Instruction: Generate impression based on findings.

Input: 40 year old male with nonischemic cardiomyopathy referred for cardiovascular MRI to evaluate for etiology of LV dysfunction. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. There is global hypokinesis with septal akinesis. The overall LV ejection fraction is 19%, the LV end diastolic volume index is 172 ml/m2 (normal range: 74+/-15), the LVEDV is 310 ml (normal range 142+/-34), the LV end systolic volume index is 169 ml/m2 (normal range 25+/-9), the LVESV is 251 ml (normal range 47+/-19), the LV mass index is 89 g/m2 (normal range 85+/-15), and the LV mass is 161 g (normal range 164+/-36). Mid septal enhancement. No evidence of infarct. There is no evidence of thrombus in the LV.Left AtriumThe left atrium is mildly enlarged. No evidence of atrial or atrial appendage thrombus.Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 41%, the RV end diastolic volume index is 92 ml/m2 (normal range 82+/-16), the RVEDV is 165 ml (normal range 142+/-31), the RV end systolic volume index is 54 ml/m2 (normal range 31+/-9), and the RVESV is 97 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch. The thoracic aorta is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThere are no significant extracardiac findings.

Output: 1. Severely dilated left ventricle with severely reduced systolic function (LVEF 19%)2. There is a region of mid-myocardial late gadolinium enhancement in the basal inferior septum. In the setting of a severely dilated left ventricle this is consistent with a diagnosis of dilated cardiomyopathy.3. Normal right ventricular size with mildly reduced systolic function (RVEF 41%).


Instruction: Generate impression based on findings.

Input: 31-year-old female with two hepatic lesions seen on outside hospital exam. Differential provided: hemangioma versus FNH versus adenoma. ABDOMEN:LIVER, BILIARY TRACT: There are two T2 hyperintense lesions within the right hepatic lobe, which demonstrate faceted margins and peripheral nodular enhancement, the more superior measuring 11 mm (series 14/263) and the more inferior measuring 9 mm (series 14/252). These lesions are compatible with hemangiomas. The liver is otherwise normal in signal and morphology. The hepatic vasculature is patent. There is no intrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Hepatic hemangiomas in the right hepatic lobe as detailed above.


Instruction: Generate impression based on findings.

Input: 39-year-old male with shoulder pain. Evaluate for rotator cuff tear. ROTATOR CUFF: There is thickening and intermediate signal abnormality within the supraspinatus and infraspinatus indicating mild tendinosis. There is perhaps mild undersurface fraying of the supraspinatus tendon. The supraspinatus muscle and tendon otherwise appears intact. The infraspinatus muscle and tendon appear intact. The teres minor muscle and tendon appear intact. The subscapularis muscle and tendon appear intact.SUPRASPINATUS OUTLET: No significant fluid is identified within the subacromial subdeltoid bursa. Mild osteoarthritic changes affect the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: Heterogeneous bone marrow signal abnormality may reflect residual islands of red marrow. The glenohumeral joint alignment is anatomic. Heterogeneity and increased signal abnormality within the anterior labrum may reflect degeneration/tearing, within the limitations of this non arthrogram study. There is subchondral cyst formation within the posterior superior humeral head.BICEPS TENDON: The tendon of the long head of the biceps appears intact. ADDITIONAL

Output: 1. Mild rotator cuff tendinosis and undersurface fraying without evidence of a full-thickness rotator cuff tear. 2. Findings suggestive of degeneration/tearing of the anterior glenoid labrum within the limitations of a non arthrogram study. 3. Mild acromioclavicular joint osteoarthritis.4. Nonspecific subchondral cyst formation within the posterior superior humeral head can be seen in internal impingement in the correct clinical setting.


Instruction: Generate impression based on findings.

Input: No intra-articular contrast is identified within the radiocarpal joint. No findings to suggest ligamentous disruption. Please refer to the subsequent MRI report for further information.Exposure time: 2 minutes and 3 seconds.

