: Generate impression based on findings.

Input: The ventricles and sulci are slightly prominent, consistent with mild age-related volume loss. The basal cisterns remain patent. There is no midline shift or mass effect. There are scattered small foci of increased T2 hyperintensity within the periventricular and subcortical white matter, consistent with mild chronic small vessel ischemic changes. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. There is mild mucosal thickening within the ethmoid air cells bilaterally.

Output: 1.No acute abnormality. 2.Mild chronic small vessel ischemic changes.


Instruction: Generate impression based on findings.

Input: 60-year-old male with hepatitis C cirrhosis and encephalopathy, status post fall. Rule out bleed. There is no evidence of intracranial hemorrhage, mass or edema. Multiple areas of patchy hypoattenuation in a periventricular and subcortical pattern consistent with small vessel disease, age indeterminate. If there is clinical concern for acute ischemia, an MRI may be considered. Bilateral dystrophic calcifications noted within the basal ganglia. Proportional prominence of the sulci and ventricles.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 clinical concern for acute ischemia, an MRI may be considered.


Instruction: Generate impression based on findings.

Input: Painful nodule in the 2nd intermetatarsal space. Evaluate for neuroma. An ovoid lesion is present at the plantar aspect of the foot between the 2nd and 3rd toes at the level of MCP joint, measuring 4 mm wide in transverse dimension. This lesion demonstrates homogenously low T1 signal and heterogeneous mixed T2 signal, compatible with fibrosis of a Morton neuroma. The soft tissues are otherwise unremarkable. The bone marrow signal is normal. No significant abnormality is otherwise identified.

Output: Findings compatible with a Morton neuroma between the 2nd and 3rd digits.


Instruction: Generate impression based on findings.

Input: 51-year-old male with prostate cancer. Evaluate for extraprostatic disease. PELVIS: Suboptimal examination due to nondiagnostic diffusion-weighted imaging sequences, secondary to extensive artifact.PROSTATE:Prostate Size: 2.5 x 4.7 x 4.3 cm (AP by TR by CC)Peripheral Zone: There is a focus of decreased T2 signal abnormality in the left posterior lateral base of the peripheral zone of the prostate gland, which abuts the left seminal vesicle, measuring 11 x 10 mm. There is associated abnormal enhancement of this area on dynamic contrast-enhanced sequences.Seminal Vesicles: Possible invasion of the left seminal vesicle.Extracapsular Extension: There is a focus of T2 signal abnormality in the left posterolateral base of the peripheral zone of the prostate gland abutting the left seminal vesicle suspicious for invasion of the left seminal vesicle. BLADDER: No significant abnormality noted.LYMPH NODES: No evidence of lymphadenopathy.BONES, SOFT TISSUES: No bone marrow signal abnormality is identified.OTHER: No significant abnormality noted.

Output: Suboptimal examination, however, there is a focus of decreased signal abnormality and abnormal enhancement in the left posterolateral base of the peripheral zone of the prostate gland with findings suspicious for invasion of the left seminal vesicle, as detailed above.


Instruction: Generate impression based on findings.

Input: Multiple sclerosis follow up. There are multiple cerebral white matter T2 hyperintense lesions, primarily in a periventricular distribution, but also in juxtacortical locations, such as in the right occipital lobe. In particular, there is a new lesion in the right parietal periventricular white matter. There is no associated enhancement and there is no evidence of intratentorial lesions. The ventricles and sulci are normal is size and configuration. There is no evidence of intracranial mass lesions. There is no midline shift or herniation. The major cerebral flow voids are grossly intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Multiple sclerosis with a new lesions in the right parietal periventricular white matter.


Instruction: Generate impression based on findings.

Input: Postpartum persistent headache and preeclampsia. MRI: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.MRV: The right transverse sinus is hypoplastic. The major venous sinuses and cortical veins otherwise appear to be intact.

Output: 1. No evidence of acute intracranial hemorrhage, mass, or acute infarct.2. No evidence of intracranial venous thrombosis.