Instruction: Generate impression based on findings.

Input: History brain metastasis. Possible diskitis at T7-T8. Back pain. Alignment of the thoracic spine is anatomical. This compression deformity of T8, choroid compression fractures seen on the prior MRI study. No severe retropulsion is seen. The spinal canal and neural foramina remain patent. His face. There is noted at T8. The T9 level. A small sclerotic focus in T2 vertebra is nonspecific, but is compatible with enostosis.In L4 vertebra, there is sclerotic lesion with depression of end plate superiorly. Imaging findings is not significantly changed compared to the prior MRI study. There is no evidence of epidural lesion.There are degenerative changes in the thoracic and lumbar spine, which are better visualized on the prior MRI study.An IVC filter is noted. There is increased interstitial densities in bilateral lungs, greater on the left.

Output: 1. No significant interval change in the compression deformity of T8 and sclerotic lesion of L4. Diskitis at T7-T8 cannot be excluded based on CT findings. Lesion at L4 can represent chronic compression injury but sclerotic metastasis can have similar appearance. Continuing followup and correlation with clinical findings are recommended.2. Please refer to dedicated chest study for additional findings of the lungs.


Instruction: Generate impression based on findings.

Input: Female 61 years old; evaluate for adenoma. History: hyperparathyroidism RIGHT LOBE MEASUREMENTS: 5.3 x 1.3 x 2.4 cmLEFT LOBE MEASUREMENTS: 4.3 x 1.6 x 1.8 cmISTHMUS MEASUREMENT: 0.4 cmRIGHT LOBE: The right thyroid lobe is normal in echogenicity and echotexture. A subcentimeter predominantly cystic nodule measuring 0.4 x 0.3 x 0.4 cm is noted in the mid right thyroid pole.LEFT LOBE: The left thyroid lobe is normal in echogenicity and echotexture. A subcentimeter predominantly cystic nodule measuring 0.4 x 0.4 x 0.6 cm noted in the mid thyroid pole.ISTHMUS: No significant abnormality noted.LYMPH NODES: No regional lymphadenopathy.OTHER: And extrathyroidal hypoechoic well marginated vascular mass measuring 0.6 x 0.3 x 0.4 cm noted posterior to the superior pole of the right thyroid lobe.

Output: 1.Subcentimeter extrathyroidal hypoechoic well marginated vascular mass posterior to the superior pole of the right thyroid lobe, suggestive of a parathyroid adenoma in the appropriate clinical setting.2.Bilateral predominantly cystic subcentimeter thyroid nodules.


Instruction: Generate impression based on findings.

Input: Fungal (Candida) endophthalmitis refractory to standard therapy. Recent cataract surgery including vitreous loss leading to secondary glaucoma s/p bleb complicated with bleb failure and revision, choroidals, and persistent inflammation worsening despite topical and oral steroids in the left eye who underwent pars plana vitrectomy, vitreous and aqueous tap, intravitreal antibiotics, anterior chamber washout to the left eye. There are post-treatment findings in the left eye consisting of lensectomy and silicone oil injection. There is evidence of left retinal detachment with a collection of subretinal silicone oil medially. The retina enhances diffusely, as does the left ciliary body complex and uvea. There is also mild swelling and hyperenhancement of the left lacrimal gland, but no evidence of retrobulbar abnormal enhancement. The left globe is slightly smaller than the right globe. There is a right lens implant. The right orbital contents are otherwise unremarkable. There is no evidence of abnormal intracranial enhancement, abscess, mass, or acute infarction. There is mild nonspecific cerebral white matter T2 hyperintensity, which may represent chronic small vessel ischemic disease. The ventricles and sulci are mildly prominent due to cerebral volume loss. There is no midline shift or herniation.

Output: Findings compatible with left endophthalmitis and related post-treatment findings with retinal detachment with subretinal collection of silicone oil medially. However, no retrobulbar or intracranial extension of the infectious process is apparent.


Instruction: Generate impression based on findings.

Input: Lumbar stenosis Five lumbar type vertebral bodies are presumed to be present with hypoplastic ribs at T12 and partial sacralization of L5, where the right L5 transverse process articulates with the sacrum. Vertebral body heights are within normal limits. There is levoscoliosis of the lumbar spine with with apex at the L3 level. There is also grade 1 anterolisthesis of L3 on L4 which appears more conspicuous than on prior exam. Bone marrow signal is benign. The conus medullaris is normal in position. Multilevel degenerative changes are seen with multilevel disc desiccation stable to minimally worse since 6/3/2014. There is increase in edema involving the anterior superior corner of the L4 vertebral body and present to a mild degree previously. Individual levels as described below:L1-L2: There is minimal disc bulge, ligamentum flavum thickening, and bilateral facet arthropathy. There is minimal narrowing of the spinal canal and neural foramina.L2-L3: Minimal disc bulge, ligamentum flavum thickening and bilateral facet arthropathy. There is no significant spinal canal or neural foraminal stenosis.L3-L4: There is severe hypertrophic facet arthropathy which along with ligamentum flavum thickening, disc uncovering and minimal disc bulge contributing to moderate to severe spinal canal stenosis. Bilateral facet effusions. There is moderate right and mild to moderate left neural foraminal stenosis which are minimally worse in the interval.L4-L5: Disc bulge extending to the right. There is also mild bilateral facet arthropathy. There is no significant central spinal canal stenosis. There is partial effacement of the lateral recesses. There is mild bilateral neural foraminal stenosis.L5-S1: Minimal disc bulge. There is bilateral facet arthropathy. No significant spinal canal stenosis. There is mild right and mild to moderate left neural foraminal stenosis.

Output: There are multilevel degenerative changes in the lumbar spine which have overall slightly progressed since 6/3/2014. In particular, there is slight worsening of moderate to severe spinal canal stenosis at L3-L4, where there is also severe facet arthropathy and degenerative grade 1 anterolisthesis. There is also lumbar levoscoliosis as seen on same-day radiographs. Additional details as above.


Instruction: Generate impression based on findings.

Input: 62 year-old female status post mucinous cystadenoma resection which contained a focus of invasive adenocarcinoma. Evaluate for metastatic pancreatic cancer. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Subcentimeter hypodense lesion near the falciform ligament in the left lobe of the liver is nonspecific (image 20/112 on series number 4).SPLEEN: Status post splenectomyPANCREAS: Patient is status post distal pancreatectomy. Within the distal remaining pancreas there is a 3.1x 1.9 cm cystic collection which may be in continuity with the pancreatic duct, however this is unclear. There is no solid enhancing component to this collection. The pancreatic remnant is otherwise unremarkable.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: Small aortocaval and mesenteric lymph nodes are not pathologically enlarged by CT criteria.BOWEL, MESENTERY: A small left of midline hernia contains mesenteric fat.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXAE: Left adnexal cyst measures 3.8 x 3.6 cm (image 82/112). This can be further evaluated with gynecologic ultrasound or MRI.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: 1. No definite evidence of metastatic disease. There is a fluid attenuation collection at the distal portion of the pancreatic remnant as described above.2. Left adnexal cyst which is incompletely evaluated on this examination and should be further evaluated with gynecologic ultrasound or MRI if this patient is post-menopausal.


Instruction: Generate impression based on findings.

Input: Reason: Worsening of previously reported perianals abscess, fistulas History: Crohn's disease, perianal abscess with fistulas, s/p hospitalization for IV antibiotics, now with recurrent fevers for past 3 days Again seen is thickening and enhancement of the rectosigmoid colon with surrounding enhancement and high signal intensity on T2-weighted images, consistent with inflammation and edema. These findings appear less pronounced on today's study than those seen on the prior study. There is a persistent, enhancing sinus tract extending from the posterior wall of the rectum through the soft tissues of the right medial thigh into the perineum and base of the scrotum. A focus of enhancement is seen in the vicinity of the previously described abscess, however, no discrete fluid collection remains.

Output: Persistent anoperineal fistulization with near resolution of the perineal abscess.


Instruction: Generate impression based on findings.

Input: Reason: Crohn's DZ, now with diarrhea and belly cramping, wounds near rectum. Imaging to assess for fistula, fissure, Crohn's flare? History: Crohn's DZ, now with diarrhea and belly cramping, wounds near rectum. Imaging to assess for fistula, fissure, Crohn's flare? PELVIS:UTERUS, ADNEXA: Nabothian cysts. BLADDER: No significant abnormality noted.LYMPH NODES: Enlarged inguinal lymph nodes measuring 2.2 x 1.6 cm on the left (5/11) and 1.3 x 1.2 cm on the right (5/13). Prominent right external iliac node measures 1.7 x 0.9 cm (5/19).BOWEL, MESENTERY: There is mild edema and inflammatory changes involving the right gluteal fold and perennial region as well as the labia bilaterally. No focal fluid collections are present. A focus of increased T2 signal posterior to the anal canal distally (5/7) likely represents external contrast or fluid. No evidence of fistulas or abscesses.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Mild right gluteal and perineal inflammatory changes without definite fistula or drainable rim enhancing collection or abscess identified.2.Mild pelvic and inguinal lymphadenopathy is likely reactive.


Instruction: Generate impression based on findings.

