Instruction: Generate impression based on findings.

Input: History of recurrent small bowel obstructions with prior lysis of adhesions. ABDOMEN:LIVER, BILIARY TRACT: Several simple appearing punctate hepatic cysts. No biliary ductal dilatation focal lesion or vascular abnormality.SPLEEN: Normal size without a focal lesion.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: The mid small bowel is suboptimally distended. The small bowel fold pattern is maintained.No evidence of active inflammation or flow-limiting stricture. No free fluid or loculated fluid collection.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 abnormality noted.BOWEL, MESENTERY: No evidence of active inflammation or flow-limiting stricture. No free fluid or loculated fluid collection.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Unremarkable MR enterography.


Instruction: Generate impression based on findings.

Input: 70-year-old female with smoldering myeloma and right-sided rib lesion seen on x-rays. Evaluate for bone lesions. There is a focus of increased signal abnormality on fluid sensitive sequences within the anterior aspect of the right fifth and sixth ribs at the level of the costochondral junction, best seen on sagittal images 64 through 72 of series 901. There are also lesions within the right anterior seventh rib at the level of the costochondral junction. There is an additional punctate focus of signal abnormality within the costal cartilage at this level as well. No foci of bone marrow signal abnormality are identified within the lateral aspect of the right fourth and fifth ribs to correspond to the findings seen on recent radiographs, however. There are numerous prominent axillary lymph nodes. No additional foci of bone marrow signal abnormality are identified. The imaged musculature and subcutaneous tissues is normal in appearance. Please note that this examination was not protocoled for detailed evaluation of the thoracic viscera or vessels.

Output: Numerous nonspecific right-sided rib lesions as described above. While myelomatous deposits cannot be completely excluded, given the focality and distribution of these lesions the possibility of prior trauma to this region or costochondritis should be considered.


Instruction: Generate impression based on findings.

Input: 64-year-old male with cirrhosis complicated by HCC status post TACE/RFA ABDOMEN:LIVER, BILIARY TRACT: Redemonstrated is an elongated ablation cavity in the inferior right lobe of the liver. Additional ablation cavity in the upper right lobe.There are areas of T2 hyperintensity of anteriorly and to the right of the inferior ablation cavity margin. There is associated arterial enhancement in these regions without evidence of washout. The findings favor a perfusional abnormality.The more superior right liver lobe ablation cavity has no foci of adjacent abnormal enhancement or signal. Intrinsic T1 hyperintensity within the ablation cavity compatible with postablation changes. Cirrhotic liver morphology. The patent portal vein. 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: Mildly enlarged porta hepatis and gastrohepatic ligament lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Ablation cavities in the right lobe of the liver with adjacent areas of enhancement favored to represent perfusional abnormalities as opposed to recurrent or residual HCC.


Instruction: Generate impression based on findings.

Input: There last well formed disk space is referred to as L5-S1. There is 2-mm anterolisthesis of L5 on S1. The osseous marrow signal is benign with scattered small foci of high T1 signal intensity representing hemangiomas versus focal fat deposition. The conus terminates at superior L1.T12-L1: No disk herniation or spinal stenosis.L1-2: Mild loss of disk height with desiccation, diffuse disk bulge, ligamenta flava thickening, and facet arthropathy causing no spinal stenosis.L2-3: Mild loss of disk height with desiccation, diffuse disk bulge asymmetric to the right, ligamenta flava thickening, prominent posterior epidural fat, and facet arthropathy causing encroachment upon the bilateral subarticular zones and mild spinal canal stenosis. Mild bilateral neural foraminal stenosis.L3-4: Moderate loss of disk height with desiccation, diffuse disk bulge with right foraminal/far lateral protrusion, ligamenta flava thickening, prominent posterior epidural fat and facet arthropathy causing severe spinal canal stenosis. Severe right neural foraminal stenosis.L4-5: Moderate to severe loss of disk height with desiccation, diffuse disk bulge asymmetric to the right, moderate bilateral facet arthropathy and ligament flava thickening with prominent posterior epidural fat causing mild spinal canal stenosis, and severe bilateral neural foraminal stenosis.L5-S1: 2-mm anterolisthesis of L5 and S1. Mild loss of disk height with desiccation, uncovering of the disk, advanced facet arthropathy with right-sided joint effusion with a lateral right 7-mm synovial cyst projecting toward the spinal canal. Moderate spinal canal stenosis and severe bilateral neural foraminal stenosis.

Output: Multilevel lumbar spondylosis worst at L3-4 where there is severe spinal canal stenosis. Severe neural foraminal stenoses at L3-4, L4-5 and L5-S1.


Instruction: Generate impression based on findings.

Input: 22-year-old female with Ewing's sarcoma Left femur: Patchy and curvilinear signal abnormality and enhancement within the distal femoral metaphysis including ringlike foci with central fat appears decreased in extent compared with the MRI of the tibia and fibula dated 3/28/14 which included the distal left femur. We suspect these represent areas of bone infarction although treated metastasis is a possibility. The remainder of the signal intensity of the femur is within normal limits. The left femoral trochlea appears shallow suggesting trochlea dysplasia with slight lateral translocation of the patella. The soft tissues are unremarkable. Abnormal ringlike signal intensity seen on the large field-of-view images in the proximal right tibia may represent evolving infarction or treated metastases, also less prominent than on the prior exam.Right and left hips: We see no abnormal signal or enhancement in either the proximal femurs or pelvis. The hips and SI joints appear normal. There is no joint effusion or evidence of synovitis. Note that this exam was not protocoled for evaluation of the labrum. The soft tissues are within normal limits.

Output: 1. Normal hips and pelvis without evidence of metastatic disease.2. Foci of signal abnormality in the distal left femur and proximal right tibia as described above, which are less prominent than on the prior exam and we suspect represent evolving bone infarctions, although treated metastases are also considered.


Instruction: Generate impression based on findings.

Input: Female, 42 years old, with prior subarachnoid hemorrhage similar to AVM, pretreatment planning. A tangle of enhancing vessels is demonstrated involving the left thalamus and posterior third ventricular region with an enlarged vein which drains to the vein of Galen. The tissues surrounding this lesion are T2 hypointense indicating hemosiderin staining. Patchy hemosiderin staining is also seen along the ventricular margins compatible with prior intraventricular hemorrhage. The ventricles are of normal caliber. Evidence of prior right frontal approach ventriculostomy is seen.

Output: Findings are seen compatible with an AVM involving the left thalamus and third ventricular region. Sequelae of prior hemorrhage are also seen.


Instruction: Generate impression based on findings.

Input: 79-year-old male with history of biliary ductal dilatation on recent CT. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No intrahepatic biliary ductal dilation. The common bile duct measures up to 8 mm, borderline. No filling defects or masses are identified. Smooth tapering near the ampulla.Cholelithiasis. Mild signal dropout on out of phase imaging compatible with mild hepatic steatosis.SPLEEN: Status post splenectomy.PANCREAS: There is fullness and enlargement of the uncinate process. No abnormal enhancement or masses are appreciated. The proximal pancreatic duct is dilated measuring up to 7 mm with abrupt transition near the ampulla. The distal pancreatic duct appears normal. No filling defects or masses are appreciated.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Right lower abdominal wall ostomy with parastomal hernia.Left upper quadrant mesenteric nodule measures 1.8 cm and likely represents a splenule.Ectatic ascending aorta.Subcutaneous edema in the lower back.

Output: Borderline dilated common bile duct with smooth tapering near the ampulla with no masses or filling defects identified. Dilated proximal pancreatic duct with abrupt tapering near the ampulla. While there is fullness and enlargement of the uncinate process, no abnormal enhancement or masses are appreciated, but an underlying malignancy cannot be entirely excluded. An endoscopic ultrasound is recommended.


Instruction: Generate impression based on findings.

Input: 35-year-old male with stage IV goblet carcinoid resected October 20, 2015. Evaluate for interval recurrence of disease. ABDOMEN:LIVER, BILIARY TRACT: There is a 6 mm T1 hypointense, T2 hyperintense, persistently enhancing segment 8 lesion. An additional segment 4A/B subcentimeter nonenhancing, T2 hyperintense, and T1 hypointense lesion consistent with a benign cyst.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: Nonspecific minimally prominent retroperitoneal lymph nodes are noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Subcentimeter persistently enhancing focus in segment 8 is too small to characterize. Given inherent T2 brightness, this may represent a hemangioma. Attention on subsequent surveillance imaging is recommended.


Instruction: Generate impression based on findings.

Input: Female 24 years old Reason: PSC, eval for stricture History: PSC, UC ABDOMEN:LIVER, BILIARY TRACT: Mild focal stricture in the mid common bile duct (series 1101/71) appears similar to prior examination. Mild irregularity and stenosis of the distal common bile duct the ampulla is also similar to prior examination. Scattered areas of mild biliary ductal dilatation with scattered areas of narrowing in the right and left hepatic ducts and intrahepatic ducts, not significantly changed.Two round enhancing foci in segment 8 seen only on the arterial phase are most consistent with transient hepatic arterial difference (THAD). No suspicious hepatic lesions.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No evidence of peritoneal carcinomatosis.

Output: No significant interval change in the appearance of the biliary tree with mild focal stricture in the mid common bile duct and additional areas of stenosis and dilatation, consistent with PSC. No new suspicious hepatic lesions.


Instruction: Generate impression based on findings.