Output: Successful fluoroscopic guided left wrist arthrogram.


Instruction: Generate impression based on findings.

Input: Daily headaches and vertigo, simple visual (geometric) hallucinations, occasional tremors of individual limbs. Also has generalized hypermobility. Brain MRI: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Brain MRA: The images are degraded by patient motion, but within this limitation there is no evidence of significant steno-occlusive lesions or large aneurysms.Neck MRA: There is no evidence of significant steno-occlusive lesions, although the images are degraded by patient motion.

Output: 1. No evidence of acute intracranial hemorrhage, mass, or ventriculomegaly.2. No evidence of significant head and neck arterial steno-occlusive lesions or aneurysms, although the images are degraded by patient motion.


Instruction: Generate impression based on findings.

Input: Elevated PSA. Previous PIN on biopsy. PELVIS:PROSTATE:Prostate Size: 5.1 x 4.9 x 4.0 cm.Peripheral Zone: Within the left peripheral zone mid gland to apex there is a geographic area of increased T1 signal compatible with hemorrhage from prior biopsy. Within the posterior mid gland in the midline there is 11 x 6 mm area of decreased T2 signal and associated restricted diffusion. However, there is now associated enhancement of this is felt to reflect prominent central zone fibrous tissue. The remaining peripheral zone has heterogeneous low T2 signal, but no focal masslike lesion.Central Gland: Marked nodularity related to benign prostatic hypertrophy.Seminal Vesicles: No significant abnormality.Extracapsular Extension: No evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No definite foci of malignancy based on imaging criteria. There is signal abnormality surrounding the central zone as described above that is felt to most likely be benign, however if targeted biopsy is being performed, this area can be considered.


Instruction: Generate impression based on findings.

Input: 56 years, Female, worsening seizure, rule out brainstem stroke versus cause of worsening seizure. Patient has a vagal nerve stimulator. Brain MRI: No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. Tiny nonspecific focus of T2/FLAIR hyperintensity is present in the left subinsular white matter. Brain parenchyma is otherwise unremarkable for age. Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits. Brain MRA: The intracranial internal carotid arteries demonstrate no significant stenosis. The middle and anterior cerebral arteries are also patent. The vertebral arteries, basilar artery, and posterior cerebral arteries also are patent with no significant stenosis. No evidence of aneurysms or vascular malformations.

Output: 1. Noncontrast brain MRI appears within normal limits for age. No evidence of intracranial hemorrhage, mass, or acute infarct.2. MRA head demonstrates no significant stenosis in the intracranial vasculature.


Instruction: Generate impression based on findings.

Input: 23 year old with history of recent pregnancy and hypertension admitted with acute stroke, found to have new left ventricular dysfunction and apical thrombus on echocardiogram. Left VentricleThe left ventricle is severely dilated, severely reduced systolic function and moderate left ventricular hypertrophy. The overall LV ejection fraction is 25%, the LV end diastolic volume index is 153 ml/m2 (normal range: 65+/-11), the LVEDV is 284 ml (normal range 109+/-23), the LV end systolic volume index is 115 ml/m2 (normal range 18+/-5), the LVESV is 213 ml (normal range 31+/-10), the LV mass index is 109 g/m2 (normal range 67+/-11), and the LV mass is 203 g (normal range 114+/-24). The left ventricular dysfunction is global. There is no clear late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. Due to significant motion artifact (despite multiple attempts) small areas of LGE cannot be excluded. No left ventricular thrombus seen. Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is moderately dilated with moderate to severely reduced systolic function. The overall RV ejection fraction is 28%, the RV end diastolic volume index is 127 ml/m2 (normal range 69+/-14), the RVEDV is 235 ml (normal range 110+/-24), the RV end systolic volume index is 91 ml/m2 (normal range 22+/-8), and the RVESV is 169 ml (normal range 35+/-13). Right AtriumThe right atrium is mild to moderately dilated. Aortic ValveThe aortic valve is trileaflet, opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is at least trivial mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is upper limits normal (30 mm). Venous AnatomyThe SVC and IVC drain normally into the right atrium. PericardiumThere is a small pericardial effusion. Extracardiac FindingsThere is local susceptibility artifact at the dependant gastric fundus of uncertain etiology. No metal is visible on previous imaging exams. Correlation to possible ingested items recommended and can be followed with abdominal radiograph.