Input: 26-year-old man with history of testicular cancer, evaluate for metastases. ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter hepatic cyst (600/23). The liver is otherwise normal in signal and morphology. The gallbladder appears normal. There is no intra or extrahepatic biliary ductal dilatation.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 lymphadenopathy noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No evidence of metastatic disease in the abdomen or pelvis.


Instruction: Generate impression based on findings.

Input: 82-year-old female with branch duct type IPMN, follow-up. ABDOMEN:LIVER, BILIARY TRACT: Scattered subcentimeter T2 hyperintense foci are too small to characterize but stable compared to the prior exam and likely benign. Tiny stones within the gallbladder fundus. Stable vascular malformation of the left hepatic lobe (axial series 10013 image 350). SPLEEN: No significant abnormality noted.PANCREAS: Stable 0.9 x 0.9 cm cystic lesion of the pancreatic head (axial series 5 image 15, coronal series 9 image 50), which again likely represents a sidebranch IPMN.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable simple cyst of the left upper renal pole.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Stable sidebranch IPMN of the pancreatic head.2.Stable vascular malformation of the left hepatic lobe.


Instruction: Generate impression based on findings.

Input: Reason: Right knee lateral meniscus tear History: Right knee pain MENISCI: There is undersurface fraying/degenerative tearing of the posterior horn lateral meniscus. There is also fraying/degenerative tearing of the free edge of the body of the lateral meniscus. The anterior horn appears intact. The medial meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is focal near full-thickness to full-thickness articular cartilage degeneration along the lateral femoral condyle, posteriorly (image 9; series 9). There is also focal near full-thickness articular cartilage degeneration along the weightbearing portion of the lateral femoral condyle, above the posterior horn of the meniscus (image 10; series 9). There is subjective thinning of the medial tibiofemoral and patellofemoral articular cartilage. There are small tricompartmental osteophytes.LIGAMENTS: There are lobulated foci of fluid signal intensity along the posterior aspect of the distal fibers of the PCL as well as within the posterior aspect of the tibial plateau at the level of the insertion of the PCL likely representing mucoid degeneration. The ACL appears intact. The LCL and MCL appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Degeneration/tearing of the lateral meniscus as described above. The medial meniscus appears intact. 2. Osteoarthritis of the right knee with focal full-thickness articular cartilage degeneration as described above.


Instruction: Generate impression based on findings.

Input: Ms. Morris is a 64 year old female with biopsy proven multifocal malignancy of the right breast. Personal history of right breast lumpectomy/axillary dissection/chemoradiation for cancer in 1993. There is heterogeneous amount of fibroglandular tissue in both breasts. Moderate background parenchymal enhancement is noted bilaterally.In the right lower inner breast, clumped nonmass enhancement is identified, spanning approximately 5.5 cm in the AP dimension. This MR-detected area of enhancement corresponds in distribution and span to the mammographically detected calcifications (spanning 5.9 cm in the AP dimension). Susceptibility artifact from two biopsy marker clips are seen spanning this area of clumped nonmass enhancement, separated by approximately 3.0 cm in the AP dimension, compatible with the history of biopsy proven malignancy. Located just 1.2 cm superior to the posterior aspect of the clumped nonmass enhancement is an additional irregular mass measuring 1.0 cm, suspicious for additional malignancy.Although there is moderate background parenchymal enhancement identified in the left breast, there are no foci more suspicious than the rest. No abnormal axillary lymph nodes are identified in either axillary region.

Output: (1) Multifocal biopsy proven malignancy of the right breast, spanning approximately 5.5 cm in the AP dimension. Additional irregular mass, seen just 1.2 cm superior to the MR-detected area of enhancement, is suspicious for malignancy. Additional workup, including ultrasound and possible biopsy, can be performed if clinically warranted.(2) No MR evidence of malignancy in the left breast.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Painful growth on ulnar side of right total finger at the level of the PIP joint Normal third finger imaging. Specifically no abnormal mass or focal soft tissue abnormality is observed. No abnormal enhancement. Osseous structures are well visualized and unremarkable in alignment as well as marrow signal. Articulations are unremarkable.Remaining visualized digits including the second, fourth and fifth fingers are all otherwise unremarkable as well as the more proximal metacarpals. Of note however is a small focal hemangioma in the proximal first metacarpal demonstrating minimal appropriate enhancement.

Output: No acute abnormalities observed, specifically no discrete focal mass or findings observed involving the third finger adjacent to the PIP articulation as described.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Diagnosis: Pain in unspecified hipClinical question: spinal stenosisSigns and Symptoms: thigh pain radiating to lower leg 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. Incidental note is made of perineural cyst within the sacral spinal canal at the S2 to level measuring 11 x 8 mm sagittal dimensions.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is a minor disc bulge present at this level.At L4-5 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.The uterus is enlarged , contains multiple low signal foci within it and is fluid-filled.

Output: 1.No compromise to lumbar spinal canal or neural foramina.2.Findings suggest a multiple uterine fibroids and fluid within the uterus (can be seen with menses)which are relatively common findings. This can be confirmed clinically if needed.


Instruction: Generate impression based on findings.

Input: A 56 year old female with congestive heart failure, hypertension, hyperlipidemia, obesity, hypothyroidism and breast cancer. Pre-treatment of Herceptin, an echocardiography showed left ventricular ejection fraction of 32% and the patient was referred to stress cardiac MRI to evaluate etiology.MEDICATIONS: aspirin, atorvastatin, calcium, carvedilol, digoxin, letrozole, levothyroxine, lorazepam, spironolactone, valsartan First Pass PerfusionDuring hyperemia, no perfusion defects were present. A dark rim artifact is noted. Viability/ Myocardial ScarThere is a mild mid-wall stripe pattern of late gadolinium enhancement noted in the septum. The pattern is not consistent with prior myocardial infarction and suggests the presence of underlying myocardial fibrosis.Left VentricleThe left ventricle is severely dilated with mild to moderately reduced systolic function. The overall LV ejection fraction is 41%, the LV end diastolic volume index is 116 ml/m2 (normal range: 65+/-11), the LVEDV is 246 ml (normal range 109+/-23), the LV end systolic volume index is 66 ml/m2 (normal range 18+/-5), the LVESV is 144 ml (normal range 31+/-10), the LV mass index is 65 g/m2, and the LV mass is 141 g. There is global hypokinesis with regional variation. No intracavitary thrombus was seen. Left AtriumThe left atrium is normal in size (90ml). Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 46%, the RV end diastolic volume index is 88 ml/m2 (normal range 69+/-14), the RVEDV is 191 ml (normal range 110+/-24), the RV end systolic volume index is 47 ml/m2 (normal range 22+/-8), and the RVESV is 103 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with "pseudo bovine" brachiocephalic branching pattern (normal variant).Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsSmall axillary lymph nodes are noted. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. No perfusion defects/ "ischemia" present during hyperemia.2. No prior myocardial infarction. 3. The LV is severely dilated with mild to moderately reduced systolic function (LVEF 41%) and evidence of mild late gadolinium enhancement in the septum. The pattern is most consistent with underlying myocardial fibrosis due to dilated cardiomyopathy.4. Normal RV size with mildly reduced systolic function (RVEF 46%).5. See extra-cardiac findings.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 52 years old. Reason: any pelvic lesions? History: woman with NF2 who has abdominal pain Again seen is a multilobulated mass posterior to the left iliac crest which enhances following administration of contrast and again measures approximately 2 cm in greatest dimension. Additionally, there is a second lobulated mass along the periphery of the lateral aspect of the left gluteus maximus muscle measuring approximately 2 cm in greatest dimension which also enhances following administration of contrast. These may represent small neurofibromas and are unchanged from prior study. Within the spinal canal posterior to L5, there is a 1 cm enhancing focus which may represent a small meningioma or nerve sheath tumor but is unchanged from prior study. The cervix appears unremarkable given the prior history of stenosis, however, please note that the current study is not optimized for details evaluation of pelvic visceral structures. Within these limitations, there is no significant change when compared to the study from 2008. Bone marrow signal intensity is unremarkable. The hip joints and sacroiliac joints appear normal.

Output: Small suspected neurofibromas without significant interval change.


Instruction: Generate impression based on findings.

Input: Right lumbar radiculopathy, reduced patellar reflex. Five lumbar type vertebral bodies are present. Vertebral body heights are within normal limits. Alignment is grossly maintained with perhaps minimal anterolisthesis of L3 on L4 and L4 on L5. Bone marrow signal is benign with prominent edematous/Modic 1 type endplate marrow signal changes involving the right aspect of the L4 and L5 vertebral bodies. The conus medullaris is normal in position.Multilevel degenerative changes are seen, including disc height loss at L3-L4 and L4-L5 with vacuum phenomena. Individual levels as described below:L1-L2: Minimal disc bulge. No spinal canal or neural foraminal stenosis.L2-L3: Minimal disc bulge. No spinal canal or neural foraminal stenosis.L3-L4: Mild disc bulge, ligamentum flavum thickening and facet arthropathy contribute to mild narrowing of the spinal canal. There is mild right and minimal left neural foraminal narrowing.L4-L5: There is mild disc bulge, moderate bilateral facet arthropathy, and ligamentum flavum thickening. There is moderate degree of spinal canal stenosis. There is severe right and minimal left neural foraminal stenosis.L5-S1: Mild disc bulge, ligamentum flavum thickening, and bilateral facet arthropathy. There is no significant spinal canal stenosis. There is mild to moderate right and mild left neural foraminal stenosis.Paraspinous soft tissues are within normal limits.