Input: CERVICAL SPINE:An ACDF involving the C3/4, C4/5, C5/6 and C6/7 levels obscures full evaluation of the cervical spine at these levels. Significant motion also limits full evaluation at all cervical levels. Within these limitations:The cervical spine is straightened. The marrow signal is benign. The cervical cord is normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.C1/2: Normal atlantodental interval.C2/3: There is 2 mm of Grade 1 anterolisthesis of C2 on C3. No significant spinal canal stenosis or neuroforaminal narrowing.C3/4: Mild left posterior osteophyte formation and residual disc material in the far lateral recess causes encroachment on the exiting nerve root. No significant spinal canal stenosis.C4/5: No significant spinal canal stenosis or neuroforaminal narrowing.C5/6: No significant spinal canal stenosis or neuroforaminal narrowing.C6/7: Facet hypertrophy. No significant spinal canal stenosis or neuroforaminal narrowing.C7/T1: No significant spinal canal stenosis or neuroforaminal narrowing.THORACIC SPINE:There is thoracic kyphotic curve. There is multilevel disc dessication and disc height loss. The vertebral body of T10 is collapsed with approximately 50% loss of height which is new compared to the CT exam from 12/27/14. There is increased signal on STIR indicating a subacute fracture. There is minimal restropulsion The remaining thoracic vertebral body heights and disc spaces are maintained. Marrow signal intensity is benign throughout. The spinal cord has a smooth contour and is without focal atrophy, edema, or myelomalacia. There are no masses. T1/2 Small broad based disc bulge. No significant spinal canal stenosis or neuroforaminal narrowing.T2/3 Small broad based disc bulge. No significant spinal canal stenosis or neuroforaminal narrowing.T3/4 No significant spinal canal stenosis or neuroforaminal narrowing. T4/5 No significant spinal canal stenosis or neuroforaminal narrowing.T5/6 Small left paracentral disc protrusion. No significant spinal canal stenosis or neuroforaminal narrowing.T6/7 Small left paracentral disc protrusion. No significant spinal canal stenosis or neuroforaminal narrowing.T7/8 Small left paracentral disc protrusion. No significant spinal canal stenosis or neuroforaminal narrowing. T8/9 Small right paracentral disc protrusion. Mild to moderate right neuroforaminal narrowing. No significant spinal canal stenosis. T9/10 Mild disc bulge. The compression fracture of T10 demonstrates mild retropulsion of fracture fragments which causes mild spinal canal narrowing. This is more likely a benign compression fracture. No significant neuroforaminal narrowing. T10/11 No significant spinal canal stenosis or neuroforaminal narrowing. T11/12 Small right paracentral disk protrusion. No significant spinal canal stenosis or neuroforaminal narrowing. T12/L1 demonstrates no significant disc bulge or cord encroachment. Lumbar spine:Alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign. The conus is normal in signal and morphology and terminates at an appropriate level. There is a right laminotomy defect at L4-5.T12/L1: No significant spinal canal stenosis or neuroforaminal narrowing noted on sagittal images. L1/2: No significant spinal canal stenosis or neuroforaminal narrowing. L2/3: Disk dessication and loss of disc height. Small left paracentral disc herniation with resultant mild left neuroforaminal narrowing. No significant spinal canal stenosis. L3/4: Facet hypertrophy and ligamentum flavum thickening. No significant spinal canal stenosis of neuroforaminal narrowing. L4/5: There is loss of disc space height with endplate reactive change, mild broad based disc bulge, facet hypertrophy, and ligamentum flavum thickening which causes encroachment of the exiting nerve roots right more than left. There is no significant spinal canal stenosis at this level. There is a right laminotomy defect at this level.L5/S1: Moderate facet hypertrophy and ligamentum flavum thickening. No significant spinal canal stenosis. Mild bilateral neuroforaminal narrowing.SI Joints: No significant abnormalities.

Output: 1.Artifact from motion and a ACDF from C3-C7 limits evaluation of the cervical spine. Within these limitations, there are multilevel degenerative changes and grade 1 anterolisthesis of C2 on C3 but no cord compression.2.Multilevel degenerative changes of the thoracic spine with a compression fracture of the T10 vertebral body with approximately 50% height loss,significantly progressed compared to the CT exam from 12/27/2014. Morphologic features of this compression fracture suggest a benign etiology.3.Multi-level degenerative changes of the lumbar spine most severe at L4/5 but no significant spinal canal narrowing as described above.


Instruction: Generate impression based on findings.

Input: Female, 66 years old, with acute onset altered mental status, right gaze preference and left-sided weakness. Image quality is significantly degraded by motion artifact. On the left, multiple scattered small foci of restricted diffusion are seen within the bilateral cerebral hemispheres, predominantly in the watershed zones. There is evidence of moderately extensive patchy periventricular and subcortical T2 hyperintensity. Also noted is a probable chronic left parietal infarct. No large fluid collections are suspected. The ventricles are normal in size and morphology.

Output: 1.Multiple scattered small foci of acute ischemia are seen in the bilateral cerebral hemispheres, likely watershed in nature.2.Evidence of chronic microvascular ischemic disease and a chronic left parietal infarct is also seen.3.Please note that due to image degradation, subtle lesions may not be detected.


Instruction: Generate impression based on findings.

Input: Reason: elbow pain and biceps pain History: pain. LIGAMENTS: Ligaments are intact.TENDONS: Tendons are intact. The biceps tendon is seen to its insertion on the radial tuberosity without abnormality.ARTICULAR SURFACES AND BONE: No significant abnormality noted. No bone marrow signal abnormality.SURROUNDING STRUCTURES: Large amount of fluid within the olecranon bursa compatible with bursitis. Adjacent subcutaneous fat edema in the dorsal soft tissues and within the cubital tunnel. The ulnar nerve appears intact.ADDITIONAL

Output: Findings compatible with olecranon bursitis.


Instruction: Generate impression based on findings.

Input: 60 year-old male with pain and constipation. Rule-out obstruction. The the patient has cholangiocarcinoma, status post Roux-en-Y resection and cholecystectomy. ABDOMEN:LIVER, BILIARY TRACT: The circumferential mass encasing the common hepatic duct at the confluence of the main, right and left ducts is smaller with resolution of the intrahepatic biliary ductal dilatation since the MRI examination in September 2010. No new or additional hepatic lesions were identified.SPLEEN: Not seen. Presumed splenectomy. PANCREAS: No pancreatic ductal dilatation is identified. No significant abnormality is seenADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Enlarged periportal and portacaval lymph nodes are identified. The largest of which is portocaval measuring 2 x 1.5 cm. (image number 39; series number 3.). ABOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Status post mesh reconstruction of the abdominal wall with large numbers of surgical staples.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: The rectosigmoid is markedly dilated with inspissated stool compatible with constipation. There is a 3-cm long segment of sigmoid which appears markedly narrowed with increased wall thickness and coronal image 65 and axial image 90 - 92 of series 3. This could represent spasm or a colonic lesion not seen on the 9/29/2010 MR examination.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: 1.Hepatic findings are consistent with cholangiocarcinoma, status post Roux-en-Y resection. Severe constipation. Questionable lesion in sigmoid colon.2.Periportal and portacaval lymphadenopathy.


Instruction: Generate impression based on findings.

Input: 64-year-old female with a history of Meniere's disease, trigeminal neuralgia, and migraines. Facial pain. The study is limited for the technique and patient motion.Brain:There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma is notable for nonspecific frontoparietal T2 hyperintense lesions which may reflect microvascular ischemia. 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 sella turcica is enlarged and fluid filled, compatible with empty sella turcica. The right eye lens is replaced. The orbits are otherwise unremarkable. There is minimal fluid in the mastoid air cells.Internal Auditory Canals/Trigeminal Nerves:The cisternal segments of the trigeminal nerves are unremarkable. There is no vascular loop. The Meckel's caves are also symmetric. The cavernous sinuses are normal. Postcontrast images show no abnormal contrast enhancement. There is no brainstem lesion.The internal auditory canals are symmetric. The seventh/eighth cranial nerve complexes are also unremarkable. The endolymphatic sac and duct are not well delineated on 3-D T2 images, although these are somewhat limited by slice thickness artifact. Inner ear structures are normal. The right parotid gland is enlarged though without a focal lesion or abnormal signal. There is asymmetric T2/FLAIR hyperintense signal within the right petrous apex, likely relating to fluid and asymmetrically pneumatized bone. There is mild associated peripheral enhancement in these areas.

Output: 1.The study is limited because of technique and patient motion as described above.2.There are small T2 hyperintense cerebral white matter lesions which are nonspecific but may represent microvascular ischemia.3.There is no definite abnormality in the brainstem or along the course of the trigeminal nerves.4.Asymmetric abnormal fluid signal in the right petrous apex without expansion relating to opacification of asymmetric pneumatized bone.


Instruction: Generate impression based on findings.