Output: 1. The left ventricle is severely dilated, severely reduced systolic function and moderate left ventricular hypertrophy. The overall LV ejection fraction is 25% The left ventricular dysfunction is global. There is no clear late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. Due to significant motion artifact (despite multiple attempts) small areas of LGE cannot be excluded. 2. The right ventricle is moderately dilated with moderate to severely reduced systolic function. The overall RV ejection fraction is 28%.


Instruction: Generate impression based on findings.

Input: Left pelvic pain For the purposes of numbering there are 5 lumbar type vertebral bodies labeled L1-L5. L5 vertebra demonstrates transitional anatomy with fusion involving the left L5 transverse process and sacrum. Vertebral body heights are within normal limits. There is minimal retrolisthesis of L1 on L2 and grade 1 anterolisthesis of L4 and L5. Bone marrow signal is benign. The conus medullaris is normal in position.Multilevel degenerative changes are seen including disc desiccation and disc height loss. Individual levels as described below:L1-L2: Mild disc bulge eccentric to the right. No significant spinal canal stenosis. Mild right neural foraminal narrowing. No significant left neural foraminal narrowing. Mild facet arthropathy.L2-L3: Minimal disc bulge and mild facet arthropathy. There is minimal right neural foraminal narrowing. No significant spinal canal or left neural foraminal stenosis.L3-L4: There is annular fissure and central disc extrusion. There is also facet arthropathy and ligamentum flavum thickening. There is moderate spinal canal stenosis. There is moderate right and mild to moderate left neural foraminal stenosis.L4-L5: Disc covering on the right related to mild anterolisthesis. There is moderate facet arthropathy, right worse in left. There is partial effacement of the right lateral recess. There is no significant central canal stenosis. There is minimal right neural foraminal narrowing. No significant left neural foraminal stenosis.L5-S1: Minimal disc bulge. There is bilateral facet arthropathy. There is minimal left neural foraminal narrowing. No significant central spinal canal or right neural foraminal narrowing.Paraspinous soft tissues are within normal limits aside from mild fatty replacement/atrophy involving the lower lumbar paraspinous musculature. Mild degenerative changes are seen at the left sacroiliac joint.

Output: 1. Multilevel degenerative changes in the lumbar spine as detailed above, worst at the L3-L4 level, where there is moderate spinal canal stenosis, moderate right neural foraminal stenosis, and mild to moderate left neural foraminal stenosis. Additional levels as above. No higher grade of left-sided neural foraminal stenosis.2. Multilevel facet arthropathy, relatively worse at the L3-L4 and L4-L5 levels.3. Transitional L5 anatomy with fusion of the left transverse process with the sacrum. Mild degenerative changes at the left sacroiliac joint.


Instruction: Generate impression based on findings.

Input: 58-year-old female with pain. Evaluate for rotator cuff tear. ROTATOR CUFF: There is increased signal intensity within the supraspinatus tendon indicating mild tendinosis, but we see no discrete tear. There is mild fatty infiltration along the myotendinous junction, but otherwise the muscle is normal in appearance. There is mild tendinosis of the infraspinatus tendon. Additionally, there are small foci of immediate signal intensity within the insertional fibers of the tendon that may represent small concealed tears or more focal regions of tendinosis, but we see no discrete fluid-filled or full-thickness tears. There are small underlying subchondral cysts within the humeral head. There is mild fatty infiltration along the myotendinous junction, but the muscle of the infraspinatus otherwise appears normal. There is increased signal intensity within the distal fibers of the subscapularis, likely representing a combination of tendinosis and interstitial tearing, perhaps extending to the articular surface. The teres minor muscle and tendon appear intact.SUPRASPINATUS OUTLET: Mild osteoarthritis affects the acromioclavicular joint. There is a small amount of fluid within the subacromial/subdeltoid bursa which is of questionable clinical significance.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is within normal limits. There is mild osteoarthritis of the glenohumeral joint. There is a small amount of fluid within the joint but no large effusion. There is globular and linear signal abnormality within the superior labrum which likely represents a combination of degeneration and degenerative tearing.BICEPS TENDON: There is abnormal signal intensity within the tendon of the long head of the biceps, particularly at its transition from the rotator interval to the intertubercular sulcus, likely representing a combination of degeneration and partial thickness tearing. There is fluid signal intensity surrounding the tendon within the bicipital groove suggesting a mild tenosynovitis.ADDITIONAL