Output: Multilevel degenerative changes in the lumbar spine, worst at the L4-L5 level. There is moderate L4-L5 spinal canal stenosis. There is also severe right L4-L5 neural foraminal stenosis which is suspected to be impinging on the exiting right L4 nerve root.


Instruction: Generate impression based on findings.

Input: Elevated PSA. His PSA over the last several years has been in the range of 3-4, but in August rose to 5.3 ng/mL. He was referred to a urologist (Dr Lyon in Naperville) who repeated a free/total PSA which showed a PSA of 5.6 ng/mL with free/total ratio of 11%. No Biopsy. PELVIS:PROSTATE:Prostate Size: 3.1 x 4.2 x 4.7 cmPeripheral Zone: In the left lateral mid gland there is a 1.4 x 1.0 x 1.1 cm lesion demonstrating low T2 weighted signal intensity (series 901/15), restricted diffusion (series 704/284) and avid early enhancement with washout (series 1501/1531).Central Gland: 8 mm right mid gland transitional zone T2 weighted hypointense lesion (series 901/16) with restricted diffusion (series 7 04/304) is very well-defined and likely represents a BPH nodule. Additional changes of benign prostatic hyperplasia.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: The left lateral mid gland lesion has a broad base abutting and bulging the lateral fibromuscular "capsule".BLADDER: No significant abnormality noted.LYMPH NODES: Small non-specific 5 mm lymph node at the aortic bifurcation. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.4 cm lesion in the left lateral mid gland is very suspicious for prostatic adenocarcinoma. It has a broad base and bulges the fibromuscular "capsule" suspicious for probable extraprostatic extension.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for abnormality that can explain syncope. Signs and symptoms: Syncope Non-enhanced CT of brain:The examination demonstrates a mass in basal cistern. There is also suggestion of expansion of the sella on reformatted images.This mass measures approximately 19 mm times 16 -mm on axial image 7. There appears to be a second mass at the level of left cavernous sinus with no distinct communication with the mass within the basal cistern. This second mass measures approximately 12 times 17-mm in size measured on axial image 5. Although the lesion within the basal cistern may represent a pituitary macroadenoma sagittal reformatted images demonstrate residual CSF density within the sella which makes possibility of a macroadenoma less likely. And follow-up with an MRI examination is recommended. The second mass in the left cavernous sinus could represent an aneurysm or a meningioma. This also should be further evaluated with a dedicated enhanced MRI brain and an MRA.There is no evidence of intracranial hemorrhage, edema, mass effect, midline shift or hydrocephalus. The cortical sulci, ventricular system and CSF cisterns are otherwise unremarkable. The gray -- white matter differentiation is within normal.Above findings were relayed via paging tool to Dr. Kuznetsov on pager number 2782 after attempts to contact directly failed due to lack of response at the time of interpretation.

Output: 1.Mass within the basal cistern which may represent a pituitary macroadenoma. Follow up with dedicated MRI is recommended.2.Mass centered at the level of left cavernous sinus is concerning for an aneurysm, meningioma or a pituitary adenoma. It is possible that the above two masses are components of a single larger mass which should be further investigated with dedicated enhanced MRI and MRA.3.This examination is otherwise is unremarkable.


Instruction: Generate impression based on findings.

Input: Epilepsy. The left hippocampal head appears to have slightly indistinct internal architecture and slight volume loss, with minimal signal abnormality. There is unchanged minimal asymmetry of the temporal horns of the lateral ventricles. There is also unchanged slight prominence of the bilateral lateral cerebellar hemisphere folia. Otherwise, there is no evidence of intracranial hemorrhage, mass, or acute infarct. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Suggestion of mild left medial temporal sclerosis, but no evidence of acute intracranial tumor.


Instruction: Generate impression based on findings.

Input: 58-year-old male with history of prostate cancer. PSA 3.4 with Gleason grade of 7. PELVIS:PROSTATE:Prostate Size: 2.1 x 3.9 cm. Signal intensity: Note is made of multiple foci of low T2 signal abnormality in the peripheral zone of the prostate gland. There is a 6 x 5 mm, focus of low T2 signal abnormality in the left base of the prostate gland with associated restricted diffusion and contrast enhancement, consistent with the patient's known history of prostate carcinoma. Additionally, note is made of multiple additional foci of low T2 signal abnormality in the right base are as well as the left apex. There is associated enhancement consistent with multiple additional foci of prostate carcinoma.Seminal Vesicles: Normal appearance.Extracapsular Extension: No evidence of extracapsular extension. There is no bulging of the capsule identified.BLADDER: There is diffuse wall thickening of the bladder, which is nonspecific, but may be related to chronic outlet obstruction.LYMPH NODES: No evidence of lymphadenopathy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Multiple foci of signal abnormality involving the left base, the left apex, and right base of the prostate gland, which are consistent with the patient's known history of multifocal prostate carcinoma. There is no evidence to suggest extracapsular extension or invasion of the neurovascular bundle.


Instruction: Generate impression based on findings.

Input: Reason: internal derangement resulted from recurrent right shoulder dislocation with possible Hill Sachs lesion on fluoroscopy, history of EDS, frequent dislocations History: difficulty with raising shoulder, pain ROTATOR CUFF: Note is made of partial thickness tearing of the bursal surface supraspinatus just proximal to the level of its insertion on the greater tuberosity measuring approximately 4 mm in the AP dimension. There is no significant retraction. There is thinning of the supraspinatus tendon likely representing chronic attritional tearing. There is partial thickness undersurface tearing of the subscapularis at the level of its insertion on the lesser tuberosity involving less than 50% of the tendon width. There is no significant retraction. The teres minor and infraspinatus muscles and tendons appear intact.SUPRASPINATUS OUTLET: There is a trace amount of fluid within the subacromial subdeltoid bursa. The acromioclavicular joint is normal in appearance.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is slight posterior translation of the humeral head relative to the glenoid. There is deformity of the anterior humeral head which may reflect a reverse Hill Sachs impaction fracture deformity. Evaluation for labral tears is limited on this non arthrogram examination. However, there is a subcentimeter focus of fluid signal intensity along the posterior aspect of the inferior labrum which likely represents paralabral cyst formation, indicating a tear. There is articular cartilage degeneration along the posterior aspect of the glenoid. There is linear increased signal abnormality traversing the superior glenoid labrum which may represent a normal variant sublabral recess versus a superior labral tear.BICEPS TENDON: Evaluation of the tendon of the long head of the biceps is limited secondary to extensive susceptibility artifact from prior surgery and patient motion artifact.ADDITIONAL

Output: 1. Postsurgical changes of prior rotator cuff repair with partial thickness bursal surface as well as chronic attritional tearing of the supraspinatus as described above. No full-thickness rotator cuff tear or retraction is identified. Partial-thickness tearing of the subscapularis as described above.2. Findings suggestive of a reverse Hill Sachs impaction fracture deformity of the humerus with probable labral tears, within the limitations of this non arthrogram study. These findings may represent the sequelae of prior posterior dislocation. This could be further evaluated with a dedicated arthrogram MRI examination if clinically warranted.


Instruction: Generate impression based on findings.

Input: Clinical question: hx brain met- f/u 6 months for change. Signs and Symptoms: none- surveillance imaging. Pre and post enhanced brain MRI:Examination redemonstrate a large focus of left anterior frontal cystic encephalomalacia and gliosis spanning the cerebral cortex and subcortical/periventricular white matter reaches the left frontal horn of the lateral ventricle. There is mild ex vacuo dilatation of the left lateral ventricle. The signal intensity, extending and the overall appearance of findings remains identical to prior exam and without evidence of residual or recurrence of tumor. A thick localized dural based enhancement with T2 hypointense signal pattern also remains identical in size, extent, pattern of enhancement and highly suggestive of dural/epidural scarring. The finding measures approximately 11 x 26 mm in transaxial dimensions are identical to prior study.Small focus of FLAIR hyperintensity in the left anterior temporal lobe laterally without enhancement remains similar to prior exam and highly suggestive of post surgical changes of left-sided craniotomy. There is mild prominence of cerebral cortical sulci similar to prior exam. CSF cisterns remain within normal and similar to prior exam.No detectable new foci of FLAIR/T2 signal abnormality or abnormal parenchymal, meningeal enhancement to suggest new metastatic lesions.Unremarkable calvarium other than expected postoperative changes of left sided craniotomy.Unremarkable images through the orbits including axial fat sat post enhanced series.Paranasal sinuses and bilateral mastoid air cells demonstrate normal pneumatization signal patterns.

Output: 1.Stable postoperative/treatment changes of the left anterior frontal tumor removal since prior exam. No evidence of residual or recurrence of tumor.2.Stable dural focus of enhancement in size and extent and consistent with postoperative changes in the left anterior frontal.


Instruction: Generate impression based on findings.