Input: Multiple myeloma. Is there evidence of multiple myeloma involvement. Five lumbar type vertebral bodies are presumed to be present. Conus is in normal position. There is mild loss of vertebral body height and deformity involving the superior endplate of the L2 vertebral body as well as mild loss of height involving the L4 vertebral body, without significant edema, and likely representing chronic mild compression fractures. Minimal deformity at additional levels is also suspected without significant height loss.There is grade 1 anterolisthesis of L5 on S1. There is also straightening of the lumbar curvature. Alignment is otherwise maintained.No discrete marrow infiltrative lesions are appreciated to definitively suggest multiple myeloma. T1 hyperintense lesions involving the T12 vertebral body as well as the posterior L3 vertebral body are consistent with small hemangiomas or foci of fat. Additional areas of T1 hypointensity along the endplates is most likely on a degenerative basis.There are multilevel degenerative changes which are suboptimally evaluated due to motion degradation, individual levels as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: Mild disc bulge. No spinal canal or neural foraminal stenosis.L3-L4: Mild disc bulge. No spinal canal or neural foraminal stenosis.L4-L5: Minimal retrolisthesis and minimal disc bulge. No spinal canal or left neural foraminal stenosis. Mild right neural foraminal stenosis.L5-S1: Moderate to severe disc height loss and grade 1 anterolisthesis. Facet arthropathy, particularly on the left. There is no significant spinal canal stenosis. The moderate bilateral neural foraminal stenosis. Suggestion of L5 pars defects, not well assessed due to motion degradation.Paraspinous soft tissues are within normal limits.

Output: 1. No findings to suggest myelomatous involvement of the lumbar spine within the limitations of a noncontrast and mildly motion degraded study.2. Mild chronic compression fractures involving the L2 and L4 vertebral bodies.3. Multilevel degenerative changes without spinal canal stenosis at any level. There is mild to moderate bilateral L5-S1 neural foraminal stenosis.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for stroke. Signs and symptoms: LUE pain/numbness, slurring of speech. Nonenhanced brain MRI:Examination demonstrates small foci of restricted diffusion involving the cortex of the right post central gyrus and adjacent subcortical white matter consistent with acute to late acute nonhemorrhagic ischemic stroke. This finding was noted on the prior head CTs. There is no associated mass effect with this finding.Additionally examination demonstrate several tiny foci of flair hyperintensity in the subcortical and periventricular white matter of cerebral hemispheres. Tiny similar finding in the right external capsule is also noted. Findings highly suggestive of chronic small vessel ischemic stroke of mild degree.The signal intensity of brain parenchyma remains within normal otherwise. There is a slight prominence of cortical sulci for patient's stated age in a generalized pattern. Ventricular system are within normal size and morphology and maintained midline.There is revisualization of a small arachnoid cyst in the anterior aspect of right middle cranial fossa with subtle mass effect on the right temporal tip similar to prior head CT.Signal void of major intracranial arterial branches are identified.The signal intensity of intracranial venous sinuses are within normal.Calvarium, orbits, paranasal sinuses and mastoid air cells are unremarkable there

Output: 1.Tiny foci of cortical and subcortical restricted diffusion involving right post central gyrus as was seen on prior head CTs.2.Findings of mild chronic small vessel ischemic strokes as detailed.3.Mild generalized prominence of cerebral cortical sulci for age and unremarkable exam otherwise.


Instruction: Generate impression based on findings.

Input: History of prostate cancer. PELVIS:PROSTATE:Prostate Size: 3.7 x 4.8 x 5.0 cm.Peripheral Zone: Diffuse hypointensity of the peripheral zone somewhat limits evaluation for neoplasm. There is a focus of decreased T2 and ADC signal within the right mid gland peripheral zone measuring 4 x 4 mm (series 301/image 42) which is suspicious for neoplasm.Central Gland: No significant abnormality noted.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 4 x 4 mm focus of signal abnormality within the right mid gland peripheral zone suspicious for neoplasm.


Instruction: Generate impression based on findings.

Input: The vertebral column alignment is within normal limits. The vertebral body heights are preserved. The vertebral bone marrow signal is unremarkable. The imaged spinal cord displays normal signal and morphology. There is no evidence of intraspinal mass or abnormal enhancement. There is a subcentimeter unchanged right renal cyst. There are a few scattered subcutaneous subcentimeter nodules likely corresponding to neurofibromas. There is a partially imaged unchanged mild disc bulge at T11-T12 without significant spinal canal or neural foramen stenosis. There is multilevel mild disc desiccation. T12-L1: There is a mild disc bulge as well as mild facet arthropathy and ligamentum flavum thickening without significant spinal canal or neural foramen stenosis.L1-L2: There is minimal facet arthropathy and ligamentum flavum thickening without significant spinal canal or neural foramen stenosis.L2-L3: There is minimal facet arthropathy and ligamentum flavum thickening without significant spinal canal or neural foramen stenosis.L3-L4: There is minimal facet arthropathy and a mild disc bulge. These findings result in unchanged mild left neural foramen narrowing and no significant spinal canal stenosis. There is a new small subcentimeter synovial cyst arising from the posterior aspect of the right facet joint outside the spinal canal.L4-L5: There is loss of disc height, and a mild disc bulge with a superimposed small posterior disc extrusion, and marked facet arthropathy with mild associated ligamentum flavum thickening. These findings result in unchanged moderate bilateral neural foramen narrowing and no significant spinal canal stenosis.L5-S1: There is a mild disc bulge as well as mild facet arthropathy. These findings result in unchanged moderate bilateral neural foramen stenosis without spinal canal stenosis.

Output: 1.No evidence of metastasis or intraspinal neurofibroma.2.Unchanged lumbar spine degenerative changes resulting in neural foramen stenosis at L3-L4, L4-L5, and L5-S1.3.Multiple small cutaneous neurofibromas.


Instruction: Generate impression based on findings.

Input: Male, 78 years old, with altered mental status and bacteremia. Evaluate for abscess, source of infection. Brain:No evidence of restricted diffusion is seen. Confluent and patchy periventricular T2 hyperintensity is demonstrated. No edema or mass effect is detected. No evidence of intracranial hemorrhage or any abnormal extra axial fluid collection is seen. The ventricles and sulci are slightly prominent compatible with underlying parenchymal volume loss. Postcontrast images are limited by motion artifact, but no definite pathologic enhancement is seen. The mastoid air cells are opacified.Lumbar spine:For the purposes of numbering, the last fully formed disc space will be designated L5-S1. The L5 vertebral body demonstrates transitional morphology.Postoperative findings are seen consistent with laminectomy at L3 and L4. Heterogeneous fluid and/or debris is evident within the operative bed. The margins of the operative bed are enhancing. The posterior paraspinal soft tissues are also edematous and enhancing, particularly on the left.Sagittal spinal alignment is grossly anatomic. Vertebral body heights are preserved. Scattered Schmorl's node deformities and degenerative endplate signal abnormality are seen. Otherwise, no concerning marrow replacement is evident.The visualized distal spinal cord, conus and nerve roots of the cauda equina are unremarkable. No definite pathologic intrathecal enhancement is observed.L1-2: Bulky left lateral osteophyte formation is seen. No significant spinal canal stenosis. Moderate left foraminal narrowing. L2-3: Facet arthropathy. Ligamentum flavum thickening. Disc bulging with bulky left anterolateral osteophyte formation. Mild to moderate spinal canal narrowing. Moderate bilateral foraminal narrowing. L3-4: Postoperative changes. Facet arthropathy. Bulging disc with a right foraminal protrusion. Mild to moderate spinal canal narrowing. Severe right foraminal narrowing with possible nerve root impingement. Moderate left foraminal narrowing. L4-5: Postoperative changes. Facet arthropathy. Mild to moderate spinal canal narrowing is seen, to which bulging of the fluid in the resection bed contributes. Severe right foraminal narrowing with probable nerve root impingement. Moderate to severe left foraminal narrowing. L5-S1: Facet arthropathy. No significant spinal canal or foraminal stenosis.

Output: 1.No acute intracranial abnormality or specific infectious source is identified in the head. There are findings which likely reflect chronic microvascular ischemia.2.Postoperative findings are seen compatible with laminectomy at L3-4. The operative bed contains fluid and demonstrates marginal enhancement. This appearance is nonspecific and while the possibility of infection cannot be excluded on the basis of imaging alone, these findings are also within acceptable limits in the recent postoperative period.3.Multilevel disc and posterior element degeneration is seen. Mild to moderate spinal canal narrowing is demonstrated at L2-3, L3-4 and L4-5. In addition, severe foraminal narrowing is evident on the right at L3-4 and on the right at L4-5.


Instruction: Generate impression based on findings.

Input: MRI brain: There are no areas of abnormal T2/FLAIR signal in the supratentorial or infratentorial compartment to suggest demyelinating disease. The ventricles and sulci are within normal limits. The basal cisterns remain patent. There is no midline shift or mass effect. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. MRI cervical spine: There is straightening of the cervical spine, which may be positional. Otherwise, the cervical spine is in normal alignment. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal.There is mild degenerative changes in the cervical spine. At C5-C6, there is central disc osteophyte complex causing mild indentation on the ventral thecal sac. No evidence of neuroforaminal narrowing or spinal canal stenosis. Remaining intervertebral disc levels show no significant disk bulge, herniation, spinal canal or foraminal stenosis within the cervical spine. There are a few subcentimeter rounded T2 hyperintense lesions in the bilateral thyroid lobes.

Output: 1. Unremarkable MRI of the brain. Specifically there is no evidence of demyelinating lesions in the brain parenchyma.2. MRI of the cervical spine shows no evidence of demyelinating disease.3. Mild degenerative changes in the cervical spine without significant neural foraminal stenosis or spinal canal stenosis.4. Subcentimeter T2 hyperintense lesions in the thyroid gland bilaterally. Please correlate with TFTs, and consider further evaluation with dedicated thyroid ultrasound.


Instruction: Generate impression based on findings.