Output: 1. Tendinosis and possible mild superimposed insertional tearing of the rotator cuff as described above; however, we see no fluid-filled or full-thickness rotator cuff tear.2. Moderate tendinosis and partial-thickness tearing of the long head of the biceps, particularly at its transition from the rotator interval to the bicipital groove, with fluid in the tendon sheath suggesting tenosynovitis.3. Mild osteoarthritis of the glenohumeral and acromioclavicular joints with degeneration/degenerative tearing of the superior labrum.4. Subcoracoid bursitis.


Instruction: Generate impression based on findings.

Input: Clinical question: Patient with right vertebral dissection. Signs and symptoms: Diplopia and vomiting. Nonenhanced brain MRI:Examination demonstrates diffuse scattered foci of restricted diffusion in the right cerebellum both inferiorly and superiorly as well as a punctate focus within the right cerebellar tonsil consistent with acute ischemic strokes. Findings are also well visualized on Flair and T2-weighted images. There is no evidence of hemorrhage or mass effect. Fourth ventricle remains within normal size and midline and CSF spaces/cisterns in the posterior fossa remain patent.There is no detectable acute ischemic stroke in the supratentorial brain parenchyma.FLAIR and T2-weighted images demonstrate above detailed acute nonhemorrhagic strokes. Additionally there is a single tiny focus of FLAIR hyperintensity in the subcortical white matter of right parietal lobe which is believed to represent an artifactual finding. The signal void of the right vertebral artery is identified intracranially.Unremarkable cerebral cortex, cortical sulci, ventricular system and CSF spaces.Unremarkable calvarium and soft tissues of the scalp.Unremarkable images through the orbits, paranasal sinuses and mastoid air cells.Findings and concerns on this exam were discussed by phone with referring services Fadi Mikhail #6229 at the time of review of the study.

Output: 1.Diffuse patchy foci of acute nonhemorrhagic ischemic stroke in the right cerebellum and right cerebellar tonsil without significant mass effect.2.Unremarkable nonenhanced brain MRI otherwise.


Instruction: Generate impression based on findings.

Input: Compared to 10/1/2015, there is no significant change in enhancing lesion along the left optic tract measuring 9 x 7 x 7 mm. Enhancing nodule at the level of the left thalamus measuring 14 x 16 x 13 mm is also not appreciably changed in size. Mild enhancement involving the left globus pallidus lesion is similar to prior but clearly improved since 6/11/2015. Expansile T2/FLAIR signal abnormality with minimal enhancement of the optic chiasm is similar to prior. FLAIR hyperintensity involving the right optic tract is also similar. There is also no significant change in appearance of the intraorbital component of the optic nerve gliomas, right larger than left, again noted to have mild enhancement of the right intraorbital optic nerve and persistent dilatation of the right optic nerve sheath. T1 shortening involving the basal ganglia and dentate nuclei are compatible with posttreatment change. Linear focus of FLAIR hyperintensity along the left frontal lobe presumably related to prior biopsy. Unchanged minimal chronic blood products in the left basal ganglia region. No new intracranial mass or mass effect. No evidence of acute infarct or hemorrhage. No hydrocephalus.