Input: 38 year old female with metastatic ovarian cancer now with rising LFT's and bilirubin, rule out biliary obstruction or need for stent. Epigastric pain, rising LFTs, and jaundice. Limited examination secondary to extensive motion artifact. ABDOMEN:LIVER, BILIARY TRACT: There is intrahepatic biliary ductal dilation extending to the level of Klatskin's point. There is an associated large perihepatic mass which encases the portal vein at the level of Klatskin's point, measuring approximately 6.9 x 5.6 cm, consistent with the patient's known history of metastatic ovarian carcinoma. There are multiple foci of increased signal abnormality in the liver with associated peripheral enhancement which are also suspicious for metastatic disease. 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: IVC filter in place. There is extensive retroperitoneal lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.There is a large perihepatic mass which encases the portal vein at the level of Klatskin's point, consistent with the stated history of metastatic disease. There is associated moderate intrahepatic biliary ductal dilation. 2.There is retroperitoneal lymphadenopathy and hepatic lesions consistent with metastatic disease.


Instruction: Generate impression based on findings.

Input: 56 year-old female with metastatic breast cancer to the bone. On chemotherapy (Xeloda) Evaluate response. Restaging. CHEST:LUNGS AND PLEURA: Bilateral decrease in diffuse pleural thickening and resolution of the right-sided minimal pleural effusion. No discrete nodules are identified. Hazy groundglass opacities in the lung bases, more prominent on the right side likely represent dependent atelectasis.MEDIASTINUM AND HILA: Esophagus is slightly dilated.CHEST WALL: Status post right mastectomy. Numerous bone metastases involving the thoracic vertebral bodies, ribs and bilateral scapula. Compression fracture of T7 vertebral body and the T8 vertebral body with metastatic lesions are stable. At the level of the T8 vertebral body there is extension into the spinal canal. This has been evaluated with MRI since the prior exam.ABDOMEN:LIVER, BILIARY TRACT: Numerous new metastatic lesions in the liver. A reference lesion in the right lobe measures 3.1 x 3 cm in image number 78, series number 3.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: A large soft tissue mass destroying the left iliac bone and extending into the left hip joint is stable. Additional numerous extensive mass metastatic lesions involving the thoracic vertebral bodies and pelvic bones are stable.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Atrophic, but otherwise unremarkable.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Small collection in the right gluteal region seen on the prior exam has resolved or is outside the field of view. OTHER: No significant abnormality noted.

Output: Extensive skeletal metastatic disease is stable. Stable hepatic metastases and interval no change in size of the left iliac bone metastatic lesion.Right gluteal collection is no longer seen.


Instruction: Generate impression based on findings.

Input: Rotator cuff tear, weakness The exam is significantly limited by motion artifact. Additionally, susceptibility artifact from prior intervention also limits evaluation.ROTATOR CUFF: There is full-thickness tearing of the distal insertional fibers of the supraspinatus tendon with retraction of the undersurface fibers to the level of the glenoid. There is extension relating to partial tearing of the infraspinatus tendon as well. There is thickening and increased signal of the distal fibers of the subscapularis although some fibers are noted to traverse the bicipital groove. The teres minor tendon is intact.There is mild atrophy of the supraspinatus and infraspinatus muscles. The remaining rotator cuff muscles are preserved.SUPRASPINATUS OUTLET: Mild amount of fluid is noted in the subacromial subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Small focus of increased signal is noted in the anterior superior labrum reflecting small tear. This is superimposed upon age-related degeneration of the superior labrum. There is mild cartilage thinning of the humeral head at the glenohumeral articulation.BICEPS TENDON: The intra-articular biceps tendon is absence of secondary to biceps tenodesis. ADDITIONAL

Output: 1. Full-thickness tearing of the distal fibers of the supraspinatus with retraction of undersurface fibers to the level of the glenoid. Additionally, there is partial-thickness tearing of the infraspinatus and subscapularis tendon. There is mild associated atrophy of the supra and infraspinatus musculature.2. Small anterior superior labral tear.3. Absence of the intra-articular biceps tendon related to biceps tenodesis.


Instruction: Generate impression based on findings.

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

Output: 1. No evidence of acute intracranial hemorrhage, mass, or acute infarct.2. A nodular lesion in the left cheek subcutaneous tissue that measures up to 15 mm may represent an inclusion cyst, for example, but is nonspecific.


Instruction: Generate impression based on findings.

Input: 82-year-old female status post fall and hit right forehead. There is no evidence of intracranial hemorrhage, mass or edema. Periventricular and deep white matter diffuse hypodensities consistent with small vessel ischemic disease, age indeterminate. If there is clinical concern for stroke, an MRI may be considered.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Diffuse white matter hypodensities consistent with ischemic disease, age indeterminate. If there is clinical concern for stroke, an MRI may be considered.


Instruction: Generate impression based on findings.

Input: Reason: demyelinating lesion History: right leg weakness and numbness Thoracic spine:Vertebral body heights are within normal limits. Alignment is within normal limits. No abnormal marrow signal. No abnormal enhancement. No abnormal signal within the cord. No significant spinal or neural foraminal stenosis.Multiple bilateral renal cysts. The largest one measures approximately 3.5 cm in the right kidneyLumbar spine:There is a compression fracture at L1 with 50% loss of vertebral body height and mild increased T2 STIR signal and enhancement along the superior endplate. No abnormal signal within the cord or conus which ends at L1-L2..T12-L2: Minimal diffuse disc bulge. No spinal canal or neural foraminal stenosis.L1-L2: There is no significant compromise to spinal canal or neural foramina this level.L2-L3: There is no significant compromise to spinal canal or neural foramina this level.L3-L4: There is no significant compromise to spinal canal or neural foramina this level.L4-L5: There is a diffuse disc bulge present with superimposed central extrusion extending superiorly behind the inferior endplate of L4. There is loss of disc space height and some disc desiccation at this level. There is moderate facet arthropathy with synovial effusions and moderate ligamentum flavum thickening at this level. The fat at the lateral recess is bilaterally effaced at this level. There is crowding of the nerve roots within the thecal sac. There is moderate central canal stenosis. The neural foramina are narrowed at this level, however, the fat surrounding the exiting nerve roots is preserved. There is mild anterior subluxation of L4 on L5.L5-S1: Mild diffuse disc bulge No spinal canal or neural foraminal stenosis. There is disc desiccation, loss of disc space height, endplate reactive changes and Schmorl nodes present at this level.There are 2 cysts adjacent to the L5 spinous process with peripheral enhancement. One to the right of the spinous process measures 6 mm diameter whereas one to the left of the L5 spinous process measures 5 mm. There is associated ill-defined enhancement in the adjacent soft tissues.

Output: 1.No abnormal signal within the cord to suggest demyelinating disease.2.There is a compression fracture present at L1 associated with findings suggesting subacute stage.3.There are degenerative changes present in lumbar spine with moderate spinal stenosis at L4-5 as detailed above4.There are cystic lesions adjacent to the L5 spinous process associated with findings suspicious for adjacent inflammation. The possibility that these are infectious in origin cannot be excluded. Although unusual it could also be degenerative in nature possibly related to Baastrup's disease with bursal fluid.5.Multiple renal cystic lesions.Findings discussed with Dr. Del Brutto at 10:45 AM on 7/27/2015.


Instruction: Generate impression based on findings.

Input: Female, 66 years old, with history of craniotomy for resection of parafalcine meningioma with progressive weakness. Again seen is evidence of craniotomy at the high vertex. A partially resected falcine meningioma is again seen. Enhancement along the left aspect of the resection cavity has become thicker when compared to the prior examination though it remains nonspecific. Nodular enhancement along the right aspect of the resection cavity has also become thicker than on prior and likely represents residual tumor. The parenchyma of the adjacent superior frontal gyri is edematous, but this appears grossly similar to the prior examination.Evidence of prior left frontal and parietal craniotomy is again seen with the resection cavity evident in the left middle frontal gyrus. Findings are unchanged. An 8 mm nodule of enhancement along the left superior temporal gyrus is unchanged. An enhancing focus within the left squamous temporal bone is also unchanged.On MRV imaging, the superior sagittal sinus directly beneath the craniotomy is flattened and narrowed, largely due to anatomic changes related to craniotomy. However, there does remain a distinct flow related signal throughout the sinus indicating patency. The dural venous sinuses and deep venous structures are otherwise patent.

Output: 1.Sequelae of partial resection of the falcine meningioma are again seen. Nodular enhancement along the right aspect of the resection cavity is favored to represent residual tumor and has become thicker in the interval. Enhancement along the left aspect of the resection cavity has also become thicker but it remains nonspecific and could represent evolving postoperative change with granulation tissue or some residual tumor as well.2.MRV imaging demonstrates mass effect upon the superior sagittal sinus as it passes beneath the high vertex craniotomy. However, the sinus remains patent.3.Findings are redemonstrated compatible with prior left sided surgery. A small presumed meningioma along the left superior temporal gyrus is also unchanged.


Instruction: Generate impression based on findings.

Input: Female; 60 years old. Reason: 60yo F w/ uptrending TBili, RUQ pain and concern for cholangitis vs acute liver injury History: as above Lack of intravenous contrast limits today for solid organ pathology.ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesions. Low T2 signal of the liver diffusely is suggestive of iron deposition, though there is no paradoxical loss of signal on in-and-out of phase images to confirm this. Nonspecific periportal edema and pericholecystic free fluid, which may be related to generalized ascites. Gallbladder is not distended. No cholelithiasis. No biliary ductal dilation. Note that MRCP images are limited due to ascites.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Mild left axillary lymphadenopathy, partially visualized. Body wall anasarca.OTHER: Cardiomegaly and bilateral pleural effusions, partially visualized. Moderate upper abdominal ascites.