Input: 56-year-old male with metastatic small cell lung carcinoma status post radiation therapy. Neck mass. Headache. There is a 1.7 x 1.5 cm ring enhancing mass within the right high parietal convexity, with surrounding hypodensity consistent with a metastatic lesion with surrounding vasogenic edema. There are also questionable punctate enhancing lesions within the left frontal lobe and the left high parietal convexity. Brain MRI with contrast is recommended for more sensitive evaluation of these lesions. No midline shift or intra-cranial hemorrhage is seen. 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.The neck demonstrates a 2.8 x 2.7 x 3.1 cm enhancing mass within the right neck, with mass effect and compression of the right internal jugular vein. This likely represents a deep cervical nodal metastasis. In addition, there are multiple sclerotic lesions within the C3, T1, T3, T5, and T6 vertebral bodies, as well as the right posterior elements of C5. Within the visualized lung, there is bilateral pleural thickening and left-sided fibrosis and focal calcification. Please refer to dedicated chest CT for further discussion.

Output: Multiple intracranial, osseous, and deep cervical metastatic lesions as described above. Brain MRI with contrast is recommended for more sensitive characterization of intracranial lesions.


Instruction: Generate impression based on findings.

Input: 57 year-old female with headache. There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: No acute intracranial abnormality.


Instruction: Generate impression based on findings.

Input: 50-year-old male, locks rotation at wrist after radial head fracture. Evaluate for TFCC tear. Evaluation of the wrist is limited due to the inability to optimally position the patient. A flex coil was utilized instead of a wrist coil.Mild to moderate osteoarthritis affects the distal radioulnar joint with subchondral cysts within the distal ulna that are associated with mild edema. Best seen on the fat-saturated T2-weighted axial images is high signal intensity along the volar aspect of the distal ulna, between the extensor digiti minimi and extensor carpi ulnaris tendons, that we suspect represents synovitis extending from the distal radioulnar joint. The triangular fibrocartilage fibers can be followed from their radial insertion to their ulnar styloid attachment. There is mild increased signal intensity along the proximal surface of the articular disc, near its ulnar attachment, which may represent mild fraying, but we see no complete fluid-filled tear. There is a small amount of fluid within the tendon sheath of the extensor carpi ulnaris, which may reflect a very mild tenosynovitis with a small amount of increased signal intensity within the tendon suggesting a mild tendinosis. There is also increased signal intensity along the inferior margin of the pisotriquetral articulation which may reflect a mild synovitis within the inferior recess. There is a small amount of fluid within the radiocarpal joint as well as a small amount of synovitis along the scaphoid. We see no carpal bone erosions. The bone marrow signal intensity is otherwise normal. The remaining tendons are within normal limits. We suspect that there is a persistent median artery coursing within the median nerve. Evaluation of the interosseous ligaments is limited but we see no findings to suggest a scapholunate or lunotriquetral ligament disruption. There is a small ossicle seen on prior radiographs which appears to lie volar to the volar radioulnar ligament and probably is of no clinical significance.

Output: 1. Limited study as described above. Osteoarthritis of the distal radioulnar joint with what appears to be synovitis extending volarly from the joint. There may be mild proximal fraying of the triangular fibrocartilage complex, but no complete fluid-filled tear is evident.2. Minimal tenosynovitis and tendinosis of the extensor carpi ulnaris.3. Mild synovitis of the radiocarpal joint.


Instruction: Generate impression based on findings.

Input: Ms. Huisenga is a 47-year-old female presenting with left breast pain x1 month (not associated with menstrual cycles or caffeine) with a palpable mass in the left subareolar region. Prior diagnostic workup has been negative. There is scattered fibroglandular tissue in both breasts. Minimal parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. Specifically, there is no abnormal enhancement in the left retroareolar region, at site of palpable abnormality. No dilated retroareolar ducts, skin thickening, or nipple abnormalities are identified.No abnormal axillary lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: History of enterography and IPMN. Evaluate for interval change. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: The cystic lesion in the uncinate process measures approximately 13 x 7 mm (series 5/21), compared to 12 x 6 mm previously. It appears to communicate with the pancreatic duct and remains compatible with a sidebranch IPMN.The previously measured cystic lesion in the tail measures approximately 8 x 7 mm (series 5/12), compared to 10 x 7 mm previously.No suspicious postcontrast mural nodularity or enhancement of the cystic lesions is appreciated.There are additional punctate cystic lesions in the pancreas which appear to communicate with the pancreatic duct and is not significant changed. The main pancreatic duct is normal in caliber.Normal dilatory response and exocrine excretion following secretin administration.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Benign left renal cyst is unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No significant change in the size and number of the multiple cystic lesions in the pancreas which appears to communicate with the main pancreatic duct and remain compatible with multiple side-branch type IPMNs.


Instruction: Generate impression based on findings.

Input: A 46 year female with history of new onset atrial fibrillation, asthma and iron deficiency anemia, a recent echocardiography showed normal left ventricular function with left atrial enlargement. Referred to cardiac MRI to rule out sarcoidosis. Left VentricleThe left ventricle is moderately dilated with low normal systolic function. The overall LV ejection fraction is 54%, the LV end diastolic volume index is 99 ml/m2 (normal range: 65+/-11), the LVEDV is 125 ml (normal range 109+/-23), the LV end systolic volume index is 46 ml/m2 (normal range 18+/-5), the LVESV is 98 ml (normal range 31+/-10), the LV mass index is 58 g/m2 (normal range 67+/-11), and the LV mass is 125 g (normal range 114+/-24). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.No intracardiac thrombus is present.Left AtriumThe left atrium is mild to moderately dilated. The LA volume is 104 ml.Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 45%, the RV end diastolic volume index is 87 ml/m2 (normal range 69+/-14), the RVEDV is 188 ml (normal range 110+/-24), the RV end systolic volume index is 48 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 tricuspid regurgitation which was not quantified.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no pericardial effusion.Extracardiac FindingsOvoid nodule within the right breast medially superior to the nipple line measuring 2.0 x 2.5 cm (301/16. This is hypodense to surrounding dense breast stroma and is atypical for a cyst. Additional smaller nodules are noted in the left breast. When correlated to recent mammogram and breast ultrasound of 8/5/2015, patient has noticed nodularity in bilateral breasts for 20 years and these were concluded with high probability to be benign masses. Continued physical examination and bilateral ultrasound as per mammographic report is recommended.

Output: 1. The left ventricle is moderately dilated with low normal systolic function, the LVEF is 54%. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.2. The left atrium is mild to moderately dilated. The LA volume is 104 ml.3. The right ventricle is normal in size with mildly reduced systolic function, the RVEF is 45%. 4. Tricuspid regurgitation is present.


Instruction: Generate impression based on findings.

Input: 61-year-old woman with history of abdominal pain and cystic pancreatic neoplasm seen on CT. ABDOMEN:LIVER, BILIARY TRACT: There are scattered subcentimeter hepatic cysts, otherwise the liver is normal in signal and morphology. There is no significant intra or extrahepatic biliary ductal dilatation. The gallbladder appears normal.SPLEEN: The spleen is normal.PANCREAS: In the tail of the pancreas (5/23) there is a 15 x 14 mm cystic lesion without enhancement or internal septation. This lesion appears to communicate with main pancreatic duct (9/22), but the main pancreatic duct is normal in caliber.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: The native kidneys are atrophic. A right pelvic kidney is seen on the survey images.RETROPERITONEUM, LYMPH NODES: No significant retroperitoneal lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Simple cystic lesion in the pancreatic tail, likely a main duct IPMN. Given its size, one year follow-up with MR is recommended to confirm stability (JACR 7.10 Oct 2010).


Instruction: Generate impression based on findings.

Input: Clinical question: assess brain massSigns and Symptoms: posterior fossa mass on CT, HA There is a 33 x 38 mm sagittal dimension heterogeneously enhancing mass centered in the vermis which measures 33 mm in width. There are punctate foci of susceptibility effect associated with this. On T2 imaging there are cystic-appearing components as well as low signal component medially. It appears multiseptated and well circumscribed. There is no associated diffusion restriction. There is surrounding T2 and FLAIR signal hyperintensity within the left cerebellar hemisphere into a lesser degree right cerebellar hemisphere compatible with edema and/or tumor infiltration. There is some signal hyperintensity present within the medial aspect of the left middle cerebellar peduncle on T2 and FLAIR imaging. It is associated with the mass effect and compression of the fourth ventricle. The lateral ventricles are minimally dilated. The cerebellar tonsils are low lying.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified in the frontal lobes and parietal lobes bilaterally on the FLAIR and T2 images.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. There is thinning of the left posterior sclera compatible with staphyloma. The right eye is irregular in shape. There is no enhancing lesion identified in the right eye.Fiducial markers are in place.

Output: 1.There is a well circumscribed multiseptated mass centered in the superior aspect of the vermis and eccentric towards the left which is suspicious for neoplasm. This mass compresses the fourth ventricle but is currently not associated with any significant amount of ventriculomegaly. In this age group metastatic disease is the most likely explanation. The patient is known to have a history of colon cancer. A primary brain tumor would be alternative but less likely.2.There is a staphyloma in the left eye. 3.The right eye is irregular and the right retina possibly appears thickened. This is an equivocal finding. The possibility of retinal lesion cannot be excluded if clinically appropriate ophthalmoscopy the may be of further benefit


Instruction: Generate impression based on findings.

Input: History of GBM brain tumor, on Avastin. Per technologist's note, patient had difficulty tolerating the study; several sequences are mildly degraded by motion.Again seen are postsurgical changes of suboccipital craniotomy for resection of posterior fossa tumor. Compared to the 6/16/2016 and 4/14/2016 examinations, there has been an interval decrease in the FLAIR hyperintensity in the cerebellar vermis and right greater than left cerebellar hemisphere surrounding the resection cavity. There is also a decrease in the heterogeneously enhancing tissue surrounding the resection cavity. Mass effect on the fourth ventricle has decreased. There is mild restricted diffusion along the resection cavity without restricted diffusion elsewhere to suggest acute ischemic infarction. No new enhancing lesions are identified within the brain. A nonspecific punctate focus of increased T2/FLAIR signal within the white matter adjacent to the frontal horn of the left lateral ventricle is unchanged. There is increased T2/FLAIR signal within the bilateral medullary olives which may be related to hypertrophic olivary degeneration. The lateral and third ventricles remain mildly prominent, likely related to volume loss, and not significantly changed. The basal cisterns remain patent. There is no midline shift. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. There is trace mucosal thickening within the paranasal sinuses.

Output: Interval decrease in FLAIR hyperintensity and enhancement surrounding the cerebellar resection cavity is seen compatible with antiangiogenic effect.


Instruction: Generate impression based on findings.

Input: Male, 40 years old, with hypogonadism. Enhancement of the pituitary gland is slightly heterogeneous, but no clear or discrete focal lesion is identified. The ill-defined T1 hyperintensity noted within the gland on the prior examination is not appreciated on today's study.The pituitary gland is normal in size and morphology. The pituitary stalk sits at midline and demonstrates normal enhancement. The visualized optic apparatus is within normal limits. The left Meckel's cave remains larger than the right but with no clear lesion to account for this.

Output: The pituitary gland is within normal limits. No discrete lesions are identified. The previously noted pituitary gland signal abnormality is not appreciated on today's study.


Instruction: Generate impression based on findings.

Input: Please evaluate for cause of bleeding noted on MRI 2months ago: Double vision, bleeding noted on outside imaging in July, fatigue, gait unsteadiness. There is interval evolution of signal characteristics and size of a lesion within the posterior left midbrain that now displays intrinsically T1 and T2 hyperintensity with a complete rim of low susceptibility signal and measures up to 15 mm, previously 11 mm. There is effacement of the adjacent cerebral aqueduct, but the third and lateral ventricles are not particularly enlarged. There is no evidence of an associated developmental venous anomaly. 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: Interval increase in size and evolution of the appearance of a lesion within the posterior left midbrain may represent a cavernous malformation with subacute hemorrhage.


Instruction: Generate impression based on findings.

Input: Multiple myeloma. New right lower extremity paralysis. A limited noncontrast enhanced examination was performed to assess for cord compression.Since the previous examination, there has been decompressive laminectomies (partial at T3, complete at T4-T5) with resection of the intraspinal, extradural posterior component. There is focal T2-hyperintensity in the spinal cord at T4-T5 level which is probably related to previous spinal cord compression.However, new right anterior epidural mass has developed which is an extension from an expansile soft tissue mass that involves the right aspect of T2 vertebral body as well as the paraspinal soft tissue. This mass measures in the axial plane 3.1 cm x 2.8 cm and 2.9 cm craniocaudally. Its intraspinal apical component measures in thickness 7 mm and causes leftward displacement of the spinal cord without definite cord signal abnormality. The intradural component extends from the mid/upper T1 level to the upper most T3 level. The right T2-T3 neural foramen is involved.A similar involvement is present at the L4 level where the vertebral body involvement is associated with an anterior epidural component that measures 9 mm in thickness and mildly to moderately narrows the spinal canal and both L4-L5 neural foramina. While the epidural component has not significantly changed since the previous examination, the remainder of the mass has grown though no axial images are available from the previous examination.There is new soft tissue thickening involving the right L3-L4 neural foramen which does cause mild mass-effect on the thecal sac is well.Central/anterior compression fracture at T12 resulting in about 30% height loss is not significant changed. Diffuse loss of marrow fat signal intensity reflecting replacement remains. There is still STIR hyperintensity involving the T2, T7-T10, L3 and L4 vertebral bodies in addition to the sacral first, third and fourth segments, which may reflect more focal involvement of these levels. The focal fat intensity along the anterior inferior endplate of T7 is unchanged and is probably degenerative in nature.Sacral involvement is predominately right sided and is associated with extraosseous soft tissue that is better assessed on the CT scan from February 15, 2016, which seems to involve the right sacral plexus.

Output: 1.Compared to the previous January 7, 2016 MRI, the T4-T5 spinal canal compression has been decompressed. Focal T2-hyperintensity in the spinal cord is probably noted related to previous compression.2.New epidural component related to T2 vertebral body involvement has developed since the previous examination and does displace the spinal cord though without definite signal abnormality in the cord. It does also involve the right T2-T3 neural foramen.3.New soft tissue component involves the right L3-L4 neural foramen including the exiting right L3 nerve root.4.Similar epidural involvement at L4 level has not changed since the previous examination which mildly to moderately narrows the spinal canal and the L4-L5 neural foramina. However, the mass itself has increased in size since the previous examination.5.The right sacral involvement with associated soft tissue thickening along the right sacral plexus/sciatic nerve is better assessed on the CT scan from February 15, 2016 and likely account for patient's right lower extremity weakness.Dr. Monther Qandeel discussed the above findings and recommendations with Dr. Thomas Couri over the phone on 2/16/2016 1:39 PM.


Instruction: Generate impression based on findings.

Input: The last well formed disk space is referred to as L5-S1. There is straightening of lumbar lordosis. There is minimal grade 1 retrolisthesis of L5 on S1. There is loss of T2 disk signal at L3-4, L4-5 and L5-S1 with moderate loss of disk height at L5-S1. The osseous marrow signal is benign. There is a high T1 signal focus along the left aspect of the L5 vertebral body superiorly likely representing focal fat versus hemangioma. The conus terminates at L1-2. The conus shows normal caliber and signal.L1-2: No disk herniation or spinal stenosis.L2-3: Mild disc bulge with mild bilateral neural foraminal narrowing. No significant spinal canal narrowing. L3-4: Right foraminal and far lateral disk protrusion with annular fissure, diffuse disk bulge and mild bilateral facet arthrosis causing severe right neural foraminal stenosis and mild left neural foraminal stenosis. No spinal canal stenosis.L4-5: Diffuse disk bulge, bilateral facet arthropathy and ligament flava thickening causing severe bilateral neural foraminal stenosis and minimal spinal canal stenosis. There is distension of the facet joints.L5-S1: Diffuse disk bulge asymmetric to the right with tiny central disk protrusion, mild bilateral facet arthropathy causing moderate bilateral (right greater than left) neural foraminal stenosis.

Output: 1. Multilevel lumbar spondylosis worst at L4-5 and L5-S1 where there is moderate to severe bilateral neural foraminal stenosis. No high grade spinal canal stenosis in the lumbar spine.2. Facet arthropathy particularly at L4-5 which may be contributing to patient' s low back pain.


Instruction: Generate impression based on findings.

Input: There is bone marrow edema involving the L4 and L5 vertebral bodies, which has significantly diminished since 3/5/2016. There is loss of disc height at the L4-5 level is redemonstrated. There remains diffuse enhancement in the L4-5 disc space and the adjacent vertebral bodies and paraspinal soft tissues. However, there is an area of nonenhancement in the posterior paraspinal soft tissues adjacent to the left fact joint at L3-4 that measures up to10 mm, with enhancement of the underlying facet. The L4 vertebral body height has decreased since 3/5/16 and there is persistent extensive erosion of the L5 superior endplate. There remains severe spinal canal stenosis at L4-5, as well as moderate to severe bilateral neuroforaminal stenosis due to a disc-osteophyte complex and ligamentum flavum thickening. There is also moderate spinal canal stenosis and mild bilateral neuroforaminal stenosis at L3-4, as well as a disc-osteophyte complex and facet hypertrophy at L5-S1 with mild spinal canal narrowing and moderate bilateral neural foraminal stenosis. There is a small Schorl node in the inferior L3 vertebral body. In addition, degenerative bone marrow signal alterations and irregularity persist alongside the endplates alongside the L5-S1 disc space. There are subcentimeter posterior synovial cysts at multiple levels between L3 and S1 on the right side with associated enhancement. There is mild diffuse epidural lipomatosis. There appears to be clumping and deviation of the nerve roots towards the left and anteriorly at the L2 and L3 levels, measuring up to 5 mm in axial cross-section. There is mild hyperenhancement of the overlying posterior dura. In addition, there is a persistent small area of high T2 signal and enhancement within the right aspect of the spinal cord at the T12-L1 level. There is a punctate enhancing lesion in the spinal canal at S1-2. There is atrophy of the bilateral kidneys and a renal transplants.