Output: 1. Findings suggestive of CHF and/or volume overload.2. Nonspecific periportal edema and pericholecystic fluid may be related to generalized edema.3. No biliary ductal dilation.


Instruction: Generate impression based on findings.

Input: 45 years Female (DOB:12/16/1970)Reason: r/o stroke History: left sided weaknessPROVIDER/ATTENDING NAME: CHRISTOPHER M GOMEZ CHRISTOPHER M GOMEZ The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal 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 are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: Periventricular and subcortical white matter signal changes of a mild degree are present which are nonspecific. They could be vascular related, related to demyelination, trauma, vasculitis, sarcoid. They are nonspecific.


Instruction: Generate impression based on findings.

Input: 51-year-old female with sarcoidosis. Cholestatic picture on LFTs. Transjugular liver biopsy demonstrating osteopenia with portal and lobular inflammation and granulomatous, compatible with sarcoidosis. Extremely limited study due to patient refusal of multiple sequences, including lack of IV contrast.ABDOMEN:LUNGS BASES: Fibrotic changes at the lung bases, as seen on prior studies, though better evaluated on prior CTs. No pleural effusions. LIVER, BILIARY TRACT: Hepatomegaly, without focal lesions evident. No biliary ductal dilation. Mild nonspecific gallbladder wall edema.SPLEEN: Splenomegaly, without focal lesions evident.PANCREAS: No significant abnormality noted on the limited sequences performed.ADRENAL GLANDS: No significant abnormality noted on the limited sequences performed.KIDNEYS, URETERS: No significant abnormality noted on the limited sequences performed.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted on the limited sequences performed.BOWEL, MESENTERY: Partially imaged non-specific mildly prominent bowel loops.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1.Significantly limited examination due to patient's refusal of multiple sequences and IV contrast administration.2.Hepatosplenomegaly, without biliary ductal dilation evident.


Instruction: Generate impression based on findings.

Input: There are scattered foci of T2 hyperintensity in the white matter without associated mass effect, restricted diffusion, susceptibility abnormality, or enhancement. The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. Note is made of a partially empty sella. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. A prominent perivascular spaces is evident along the lateral aspect of the right inferior basal ganglia. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. A mucous retention cyst is present in the right maxillary sinus, otherwise the paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain.

Output: Mild chronic small vessel ischemic disease.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Suprasellar meningioma, surveillance There is no significant change in size or appearance of the homogenously enhancing dural-based mass along the planum sphenoidale that projects into the suprasellar cistern and measures 19 x 15 x 15 mm in the AP, transverse, and craniocaudal dimensions. There is minimal if any enlargement compared to examinations dated back to 2/15/2013. Again seen is associated mass effect upon the optic chiasm and pituitary gland. The mass abuts the right cavernous sinus without evidence of invasion. Mass is also noted to abut the right supraclinoid internal carotid artery and the bilateral A1 segments of the anterior cerebral arteries. Remainder of the brain is unremarkable for patient's age with no other masses or mass effect. There is unchanged mild nonspecific scattered cerebral white matter T2 hyperintensity likely representing mild chronic small vessel ischemic changes. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles are unchanged in size and configuration. Bone marrow signal and extracranial soft tissues are unremarkable.

Output: No significant change in the planum sphenoidale/suprasellar meningioma with mass effect on the optic chiasm and pituitary gland.


Instruction: Generate impression based on findings.

Input: History of poorly differentiated sinonasal carcinoma SNUC s/p CRT. The patient also has a history of ankylosing spondylitis with sacro-iliac fusion and evidence of a C5-6 impingement. There is diffuse mild congenital narrowing of the cervical spinal canal. There is flowing anterior syndesmophyte formation at multiple lower cervical and imaged thoracic vertebrae. There is degenerative spondylosis of the cervical spine that is most pronounced at the C5-6 level with areas of uncovertebral and facet hypertrophy. There is also a mild disc-osteophyte complex with resultant moderate to severe right-sided and moderate left-sided neural foraminal stenosis at this level, as well as mild indentation upon the spinal cord. The spinal cord otherwise displays normal signal. The vertebral column alignment is within normal limits. The vertebral body heights are preserved. The vertebral bone marrow signal is unremarkable. The paravertebral soft tissues are unremarkable. There is no evidence of mass lesions in the cervical spine region. There is encephalomalacia in the right inferior cerebellar hemisphere.

Output: 1. Stigmata of ankylosing spondylitis, a congenitally narrow spinal canal, and superimposed cervical spine degenerative spondylosis that is most pronounced at the C5-6 level, where there is moderate to severe spinal canal stenosis, moderate to severe right and moderate left neural foraminal stenosis. 2. No evidence of metastatic disease in the cervical spine.3. Chronic right posterior inferior cerebellar artery territory infarct.


Instruction: Generate impression based on findings.

Input: 37-year-old female with left arm and wrist weakness, tingling. Negative EMG. There is no acute fracture or dislocation. Bone marrow signal intensity is within normal limits. There is no evidence of muscular atrophy or soft tissue edema. There is a ganglion cyst in the wrist adjacent to the distal ulna. The cyst measures 1.1 x 0.6 cm on series 3, image 40 but does not appear to involve the ulnar nerve in Guyon's canal. The imaged portions of the median and ulnar nerves are unremarkable.

Output: 1.No evidence of soft tissue injury or abnormality involving the visualized median and ulnar nerves.2.Ganglion cyst in the wrist adjacent to the distal ulna without nerve involvement.


Instruction: Generate impression based on findings.

Input: Status post SEGCA. (tuberosclerosis) with complaints of severe headache and pain. Evaluate hydrocephalus. There is no evidence of intracranial hemorrhage. Multiple subependymal tubers are again seen consistent with history of tuberous sclerosis. Subependymal mass in the right frontal horn appears stable again measuring 2.2 x 2.9 cm (image 13), suspicious for a subependymal giant cell astrocytoma. Additional lower density mass in the frontal horn and body of the left lateral ventricle also appears stable and may represent a cystic component of the presumed giant cell astrocytoma versus an arachnoid cyst. An additional subependymal mass in the body of the left ventricle is also concerning for an astrocytoma. MRI is recommended for further evaluation. The ventricles are enlarged although unchanged compared with prior examination. The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: No interval change in bilateral subependymal masses and subependymal calcifications consistent with history of tuberous sclerosis with presumed giant cell astrocytomas. Stable ventricular volumes. MRI is recommended for further evaluation.


Instruction: Generate impression based on findings.

Input: Elevated PSA. 2 previous negative biopsies. PELVIS:PROSTATE:Prostate Size: 6.3 x 3.9 x 4.5 cmPeripheral Zone: There is striated T2 heterogeneity bilaterally, left greater than right, without focal lesions, abnormal enhancement, or abnormal diffusion restriction to suggest tumor.Central Gland: Heterogeneous and enlarged, compatible with marked BPH.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: No evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted. No lymphadenopathy by size criteria.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: There is striated T2 heterogeneity bilaterally, left greater than right, no discrete lesion delineated. Marked BPH without lesion suspicious for carcinoma.


Instruction: Generate impression based on findings.

Input: 35 years, Female, Reason: possible urethral diverticulum and hematuria History: hematuria. PELVIS: FemaleUTERUS, ADNEXA: A tampon is present within the vagina. There is a left-sided nabothian cyst.There is a multiseptated cystic along the left anterior aspect of the vagina, posterior to the urethra which measures 1.4 x 1.1 x 5.1 cm (5/21 and 8/33). This lesion extends above the origin of the urethra. No definite communication with the urethra is identified, however, evaluation is limited due to lack of intravenous contrast.BLADDER: There is a punctate cystic foci along the left anterior aspect of the urethra (5/15) without definite communication.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: 1.Cystic lesion between the bladder and urethra which extends above the origin of the urethra. No definite communication with the urethra is identified, however evaluation is limited due to lack of intravenous contrast. At this point, differential diagnosis includes a Gardner duct cyst or a urethral diverticulum, with a Gardner duct cyst favored. However, it is recommended that the patient return for post contrast sequences as this may be helpful.2.Punctate cystic foci adjacent to the distal urethra without definite communication is nonspecific.


Instruction: Generate impression based on findings.

Input: 49-year-old female with a history of rotator cuff surgery presents with shoulder pain. Again seen are foci of metallic susceptibility artifact within the soft tissues of the shoulder, likely representing metallic debris from prior surgery.ROTATOR CUFF: There is perhaps mild fraying along the bursal and articular surfaces of the supraspinatus tendon, however, no discrete fluid-filled tear is identified. The remaining tendons and muscles are within normal limits.SUPRASPINATUS OUTLET: Again seen is widening of the acromioclavicular joint presumably from prior surgery. No fluid is present in the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Again seen is absence of the anterior-superior labrum with an enlarged middle glenohumeral ligament suggesting a Buford complex. Mild osteoarthritis affects the glenohumeral joint. There is also a defect in the subchondral bone plate in the posterior inferior glenoid with underlying cyst formation that appears similar to that seen on the prior study. There is linear increased signal intensity within the adjacent posterior labrum that may represent a tear.BICEPS TENDON: The tendon of the long head of the biceps is intact. ADDITIONAL

Output: Possible superficial fraying of the supraspinatus tendon, but no discrete rotator cuff tear is evident. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Hemangioma of intracranial structures [D18.02] / Unspecified convulsions [R56.9], Reason for Study: ^Reason: CCM Protocol/QSM/Permeability, 3T scanner, please evaluate cavernomas, please compare to outside images in PACS if available at time of reading. There is about 6mm x 5.8mm sized peripheral low signal intensity with central high signal intensity with multicompartment seen on the junction of the left parahippocampal gyrus entorhinal cortex and Amygdala. The lesion shows significant susceptibility artifacts and associated with branching patterned signal voids. There is no evidence of surrounding edema.Constellation of above findings indicate cavernous malformation associated with developmental venous anomaly.There is no other susceptibility lesion nor abnormal enhancing lesion. The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Left subiculum (junction of parahippocampal gyrus entorhinal cortex and amygdala area) area cavernous malformation associated with developmental venous anomaly.2. No associated surrounding edema.3. No evidence of other susceptibility lesion.Comment: outside MR scan is not available to compare at the time of this dictation.


Instruction: Generate impression based on findings.

Input: Male, 53 years old, gynecomastia status post heart transplant x2. The pituitary gland is normal in size. Although there is a mild heterogeneity to the pattern of parenchymal enhancement, no discrete lesion is identified. The pituitary stalk sits at the midline and shows normal enhancement. The suprasellar cistern is clear. No abnormality of the visualized optic apparatus are seen.Limited evaluation of the brain reveals a few scattered nonspecific small foci of white matter T2 hyperintensity as well as mild rimming hyperintensity along the right frontal horn. No evidence of parenchymal edema or mass effect is seen. No restricted diffusion is detected. No evidence of pathologic parenchymal or extra-axial enhancement is seen. Mild mucosal thickening is evident within the paranasal sinuses. The right mastoid air cells and to a lesser degree the left mastoid air cells demonstrate fluid signal opacification.

Output: No specific pituitary lesion is seen to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Male, 75 years old, with metastatic head and neck cancer to the brain status post SRS to a left cerebellar metastasis in 10/2014. Assess for brain metastases. A focus of susceptibility is redemonstrated within the left lateral cerebellum corresponding to the site of the previously treated metastasis. No suspicious enhancement or edema is detected at this location.A small focus of encephalomalacia within the right cerebellum is unchanged and may represent a tiny chronic infarct. No evidence of focal parenchymal edema, mass effect or pathologic enhancement is seen. Scattered foci of FLAIR hyperintensity are nonspecific and unchanged. Scattered punctate foci of susceptibility effect are also noted without significant change. No abnormal fluid collections are detected. The ventricles are normal in size and morphology. Post-treatment findings are noted including fatty atrophy of the right hemitongue. Chronic mucosal thickening and opacification the right maxillary sinus are redemonstrated.

Output: 1.The previously treated left cerebellar lesion is redemonstrated as a focus of susceptibility. No significant interval change is noted.2.No new or suspicious intracranial lesions are seen.


Instruction: Generate impression based on findings.

Input: Male 49 years old with prostate cancer. Biopsy showed Gleason grade 6 or 7 adenocarcinoma in every biopsy core. PELVIS:PROSTATE:Prostate Size: 4.2 x 2.9 cmPeripheral Zone: There are multiple T2 hypointense lesions involving the peripheral zone bilaterally. The dominant lesion is in the left peripheral zone extending from the apex to the base measuring 1.5 x 0.7 cm (series 801, image 13). It abuts the capsule in the left mid gland, extracapsular extension is possible. This lesion has diffusion restriction, is dark on ADC and demonstrates early enhancement.Central Gland: No significant abnormality noted.Seminal Vesicles: No significant abnormality.Extracapsular Extension: The dominant lesion in the left peripheral zone abuts the capsule in the left mid gland, extracapsular extension is possible.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Extensive lesion in the left peripheral zone is consistent with prostate carcinoma. The lesion abuts the capsule and extracapsular extension is possible. There are additional small lesion in the right gland. There is no evidence of seminal vesicle disease.


Instruction: Generate impression based on findings.

Input: History of dermatomyositis: migraines associated with nosebleeds and left sided facial numbness. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain, brainstem, cerebellum, and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

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


Instruction: Generate impression based on findings.

Input: 78 years Female (DOB:3/13/1938)Reason: preop planning for biopsy History: preopPROVIDER/ATTENDING NAME: BAKHTIAR YAMINI BAKHTIAR YAMINI There is redemonstration of a hemorrhagic lesion with a ring enhancement located at the right occipital lobe which currently measures 8 x 6 mm coronal dimensions and 8 x 6 mm axial dimensions. It has the same measurements on the prior exam from 6/17/2016.There is redemonstration of a extra-axial lesion along the left tentorial leaf adjacent to the left vermis which measures 6 mm and is unchanged prior exam. A microhemorrhage identified on the prior exam in the right cuneus is not identified on the current exam. It was never associated with any contrast enhancement.There is a mild to moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.The visualized portions of the paranasal sinuses demonstrate partial opacification of the left maxillary sinus which is stable compared to the prior exam.. The visualized portions of the mastoid air cells are opacified. There are a few are opacities in the left mastoid air cells. Mastoid opacification is stable compared to the prior exam The visualized portions of the orbits are intact. The eyeball lenses are thin.

Output: 1.There is redemonstration of a right occipital lobe hemorrhagic enhancing lesion as well as the left tentorial based lesion which are stable compared to the prior exam. These are suspicious for metastatic disease. The left tentorial leaf extra-axial lesion could also represent a meningioma which statistically would be more likely.2.Periventricular and subcortical white matter lesions of a mild to moderate degree are nonspecific. At this age they are most likely vascular related. 3.Examination was performed for the purposes of stereotactic guidance during surgery.


Instruction: Generate impression based on findings.

Input: Clinical question: Patient with history of non-Hodgkin's lymphoma in maxillary sinus. Signs and symptoms: Non-Hodgkin's lymphoma. Enhanced CT of maxillofacial:In comparison with the prior examination there is significant interval reduction in the amount of fluid/soft tissue density within bilateral maxillary sinuses and anterior ethmoids as well as left frontal sinus. There is suggestion of bilateral endoscopic functional sinus surgery of maxillary sinuses. On the current exam there is only very minimal mucosal thickening of the right maxillary sinus without any detectable tumor. There is mucosal thickening at the level of sinonasal window with occlusion.There is also significant improvement of the left maxillary sinus with residual mucoperiosteal thickening throughout the left maxillary sinus and it severely compromised sinonasal window. The frontal sinuses are well pneumatized and no evidence of residual disease. There is evidence of bilateral ethmoidectomy with some residual mucoperiosteal thickening however with interval improvement since prior exam.Images through the nasal cavity demonstrate postoperative changes and no detectable mass. This examination demonstrate no definitive evidence of lymphoma however this can be further evaluated with a dedicated MRI examination of maxillofacial region. Bony structures of the area of the study demonstrate no destructive changes.Few small nonpathologic and non-enhancing bilateral cervical nerve roots in this limited view of upper neck are again identified. Limited view of intracranial content and including cavernous sinuses demonstrate no definitive abnormality.Images through the orbits are unremarkable.40 cc of Omnipaque 350 was utilized for the above study.

Output: 1.Significant improvement of paranasal sinuses since prior study with better pneumatization as detailed above.2.Residual mucoperiosteal thickening in bilateral maxillary sinus and with occluded bilateral sinonasal windows as described.3.This examination demonstrates no definitive evidence of tumor however CT scan can miss small tumors as it can appear as mucosal thickening. This area can be better evaluated with a dedicated MRI for tumor.4.No evidence of bony destructive lesion and unremarkable limited view of intracranial content.


Instruction: Generate impression based on findings.

Input: Compressible erythematous papule on right nasal root, assess depth and extension, eval for glioma. There is an enhancing nodular lesion in the skin and subcutaneous tissues of the right nasal root region, which measures up to approximately 7 mm. The nasal skeleton and floor of the anterior cranial fossa appear to be intact. There are mild scattered paranasal sinus retention cysts. There is no evidence of measurable mass lesions or significant cervical lymphadenopathy based on size criteria. The thyroid and major salivary glands are unremarkable. The imaged intracranial structures are unremarkable.

Output: A subcentimeter lesion in the right nasal root region is non-specific, but does not appear to have deep extension beyond the skin and subcutaneous tissues. Differential considerations may include a chronically-inflamed and collapsed cyst, hemangioma, or neoplasm. Further evaluation via dedicated high-resolution MRI sequences using a microscopy coil may be useful, if clinically warranted.


Instruction: Generate impression based on findings.

Input: 64 years Female (DOB: 1/12/1952) PROVIDER/ATTENDING NAME: SERVICES ANCILLARY SERVICES ANCILLARY The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is multilevel loss of disc space height and disc desiccation present.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal. There are bilateral uncovertebral osteophytes present at this level associated with disc material and encroachment of the right-sided exiting nerve roots within the neural foramen. There is a small left paramedian disc protrusion present at this level which effaces spinal fluid ventral to the left hemicord.At C5-6 there is no significant compromise to the spinal canal. There are bilateral uncovertebral osteophytes present this level associated with disc material encroachment of the exiting nerve roots within the right neural foramina.At C6-7 there is no significant compromise to the spinal canal . There are bilateral uncovertebral osteophytes present at this level associated with disc material and encroachment of the right-sided exiting nerve roots within the neural foramen.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.There is a T1 and T2 hyperintense focus within the C7 vertebral body and left lateral aspect. It is well-circumscribed.