Output: 1. Decreased inflammation related to prior discitis-osteomyelitis at L4-5, with interval increased loss of height of the L4 vertebral body. Furthermore, degenerative spondylosis at L4-5 results in marked spinal canal narrowing.2. Apparent clumping and deviation of the nerve roots towards the left and anteriorly at the L2 and L3 levels may represent arachnoiditis, perhaps related to the overlying dural inflammation. 3. A persistent small area of high T2 signal and enhancement within the right aspect of the spinal cord at the T12-L1 level may represent a vascular lesions, neoplasm, and less likely infection, for example.4. A small area of nonenhancement in the inflamed posterior paraspinal soft tissues adjacent to the left facet joint at L3-4 may represent abscess formation with what may represent underlying facet osteomyelitis.5. An unchanged punctate enhancing lesion in the spinal canal at S1-2 may represent a schwannoma or other neoplasm.6. Degenerative spondylosis at L3 through S1. Subcentimeter posterior synovial cysts at multiple levels between L3 and S1 on the right side with associated enhancement, which may represent superimposed inflammation.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate tumor resection. Signs and symptoms: Evaluate tumor resection. Pre and post enhanced brain MRI:Examination is status post a large right temporal and frontal craniotomy. There is a large extra-axial right convexity serosanguineous subdural collection along the large right craniotomy site. Finding results in mass effect on the right temporal and frontal lobes. In the right anterior frontal the extra-axial collection measures at 14 mm in thickness, in the right posterior temporal collection measures at 12 mm in thickness and in high convexity right posterior frontal-parietal this collection measures approximately 14 mm in thickness. Since prior exam there is interval decrease postprocedural air within this collection. Compared to prior head CT from 7-7-15 there is no significant change in the overall mass effect and 15 mm the radiation of midline to the left is identical to prior study. Mild dilatation of left lateral ventricle also remains stable since prior exam.Post enhanced images demonstrate interval partial resection of right-sided extra-axial mass from the right anterior and mid temporal region. Extensive residual tumor still present. The mass in the basal cistern and with extensive encasement of right carotid artery, bilateral cavernous sinuses, right cerebellopontine angle, right skull base and right posterior temporal thickening noted. Extensive surrounding vasogenic edema demonstrate no convincing evidence of change.

Output: 1.Examination is status post large right temporal and frontal craniotomy with extra-axial serosanguineous/air subdural collection as detailed/measured above.2.There is partial resection of a large extra-axial mass from the right anterior and mid temporal region since prior exam.3.Extensive residual tumor in the basal cistern, right orbital apex, sella, sphenoid sinus, bilateral cavernous sinuses (R>L), central and rightward skull base, extensively in the right cerebellopontine angle as detailed above. There is a visualization of extensive encasement and decreased caliber of right supraclinoid internal carotid.4.Mass effect from residual tumor and edema and postop changes of the right hemisphere results in approximately 15 mm leftward deviation of midline similar to prior study and with stable mildly dilated left lateral ventricle.


Instruction: Generate impression based on findings.

Input: Reason: knee pain History: knee pain MENISCI: The lateral meniscus appears intact. The medial meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is a focal fluid-filled near full-thickness to full-thickness defect of the articular cartilage of the femoral trochlea, centrally, measuring approximately 6 mm in diameter. There is also full-thickness degeneration of the articular cartilage of the weightbearing portion of the medial femoral condyle with delamination and subchondral edema-type signal. LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: Cartilage defects involving the femoral trochlea and weightbearing portion of the medial femoral condyle.


Instruction: Generate impression based on findings.

Input: History of meningioma. Evaluate for residual/new disease. There are postoperative findings related to right-sided craniotomy, with encephalomalacia in the right frontal and temporal lobe surrounding the resection cavity. There are small unchanged foci of dural enhancement in the surgical bed region. 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 unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There are secretions in the right maxillary sinus and what may represent a left antronasal polyp.

Output: 1. Postoperative findings related to right-sided craniotomy, with encephalomalacia in the right frontal and temporal lobe surrounding the resection cavity and small unchanged foci of dural enhancement in the surgical bed region, which may represent treatment effects, but otherwise no evidence of enlarging tumors to suggest recurrent meningioma. 2. Findings suggestive of acute right maxillary sinusitis and what may represent a left antronasal polyp.


Instruction: Generate impression based on findings.

Input: Mr. Brown is a 65 year old male with a history of Philadelphia chromosome positive CML on Gleevec, papillary thyroid cancer s/p partial thyroidectomy, OSA, with complaints of palpitations and irregular heart rate. Left VentricleThe left ventricle is moderately dilated with mild to moderately reduced systolic function. The overall LV ejection fraction is 43%, the LV end diastolic volume index is 130 ml/m2 (normal range: 74+/-15), the LVEDV is 306 ml (normal range 142+/-34), the LV end systolic volume index is 73 ml/m2 (normal range 25+/-9), the LVESV is 173 ml (normal range 47+/-19). LV dysfunction is global. There are several small non-contiguous patches of nontransmural late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process in the mid lateral, inferior and septal walls that is atypical for myocardial infarction. Native T1 time is approximately 1080 ms. Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 60%, the RV end diastolic volume index is 86 ml/m2 (normal range 82+/-16), the RVEDV is 204 ml (normal range 142+/-31), the RV end systolic volume index is 34 ml/m2 (normal range 31+/-9), and the RVESV is 80 ml (normal range 54+/-17).Right AtriumThe right atrium is moderately dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a common right innominate and left common carotid brachiocephalic branching pattern (normal variant). The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is moderately dilated (33 mm x 32 mm).Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is moderately dilated with mild to moderately reduced systolic function. There are LV dysfunction is global. There are several small non-contiguous patches of nontransmural late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process in the mid lateral, inferior and septal walls that is atypical for myocardial infarction. Native T1 time is approximately 1080 ms. 2. The right ventricle is normal in size and systolic function. The overall RV ejection fraction is 60%.3. Biatrial enlargement. 4. Dilated pulmonary artery.


Instruction: Generate impression based on findings.

Input: Female, 3 years old, with infantile cerebral palsy. Evaluate for structural lesions. Former ex 23 week preemie. The corpus callosum is fully formed though it appears generally thinner than expected for age. The pattern of white matter myelination, on the other hand, does appear to be mature.The pituitary region is unremarkable. The brainstem, cerebellar vermis and cerebellar hemispheres are unremarkable. Prominence of the prepontine cistern is likely a congenital variant.No evidence of parenchymal edema or mass effect is seen. No restricted diffusion is detected. There is no evidence of any significant intracranial hemorrhage or abnormal extra-axial fluid. The ventricular system is within normal limits for size.

Output: 1.The corpus callosum is generally thinner than expected for age which may reflect either failure to properly developed or some degree of white matter loss.2.No other structural lesions or significant findings are seen to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Reason: evaluate right shoulder pathology History: right shoulder pain ROTATOR CUFF: There is mild thickening and intermediate signal within the supraspinatus tendon, suggesting tendinosis, but no fluid-filled tear is evident. The supraspinatus muscle is within normal limits. The remainder of the rotator cuff is normal in appearance. SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: Small humeral head subchondral cysts indicate minimal osteoarthritis of the glenohumeral joint. Glenohumeral joint alignment is within normal limits.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: 1.Supraspinatus tendinosis without rotator cuff tear. 2.Fluid collection in the expected site of the subcoracoid bursa, most likely representing subcoracoid bursitis.


Instruction: Generate impression based on findings.

Input: 51-year-old female with sudden vertigo and nystagmus, evaluate for posterior circulation infarct. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is a focus of increased T2 signal in the left thalamus, with minimal corresponding FLAIR signal abnormality, which is favored to represent a prominent perivascular space or less likely a prior infarct, and appears unchanged from the 2/27/2013 examination. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1.No evidence of acute intracranial hemorrhage, mass, or acute infarct.2.Unchanged focus of increased T2 signal in the left thalamus which is favored to represent a prominent perivascular space and less likely prior infarct.


Instruction: Generate impression based on findings.

Input: Female, 77 years old. Reason: 77 yo with amyloidosis, fever having worsening somnolence History: somnolence There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.Calcifications are seen at the level of the upper cervical cord likely corresponding to known expansile mass at the cervicomedullary junction as seen on prior MRI scan from 8/21/09.

Output: No intracranial abnormality. Known spinal cord mass is partially visualized on this study.


Instruction: Generate impression based on findings.

Input: Alignment is normal. The marrow signal is benign. The cervical and upper thoracic cord is normal in signal without abnormal enhancement. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable. Redemonstrated is the patient's partially into sella. There are no abnormal enhancing foci.C2/3: Mild right uncinate hypertrophy without stenosis.C3/4: Posterior osteophyte disc complex causes minimal anterior right hemicord flattening without intrinsic cord signal abnormality. There is also bilateral uncinate hypertrophy (right greater than left). There is mild right neural foraminal stenosis.C4/5: Posterior osteophyte disc complex causes minimal anterior cord flattening without intrinsic cord signal abnormality. There is also bilateral uncinate hypertrophy. There is mild to moderate bilateral neural foraminal stenosis.C5/6: Posterior osteophyte disc complex causes minimal anterior cord flattening without intrinsic cord signal abnormality. There is also bilateral uncinate hypertrophy. There is mild bilateral neural foraminal stenosis.C6/7: Posterior osteophyte disc complex causes slight anterior cord flattening, and ligamentum flavum thickening causes slight posterior cord flattening, without intrinsic cord signal abnormality. There is also bilateral uncinate hypertrophy (right greater than left). There is mild central and mild right neural foraminal stenosis.C7/T1: Mild posterior osteophyte disc complex without cord deformation or stenosis.

Output: 1.C3/4: Mild right neural foraminal stenosis.2.C4/5: Mild to moderate bilateral neural foraminal stenosis.3.C5/6: Mild bilateral neural foraminal stenosis.4.C6/7: Mild central and mild right neural foraminal stenosis.5.The cervical and upper thoracic cord is normal in signal without abnormal enhancement.


Instruction: Generate impression based on findings.