Output: 1.There are degenerative changes present in the cervical spine associated with encroachment of exiting nerve roots within the neural foramina on the right side at C4-5 and C6-7 and bilaterally at C5-6


Instruction: Generate impression based on findings.

Input: 67-year-old woman with history of vaginal pain, urinary incontinence, and vaginal fullness. PELVIS:UTERUS, ADNEXA: No uterine or adnexal mass is identified. A 9 x 6 mm simple cystic focus in the left lower vagina (series 901, image 15) is likely a Bartholin's gland cyst.BLADDER: The bladder appears normal. There is a multilobulated 19 x 16 mm T2 hyperintense lesion surrounding the left posterolateral aspect of urethra (series 1101, image 15). This lesion appears to communicate with the 7:00/right posterolateral aspect of the urethra (series 1301, image 161).LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: The partially visualized small bowel and colon are normal.BONES, SOFT TISSUES: Small injection granuloma noted in the anterior lower right abdomen.OTHER: No significant abnormality noted.

Output: Multilobulated "saddlebag" urethral diverticulum with possible communication at the 7:00/right posterolateral aspect of the urethra.


Instruction: Generate impression based on findings.

Input: History of Whipple in 2013 for IPMN with subsequent recurrent acute and chronic pancreatitis. Patient has a history of CREST syndrome, autoimmune thyroiditis and Sjogren's syndrome. ABDOMEN:LIVER, BILIARY TRACT: Postsurgical changes from hepaticojejunostomy. The central biliary tree demonstrates short segment smooth narrowing at the level of the right and left hepatic bile ducts. No focal lesion is evident, however evaluation is limited by lack of intravenous contrast. No significant intrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: Postsurgical changes from a Whipple procedure. The residual pancreatic body demonstrates normal T1-weighted signal intensity. However, the residual pancreatic tail demonstrates bulbous enlargement, decreased T1-weighted signal intensity and associated restricted diffusion. The main pancreatic duct in the tail demonstrated beaded dilatation measuring up to 4 mm with side branch ectasia. There are small unilocular cystic lesions in the pancreatic tail with the largest measuring 1.2 x 1.0 cm (series 3/20). Following secretin administration there is no significant dilatation in the residual pancreatic duct but there appears to be some excretory function of the parenchyma.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Bulbous enlargement, restricted diffusion and ectatic dilation of the pancreatic tail suspicious for an inflammatory process. The constellation of findings and the patient's history raises suspicion for auto-immune hepatopancreatitis. An underlying mass lesion cannot be excluded. EUS and tissue sampling is suggested. 2. Abnormal narrowing of the central biliary tree without a focal lesion seen on this limited non-enhanced study; also may be related to auto-immune hepatopancreatitis. 3. Small cystic foci in the pancreatic tail may represent side branch type IPMNs with the largest measuring 1.2 cm without suspicious features, within the limitations of a nonenhanced study.


Instruction: Generate impression based on findings.

Input: 39-year-old female with altered mental status. There is no evidence of intracranial hemorrhage, mass or edema. There is focal low attenuation in the left basal ganglia, which may represent a prior lacunar infarction or perivascular space. Further evaluation with MRI may be considered if clinically indicated. There is diffuse parenchymal volume loss.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: Focal low attenuation in the left basal ganglia may represent prior lacunar infarction or perivascular space. If stroke is clinically suspected, MRI may be considered for further evaluation.


Instruction: Generate impression based on findings.

Input: Pain MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: A discrete osseous fragment and suspected donor site involving the medial condyles and suspected Pellegrini steata lesion. Appearance similar to plain film without evidence of interval change or acute abnormality.Mild thinning diffusely throughout the lateral compartment without evidence of a discrete focal cartilaginous abnormality. Marked destruction and complete loss of cartilage underlying the patella, specifically involving the lateral facet. Medial compartment and associated cartilage is otherwise essentially intact. Underlying contusion and edema with small cysts most pronounced within the patella and lateral anterior condylar surfaceLIGAMENTS: No significant abnormality noted. Specifically no acute ligamentous injury upon close inspection of the MCL suspected old scarring and thickening, observed proximally. LCL and remaining ligaments are otherwise unremarkableEXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Old MCL injury and cartilaginous loss, most pronounced involving the patellofemoral compartment laterally and similar to plain film 10/24/14


Instruction: Generate impression based on findings.

Input: 46 your female with lower back pain. The bony density and vertebral alignment are normal. No central spinal stenosis is apparent on exam. The neural foramen are widely patent. L3/4, L4/5, L5/S1 show minimal disk disease, minimal hypertrophy of the posterior elements, and overall minimal degenerative changes. In the last image of the study at S2, there is expansion of the thecal sac without epidural fat. This is of CSF density and may represent an ectatic thecal sac versus a Tarlov cyst. MRI may further evaluate if indicated.

Output: 1. Minimal degenerative changes, hypertrophy of the posterior element, and disk disease in the lower lumbar spine.2. Expansion of the thecal sac at S2 that may represent an ectatic thecal sac versus a Tarlov cyst. MRI may further evaluate if indicated.


Instruction: Generate impression based on findings.

Input: Reason: left knee pain History: pain over the medial femoral condyle MENISCI: Posterior horn of the medial meniscus is fragmented with multidirectional tearing. No discrete tear of the lateral meniscus. ARTICULAR CARTILAGE AND BONE: Full-thickness medial femoral condyle cartilage tear with adjacent reactive medial femoral condyle bone marrow edema. Marked thinning of the hyaline cartilage at the undersurface of the patella with medial facet reactive bone marrow edema.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1.Full-thickness medial femoral condyle cartilage tear with adjacent reactive bone marrow edema.2.Marked thinning patellar undersurface cartilage with adjacent medial facet reactive bone marrow edema.3.Multidirectional tear of the posterior horn of the medial meniscus.4.Marked soft tissue edema and moderate joint effusion.


Instruction: Generate impression based on findings.

Input: 66 year old woman with history of dyslipidemia and polycythemia vera who presents with months of dyspnea on exertion with associated chest tightness. MEDICATIONS: aspirin, omega 3 fatty acid, prevacid First Pass PerfusionDuring hyperemia, no perfusion defects were present. There was significant dark rim artifact. Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable. Left VentricleThe left ventricle is normal in size with hyperdynamic systolic function. The overall LV ejection fraction is 69%, the LV end diastolic volume index is 78 ml/m2 (normal range: 65+/-11), the LVEDV is 127 ml (normal range 109+/-23), the LV end systolic volume index is 24 ml/m2 (normal range 18+/-5), the LVESV is 39 ml (normal range 31+/-10), the LV mass index is 45 g/m2, and the LV mass is 73 g. There are no regional wall motion abnormalities present. There is no significant iron overload of the myocardium.Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 67%, the RV end diastolic volume index is 30 ml/m2 (normal range 69+/-14), the RVEDV is 98 ml (normal range 110+/-24), the RV end systolic volume index is 20 ml/m2 (normal range 22+/-8), and the RVESV is 32 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve is trileaflet, opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve leaflets are mildly thickened. The valve opens widely with trace regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThere is heterogenous hypointensity of the bone marrow likely related to the patient's hematologic history. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. No true perfusion defects/ "ischemia" present during hyperemia.2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and systolic function (LVEF 69%).4. Normal RV size and systolic function (RVEF 67%).


Instruction: Generate impression based on findings.

Input: 70 years Male (DOB:7/13/1945)Reason: a study on PSP, clinical trial, IRB approved, PI Dr Tao Xie PROVIDER/ATTENDING NAME: TAO XIE TAO XIE The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild to moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.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 are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Periventricular and subcortical white matter lesions of a mild to moderate degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: Unremitting radicular pain radiating down right arm and right arm weakness. Evaluate for right cervical disc herniation. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained. Bone marrow signal is within normal limits. The cervical spinal cord has normal signal characteristics and overall morphology.Degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: No significant compromise to the spinal canal or neural foramina.C4-5: Minimal disc bulge. Minimal left neuroforaminal stenosis. No right neuroforaminal stenosis. No central spinal canal stenosis.C5-6: Mild disc bulge, left greater than right, and uncovertebral hypertrophy. There is mild spinal canal stenosis with effacement of the left ventral thecal sac and mild impression on the ventral cord. Mild bilateral, right relatively greater than left, neural foraminal narrowing. C6-7: Mild disc bulge. Mild-to-moderate left and minimal right neuroforaminal stenosis. No significant compromise to the spinal canal.C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: Mild degenerative changes in the cervical spine, relatively worse at the C5-C6 and C6-C7 levels, as detailed above.


Instruction: Generate impression based on findings.

Input: Clinical question: Assess for intracranial hemorrhage. Signs and symptoms: Altered mental status status post concussion two months ago with CLL and thrombocytopenia Nonenhanced CT of brain:There is no it is of intracranial hemorrhage, edema, mass-effect, midline shift or hydrocephalus. A very subtle area of low attenuation in the right basal ganglia at the level of genu of internal capsule may represent a lacunar infarct of indeterminate age. Please correlate with history and if needed follow-up with an MRI is recommended for detection of acute lacunar infarct.Cortical sulci, ventricular system and all CSF cisterns remain within normal for patient stated age of 77.There is also a small extra-axial collection of CSF density which measures approximately 36 mm in AP axis and 12-mm in thickness at the level of sylvian fissure on the left. This is associated with subtle bony remodeling of calvarium. This finding is believed to represent a small arachnoid cyst and is best appreciated on axial images 15 through 17.

Output: 1.Small low-attenuation in the genuine of right internal capsule may represent a small lacunar infarct of indeterminate age. Please correlate with history and follow-up with an MRI.2.Small extra-axial left temporal arachnoid cyst as detailed.3.Unremarkable CT examination of brain otherwise.


Instruction: Generate impression based on findings.

Input: Surveillance. History of brain metastases, NSCLC, status post resection and SRS. Again seen are postsurgical changes of left temporal craniotomy for resection of left temporal lobe metastatic lesion. There is unchanged T2/FLAIR hyperintensity along the left temporal resection cavity consistent with gliosis. There is also no significant change in mild, slightly nodular enhancement around the resection cavity which is favored to represent posttreatment change. No new or enlarging lesions involving the resection cavity or within the remainder of the brain to suggest progression. There are no masses, mass effect or hydrocephalus. There is no evidence for intracranial hemorrhage or diffusion-weighted abnormalities. Scattered foci of T2/FLAIR hyperintensity in the white matter are nonspecific but compatible with mild chronic small vessel ischemic disease. Flow voids are present within the major vessels indicating patency. There is minimal scattered paranasal sinus mucosal thickening. Orbits, calvarium, and remainder of the extracranial soft tissues are grossly unremarkable.

Output: Unchanged mild, slightly nodular enhancement surrounding the left temporal resection cavity favored to represent posttreatment change. No new or enlarging lesion to suggest progression of metastatic disease.


Instruction: Generate impression based on findings.

Input: 56-year-old male with right arm/hand pain and swelling for one week. Evaluate for infection. Severely limited examination secondary to extensive artifact related to technique and patient motion. There is increased signal abnormality within the distal tuft of the second digit likely representing artifact from incomplete fat saturation. There is decreased T1 signal abnormality within the proximal radius without associated increased T2 signal abnormality which likely represents very mild bone marrow reactive change/edema. There is no evidence to suggest osteomyelitis. No additional bone marrow signal abnormality is identified. There is extensive diffuse increased signal abnormality in the soft tissues of the right forearm and wrist consistent with edema/inflammation. Again seen are multiple fluid collections about the wrist. There is about the extensor carpi ulnaris and extensor digiti minimi tendons. There is an additional fluid collection deep to the flexor digitorum tendons, appearing similar to the prior study. However, it should be noted that evaluation for abscess formation is limited due to the patient's inability to receive contrast material.

Output: Multiple focal fluid collections about the wrist which are suspicious for abscess formation with associated extensive soft tissue swelling about the wrist and forearm.


Instruction: Generate impression based on findings.

Input: 11-year-old male patient with history of lupus nephritis neck pain with extension and shoulder pain.EXAMINATION: MR right shoulder with IV contrast, MR left shoulder with IV contrast 11/12/2015 RIGHT SHOULDER:ROTATOR CUFF: No significant abnormality noted. Specifically, muscle signal is normal and there is no abnormal enhancement.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: No significant abnormality noted.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: Reactive bilateral enlarged axillary lymph nodes. No evidence of myositis or other abnormalities.


Instruction: Generate impression based on findings.

Input: There is no acute infarct, mass effect, or cerebral edema. There a few punctate T2 hyperintensities in the right frontal subcortical white matter which are nonspecific. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable.

Output: No acute intracranial abnormality.


Instruction: Generate impression based on findings.

Input: Desmoid tumor, evaluate for progression 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: Ill-defined enhancing soft tissue mass in the right retroperitoneum measures 5.4 x 4.9 cm (series 11, image 86), previously 5.5 x 4.9 cm on 3/24/2015. The mass abuts the IVC and SMV without evidence of invasion. Prominent regional lymph nodes, unchanged.BOWEL, MESENTERY: No evidence of bowel obstruction.BONES, SOFT TISSUES: No significant abnormality noted.

Output: Unchanged right retroperitoneal mass consistent with fibromatosis. No new lesions.


Instruction: Generate impression based on findings.

Input: Primary CNS lymphoma status post chemotherapy and transplant. There are otherwise unchanged post-treatment and post-biopsy findings with patchy T2 hyperintensity and associated susceptibility effect in the right cerebellar hemisphere and left anterior cingulate gyrus. There is also unchanged focal susceptibility effect in the right globus pallidus. There are unchanged areas of high T2 signal in the cerebral white matter. There is no evidence of acute intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, orbits, and scalp soft tissues are unremarkable. There is mild mucosal thickening in the left maxillary sinus.

Output: 1. No evidence of recurrent central nervous system lymphoma with post-treatment findings in the right cerebellar hemisphere and left cingulate gyrus.2. Unchanged areas of cerebral white matter signal abnormality in the cerebral white matter are nonspecific.


Instruction: Generate impression based on findings.

Input: A patient submitted outside study for review. Submitted for review are digital mammographic images (10/7/16, 10/14/16), ultrasound images of left breast (10/14/2016), images from ultrasound guided biopsy of left breast and postprocedural left mammographic images (10/18/2016), breast MRI (10/24/2016) performed at outside institution. For comparison, digital mammographic images (7/31/2015) are available. DIGITAL MAMMOGRAPHIC IMAGES (10/7/16, 10/14/16):The breast parenchyma is heterogeneously dense (BiRADS Density Category C), unchanged in pattern and distribution. There is a new mass, measuring approximately 1 cm, at posterior 6:00 position in the left breast.No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in right breast. ULTRASOUND IMAGES OF LEFT BREAST (10/14/2016):A hypoechoic mass, measuring 7 x 5 mm, with shadowing is detected at 6:00 position in the left breast, corresponding to the mass seen on the mammogram. A normal-appearing lymph node is detected in the left axilla.IMAGES FROM ULTRASOUND GUIDED BIOPSY OF LEFT BREAST AND POSTPROCEDURAL LEFT MAMMOGRAPHIC IMAGES (10/18/2016):Ultrasound guided biopsy was performed for the mass at 6:00 position with an appropriate needle placement. Postprocedural mammographic images show a marker clip at the biopsy site.Per outside radiology report, the result was malignant; invasive ductal carcinoma grade 1 and focus of atypical ductal hyperplasia.BREAST MRI (10/24/2016):The study was performed per outside imaging protocol.A focal non-mass enhancement is present at posterior 6:00 position, measuring 16 x 14 x 12 mm (AP x LR x CC) in the left breast. This is the proven breast cancer. A marker clip is seen immediate medial to this lesion.In the right breast, there is a focal non-mass enhancement at posterior 10:00 position, measuring 17 x 12 x 10 mm.No abnormal lymph nodes are identified in either axillary region.

Output: 1. A biopsy proven unifocal left breast cancer2. A focal non-mass enhancement in the right breast at posterior 10:00 position on MRI. MR directed ultrasound study is recommended. If no sonographic correlation is detected, MR guided biopsy should be considered.3. No abnormal lymph nodes in either axillary region on MRIBIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: U - Ultrasound Study Needed - No Letter.


Instruction: Generate impression based on findings.

Input: Male, 11 days old, full term, with history of myelomeningocele status post repair. Evaluate for anatomic abnormalities and for ventricular size. Complete absence of the corpus callosum is seen. Only rudimentary development of the bodies and frontal horns of the lateral ventricles is noted. There is, however, a prominent midline interhemispheric CSF collection which may communicate with the third ventricle. The left lateral ventricular atrium is slightly prominent while the right is probably within normal limits. The massa intermedia is large. However, there are two discrete cerebral hemispheres with an interhemispheric falx. The pituitary gland appears somewhat elongated in the craniocaudal dimension. The normal posterior pituitary bright spot is seen. Image quality does not allow for accurate assessment of the optic apparatus. The posterior fossa is perhaps slightly crowded. However, the cerebellum neither enwraps the brainstem nor herniates through the tentorium or foramen magnum. No definite tectal beaking is seen.No evidence of restricted diffusion, susceptibility effect or focal parenchymal signal abnormality is seen. Within the limitations of this motion degraded examination, no definite cortical dysplasia is seen. The posterior limbs of the internal capsules and corticospinal tracts do not show clear evidence of myelination which is usually seen in the full-term infant.

Output: Multiple intracranial findings are seen including absence of the corpus callosum, a large massa intermedia and a slightly crowded posterior fossa which, in combination with a history of myelomeningocele, are suggestive of Chiari II malformation. Although the cerebellum does not appear to enwrap the brainstem or herniate out of the posterior fossa, myelomeningocele repair can produce a normalizing effect on some of the cerebellar features of Chiari II. Although not highly suspected, subtle parenchymal abnormalities such as cortical dysplasias may not be detected due to limitations of image quality. However, the possibility of slightly delayed myelination is raised. The left lateral ventricular atrium is at most slightly prominent. However, note is made of a prominent midline interhemispheric CSF space.