Input: Benign neoplasm of brain [225.0], Reason for Study: ^Reason: hx schwannoma s/p radiation History: none The patient did not want to have contrast enhancement. Therefore, only precontrast enhanced MRI scan was performed.Extra-axial mass located on the prepontine cistern as well as lateral aspect of right side cavernous sinus are again seen.Measured maximum diameter of the prepontine cistern lesion is about 31.3 mm and that of a right Meckel's cave and right cavernous sinus lesion is about 26.6 mm. Comparing to prior scan, the size, extent and MR characteristics do not show any significant interval change.Right side lower pons as well as middle cerebellar peduncle again shows high signal intensity on FLAIR imaging, no change since prior scan.Previously seen left basal ganglia lesion does not show interval change in FLAIR signal intensity but demonstrates no abnormal restricted diffusion indicate prior small ischemic infarction.There is no evidence of extension of the mass into the right internal auditory canal. No evidence of acute ischemic or hemorrhagic lesion on this scan.The ventricles, sulci and cisterns are unremarkable. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Right prepontine, right Meckel's cave and right cavernous sinus extra axial mass lesions likely represent meningioma is again demonstrated without showing any significant interval change in terms of maximum diameter, and MR characteristics.2. No change of external compression related edema on the pons and right middle cerebellar peduncle since prior scan.


Instruction: Generate impression based on findings.

Input: Female, 13 years old, with syrinx of the cervical and thoracic spinal cord, yearly follow-up. Redemonstrated is evidence of prior suboccipital craniectomy and resection of the posterior arch of C1. The foramen magnum remains somewhat crowded with a relatively pointed configuration of the cerebellar tonsils, but this is similar to the prior examination.Since the prior examination, the patient's cervicothoracic syrinx has significantly increased in caliber, now measuring 14 x 10 mm at the C6-7 level, previously 7 x 4 mm at this level. The syrinx cavity and associated T2 signal abnormality have also expanded in the craniocaudal dimension extending from the C1 level down to the T11 level. The syrinx itself contains multiple septations.Slight reversal of the cervical lordosis is seen. Spinal alignment is otherwise unremarkable. Vertebral body heights are preserved. No areas of marrow replacement or edema are seen. The thyroid gland is diffusely bulky and heterogeneous with a superimposed 15 mm T2 hyperintense lesion in the left thyroid lobe.

Output: 1.Demonstration of findings related to prior Chiari decompression. The foramen magnum remains somewhat crowded but similar to the prior study.2.Interval worsening of the cervicothoracic syrinx is demonstrated.3.The thyroid gland is incidentally noted to be prominent and diffusely heterogeneous with a focal lesion in the left lobe. This can be further assessed with sonography if clinically warranted.


Instruction: Generate impression based on findings.

Input: 37-year-old female with headaches and a history of meningiomas. The patient is status post resection of a right frontal meningioma in 3/17/2015. Compared to previous Brain MRI dated 1/23/2016 there has been no significant change in the FLAIR hyperintensity/gliosis with mild enhancement surrounding the right frontal resection cavity. Mild postsurgical dural thickening is also unchanged at the craniotomy site.An enhancing meningioma along the left anterior falx abutting the crista galli measures 0.9 x 0.9 x 1.3 cm (axial series 1001, image 14 and sagittal series 12-3, image 84) and is unchanged compared to the previous exam. There been no interval change in the minimal adjacent edema.There is stable plaque-like dural thickening and enhancement filling the left Meckel's cave and the right cavernous sinus. A stable small enhancing meningioma along the superior aspect of the right tentorium is unchanged and measures 0.6 x 0.6 cm (series 1001, image 12)There are prominent calcifications of the cord plexus with mild surrounding enhancement which are unchanged. There is grossly symmetric enhancement of the facial nerves, slightly more prominent in the left geniculate ganglion region which is nonspecific.There is no evidence of intracranial hemorrhage, mass effect, midline shift or herniation. The ventricles and basal cisterns are normal in size and configuration. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1.Stable postsurgical changes in the right frontal region status post resection of a meningioma on 3/17/2015. No findings to suggest residual or recurrent meningioma in this region.2.Stable small meningiomas along the left inferior frontal falx and along the right tentorium. Stable mild edema associated with the left inferior frontal meningioma.3.Stable enhancement involving right cavernous sinus and left Meckel's cave which may be related to meningiomas or perhaps schwannomas.4.Stable appearance of the calcified right larger than left choroid plexus with mild surrounding enhancement. Findings nonspecific, but meningiomas in these regions not excluded.


Instruction: Generate impression based on findings.

Input: history of aplastic anemia status post MUD BMT in 2004 and localized alveolar rhabdomyosarcoma of right inguinal and pelvic region who completed therapy in december 2013. PELVIS:UTERUS, ADNEXA: Stable mild T2 hyperintensity and enhancement of the labia.BLADDER: No significant abnormality noted.LYMPH NODES: Reference right inguinal lymph node measures 12 mm x 7 mm (series 501, image 14) unchanged. BOWEL, MESENTERY: The imaged bowel appears normal.BONES, SOFT TISSUES: There is new increased STIR/T2 bone marrow signal within the right femoral head and neck. Stable size and enhancement at the resection bed in the pelvis, including the right obturator internus muscle.Persistent swelling and T2 hyperintense reticulation of the anterior soft tissues of the right thigh unchanged. Enhancing focus in the posterior acetabulum unchanged.OTHER: Diminished caliber of the right iliac and right femoral vein persists. Small amount of free pelvic fluid, likely physiologic in a patient of this age.

Output: 1. New bone marrow edema within the right femoral head and neck of uncertain significance and attention to this area on followup exam recommended.2. Post surgical changes in the pelvis with no evidence of disease recurrence.


Instruction: Generate impression based on findings.

Input: Clinical question: History of PCNSL, memory with new balance and memory problems. Signs and symptoms: NHL, memory loss, imbalance.. Pre and postcontrast enhanced brain MRI: Unremarkable diffusion weighted images.Examination demonstrates diffuse periventricular, subcortical, bilateral basal ganglia and extensively of pontine foci of FLAIR/T2 hyperintensity with mild interval progression since prior exam. Additionally foci of hemorrhagic encephalomalacia in the left posterior parietal-occipital region is present without change since prior exam. Also stable since prior exam is a focus of hemorrhagic encephalomalacia in the left posterior temporal-parietal region without abnormal enhancement.There is no detectable signal abnormality of cerebellar or vermian parenchymal.The supratentorial ventricular system remain stable and within normal for age and with maintained midline. The signal void of major intracranial arterial branches are identified. Incidental note is made of anatomical variation of partially empty sella.There is no detectable abnormal enhancement of brain parenchyma, leptomeninges, calvarium or the retro-orbital spaces. There is evidence of a small left posterior temporal-parietal craniotomy without change.

Output: 1.No evidence of an acute finding.2.Extensive patchy confluent foci of FLAIR hyperintensity in the subcortical and periventricular white matter, bilateral basal ganglia and extensively within the pons with slight interval progression since prior study. Although nonspecific findings could represent chronic nonhemorrhagic small vessel ischemic strokes.3.Stable foci of hemorrhagic encephalomalacia in the left posterior temporal-parietal as well as left posterior parietal-occipital regions without abnormal enhancement.


Instruction: Generate impression based on findings.

Input: Headache. New tinnitus and hearing loss. The moderate patchy subcortical and deep white-matter T2/FLAIR hyperintensities have very minimally, if any, increased since the previous examination. Similarly, the pontine T2/FLAIR hyperintense foci are unchanged to very minimally increased. The ventricles remain mildly enlarged. There is no midline shift or brain herniation. There is no mass-effect. Major intracranial vascular flow voids are preserved. The small aneurysm arising off the posterior communicating segment of the left internal carotid artery is not adequately assessed on the current examination. Also, while there is no large cerebellopontine angle mass, the study is suboptimal for assessment of the internal auditory canals.The well-circumscribed T1/T2-hyperintense lesion involving the left posterior skull is unchanged and likely represent a benign lesion.The mastoid air cells are clear. There is mild mucosal thickening in the paranasal sinuses. There is no gross orbital abnormality.The heterogeneous lesion with foci of T1-hypointense, T2-hyperintense signal (cystic change) that involves the sella turcica with extension into the right cavernous sinus has not significantly changed since the previous examination. However, this study is not optimized for pituitary assessment.

Output: 1.Since 2013, there has been only minimal, if any, increase in the overall moderate burden of cerebral and brainstem white-matter lesions, which may reflect vasculopathy or microvascular disease. 2.The heterogeneous sellar mass with right cavernous sinus involvement is also not significantly changed. If further assessment is clinically warranted, a dedicated pituitary MRI without and with intravenous contrast recommended.


Instruction: Generate impression based on findings.

Input: There are enhancing lesions in the right frontal and temporal lobes with an additional thin, tract-like region of enhancement extending between them (which was not previously visualized). There are areas of restricted diffusion associated with the 2 largest lesions. When compared to the prior study, the lesions demonstrate increase in enhancement, regional mass effect, and surrounding T2 hyperintensity, compatible with edema. The temporal lobe lesion currently measures 3 x 2.8 cm in the axial plane, which previously only demonstrated non mass-like enhancement. The frontal lobe lesion has been surgically decompressed in the interim, but still demonstrates marked peripheral enhancement and has increased in size, measuring 4.2 x 2.7 cm, previously 3.2 x 2.1 cm. The enhancing tissue correlates to elevated rCBV.T2 hyperintensity and thickening without enhancement in the left frontal and parietal lobes is grossly stable when compared to the most immediate prior study, but has increased when compared to older exams.There are expected postsurgical findings related to right frontal and temporoparietal craniotomies with previous partial tumor resection. There is associated dural thickening and enhancement, which is likely postsurgical.The ventricles and sulci remain patent. There is no significant midline shift. No large extra-axial collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. The orbits are intact.

Output: 1.Multiple enhancing lesions in the right cerebral hemisphere which demonstrate enlargement when compared to the prior outside study from 12/10/15. The appearance on conventional MRI and rCBV mapping favors progression of disease.2.There is also T2 hyperintense thickening suspected to represent nonenhancing tumor in the left frontal and parietal regions which appears grossly similar to the most recent prior, but has increased over time.


Instruction: Generate impression based on findings.

Input: Ms. Strug is a 46 year old female with biopsy proven DCIS of the left breast. She presents for MR imaging for further evaluation. There is scattered fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.Spanning the entire left upper outer breast are multiple enhancing masses/clumped non-mass enhancement with suspicious appearance and kinetics. The total span of enhancement measures approximately 5.1 x 2.0 x 4.9 cm (AP x ML x SI). The total AP extent on the sagittal view is approximately 6.3 cm. At the mid-depth of this enhancement is the area of biopsy proven DCIS with susceptibility artifact from biopsy marker clip. At the posterior most extent of this abnormal enhancement is a spiculated enhancing mass measuring 2.1 x 1.9 x 1.6 cm. At the anterior most extent of this abnormal enhancement is an area of clumped nonmass enhancement measuring 1.5 x 0.8 x 1.1 cm, approaching to within 1 cm of the left nipple base.In the right medial breast, there are two enhancing foci/masses identified measuring approximately 0.5 and 0.8 cm respectively. These two enhancing areas do have a more benign appearance with non-suspicious kinetics. No abnormal axillary lymph nodes are identified in either axillary region.

Output: (1) Abnormal enhancement spanning the entire left upper outer breast, suspicious for additional disease than what was initially mammographically detected. Additional workup, including MR-directed ultrasound, can be performed targeting the anterior and posterior most extent of suspected disease. If found, additional biopsies with clip placement can be performed as clinically warranted.(2) Two enhancing foci/masses with benign morphology in the right breast for which MR-directed ultrasound can be performed. If no corresponding sonographic correlate is identified, then a short term 6 month MRI follow-up can be performed to confirm stability of these findings.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: 28 years Male (DOB:2/16/1988)Reason: several unsuccessful LPs, concerning for CSF infection History: eval aboveReferring Attending: MAUREEN D LYONS 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. No abnormal enhancing lesions are appreciated in the lumbar spine. The lumbar spinal canal is small on a congenital basis. The pedicles are thickened short.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: No compromise to lumbar spinal canal or neural foramina. The lumbar spinal canal is congenitally small.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for ischemia, etiology of LUE stiffening, shaking. Signs and symptoms: LUE stiffening and shaking. Nonenhanced brain MRI:Negative diffusion weighted series.Examination demonstrate multiple small foci of T2/FLAIR hyperintensity in the subcortical and periventricular white matter of cerebral hemispheres and pons and with normal signal intensity of brain parenchyma otherwise on all MRI sequences. One of the foci of FLAIR hyperintensity is in the left precentral gyrus (axial flair series 701 image 28). Although the findings are nonspecific this appearance is more suggestive of chronic small vessel ischemic strokes however possibility of other white matter lesions and including demyelinating disease cannot be entirely excluded.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination otherwise.Unremarkable images through the orbits, paranasal sinuses and mastoid air cells.Nonenhanced cervical MRI:The alignment of vertebral column is anatomical however there is mild reversal of cervical lordosis secondary to advanced disc disease and loss of disc height at C5-C6 level.Foramen magnum is unremarkable.C2-C3 is unremarkable.C3-C4 demonstrate mild degenerative/hypertrophic changes of posterior elements with mild left neural foraminal compromise and unremarkable otherwise.C4-C5 demonstrate mild degenerative changes and unremarkable otherwise.C5-C6 demonstrate advanced disc disease with near complete loss of disc height, moderate bilateral ligamentum flavum and mild facet hypertrophic changes. There is a hypertrophic spur traversing the entire transverse axis of the spinal canal at this level which results in effacement of subarachnoid space, flattening and posterior displacement of the cord and moderate central spinal stenosis and moderate bilateral neural foraminal compromise. Examination is degraded due to motion artifact and several sagittal T2 and T2 STIR series were repeated. On repeat sequences there is evidence of a large focus of T2/T2 STIR hyperintensity within the cord and extending from approximately C4-C5 disc level inferiorly to C6-C7 disc level and consistent with myelitis secondary to degenerative disease.C6-C7 demonstrate mild degenerative changes without spinal stenosis or neural foraminal compromise.C7-T1 is unremarkable.Upper most visualized thoracic spine and thoracic cord to T4 level is unremarkable.

Output: 1.Nonenhanced brain MRI demonstrate no acute intracranial process. Several small foci of FLAIR hyperintensity primarily in the subcortical/periventricular white matter (and including the lesion in the left precentral gyrus) and pons are noted. Findings are nonspecific however considering patient's stated age chronic small vessel ischemic strokes of mild degree should be considered. Less likely possibility of other white matter diseases and including demyelinating disease cannot be entirely excluded. Please see above comments.2.Nonenhanced MRI of cervical spine demonstrate advanced disc disease, loss of disc height and hypertrophic changes of posterior elements at C5-C6 with resultant moderate central spinal stenosis and bilateral neural foraminal compromise. There is increased T2 signal intensity of the cord extending from C4-C5 disc level to approximately C6-C7 disc level concerning for myelitis secondary to degenerative disease. No spinal stenosis or significant neural foraminal compromise at other levels however please review detailed report per level above.


Instruction: Generate impression based on findings.

Input: 24 year old female with seizure history. Again seen is encephalomalacia in the left temporal lobe, compatible with prior temporal lobe resection and unchanged since the prior examination.There is crowding of the foramen magnum. This is compatible with mild cerebellar tonsillar ectopia which was seen on the prior MRI dated 7/3/08No evidence of acute hemorrhage. No evidence of mass or midline shift. The gray-white differentiation is preserved. There are surgical changes compatible with prior left frontotemporal craniotomy. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Postsurgical and other chronic changes as above. No evidence of acute hemorrhage or midline shift.


Instruction: Generate impression based on findings.

Input: Markedly elevated alkaline phosphatase. Hepatic MRI inconclusive. History of known ulcerative colitis with new onset pruritis and elevated alkaline phosphatase. Evaluate for PSC versus extrinsic biliary compression. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology, signal intensity and size. No focal suspicious lesion.The common hepatic duct measures up to 7 mm. There is irregular dilatation and narrowing of the intrahepatic and extrahepatic bile ducts most noticeably of the left hepatic duct (series 5 image 1).No filling defect in the common bile duct is identified. The common bile duct tapers gradually towards the ampulla without a discrete mass lesion.. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Irregular narrowing and dilatation of the intrahepatic and extrahepatic bile ducts compatible with PSC without a discrete mass lesion.


Instruction: Generate impression based on findings.

Input: 55 years, Female, memory loss, multiple sclerosis. Again seen are multiple T2/FLAIR hyperintense lesions throughout the bilateral cerebral hemisphere subcortical and periventricular white matter with appearance and distribution consistent with known chronic demyelinating disease. Multiple infratentorial lesions are also again seen. Compared to 6/14/2013, there is a new lesion involving the right middle cerebellar peduncle. Otherwise no other new lesions are appreciated. No lesions with enhancement are definitively appreciated on the axial post gadolinium sequences, with phase artifact extending through the right middle cerebellar peduncle lesion. Multiple lesions with T1 hypointensity again seen. Evidence of mild global parenchymal volume loss which is prominent for age again seen. No evidence of intracranial mass effect, midline shift, or herniation. No hydrocephalus or extra-axial collections. Calvarium and extracranial soft tissues are grossly unremarkable.

Output: Multiple supratentorial and infratentorial lesions consistent with chronic demyelinating disease. Compared to 6/14/2013, there is a new lesion involving the right middle cerebellar peduncle. Otherwise no additional new lesions are appreciated. No lesions with enhancement to suggest active demyelination.


Instruction: Generate impression based on findings.

Input: Reason: stress fracture at distal metadiaphyseal junction History: pain There is increased bone marrow signal abnormality within the proximal tibial metadiaphysis on fluid sensitive sequences which may represent stress reaction in the correct clinical context (image 8; series 5). No discrete fracture line is identified at this time. There is no disruption of the cortex in the surrounding area. Additionally, there is a smaller focus of increased bone marrow signal abnormality within the distal tibial metadiaphysis which may simply represent residual islands of red marrow although minimal stress reaction could also be considered correct clinical context (image 13; series 5). There is slight increased signal abnormality on fluid sensitive sequences within the medial and lateral heads of the gastrocnemius muscle which may represent a mild muscle strain but this is nonspecific. The remainder of the imaged musculature of the right leg is unremarkable. On the large field-of-view images, there is also apparent increased signal abnormality on fluid sensitive sequences within the medial head of the gastrocnemius on the left which is also nonspecific but may represent a mild strain. There is also increased bone marrow signal abnormality within the medial aspect of the tibial plateau bilaterally, left greater than right. This is nonspecific but could also represent stress reaction, particularly if the patient has pain localizing to these areas.

Output: Findings indicating stress reaction of the right tibia as described above. No discrete fracture line is identified at this time. Other findings as described above.