Output: Compared to 10/1/2015, there is no appreciable change in size or appearance of multiple bilateral optic pathway gliomas.


Instruction: Generate impression based on findings.

Input: 12-year-old female presents with seizure relapse, leg stiffening, and uncontrollable laughing. There is a punctate focus of high T2 signal in the left anterior frontal lobe subcortical white matter. Otherwise, there is no evidence of hamartoma, gross cortical dysplasia, medial temporal lobe sclerosis, intracranial hemorrhage, mass, or infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: A punctate focus of high T2 signal in the left anterior frontal lobe subcortical white matter is nonspecific, but could potentially represent heterotopic grey matter or prominent perivascular space perhaps.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Clinical question: Rule out CVA. Signs and symptoms: Right upper and lower extremity weakness. Nonenhanced head CT:Large vessel intracranial calcification of bilateral vertebral and cavernous carotids are noted. Images through posterior fossa are unremarkable.On axial images 11 and 12 there is a focus of low attenuation in the pons on the left extending across the midline. This is believed to represent artifact. Please correlate with neurological examination findings and if concern persists recommend and MRI.Images through the supratentorial space demonstrate no detectable hemorrhage, edema, mass effect, midline shift or hydrocephalus. There is a slight prominence of cortical sulci and ventricular system which may represent mild underlying parenchymal volume loss.

Output: 1.No definitive acute intracranial findings.2.Foci of low-attenuation in the pons on the left which also extend across the midline to the right and is believed to represent an artifact. Please correlate with neurological findings and if there is concern for stroke in this region recommend follow-up with CT or an MRI.


Instruction: Generate impression based on findings.

Input: History of renal cancer status post left nephrectomy, evaluate nodules in renal bed and left lower quadrant. Motion artifact on several of the sequences makes assessment suboptimal.ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology, size and signal intensity without a focal lesion or biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Status post left nephrectomy. In the adjacent dorsolateral retroperitoneal space there are several soft tissue nodules that demonstrate postcontrast enhancement, the largest conglomeration of which measures 2.5 x 1.4 cm (series 21, image 255), not significantly changed in size compared to 9/3/2015 where it measured 2.5 x 1.4 cm but slightly increased in size from 5/27/2015 outside MRI where it measured 2.2 x 1.1 cm (series 12 image 31). Another discrete nodule more inferiorly measures 8 mm (series 21, image 59), unchanged from 8 mm previously. There is a discrete parasplenic implant on the left lateral transversalis fascia (series 29, image 131), not significantly changed.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: In the lower left lateral abdominal wall musculature there is a 1.8 x 1.0 cm enhancing nodule (series 21, image 191), not significantly changed.OTHER: No significant abnormality noted.

Output: 1.Status post left nephrectomy with enhancing soft tissue nodularity in left retroperitoneal compartment suspicious for residual or locally recurrent disease, not significantly changed compared to 9/3/2015 but slightly increased in size from 5/27/2015 outside MRI. 2.Additional nonspecific enhancing soft tissue nodule in the left lateral abdominal wall musculature may also represent a site of metastatic disease, not significantly changed. 3.Additional nonspecific signal abnormality and enhancement in the insertion of the left gluteus maximus muscle which could represent inflammation or an additional site of metastatic disease, and continued attention to this area on follow-up imaging is recommended.


Instruction: Generate impression based on findings.

Input: Clinical question: Hemorrhage, recent hemorrhage reports from outside hospital. Signs and symptoms: Follow-up hemorrhage A small focal area of increased density in the cingulate gyrus of right posterior parietal is suspicious for small area of hemorrhage or possible calcification (cavernoma). This finding measures approximately 6 mm times 6-mm and is visualized on axial image number 15. Subtle area of low attenuation in the subcortical white matter of the left frontal lobe is also noted. The area of low-attenuation may represent an area of ischemic change. There is a subtle linear increased density within this area of low-attenuation which may represent either minimal hemorrhage or volume averaging of the adjacent cortex. In high convexity right frontal lobe large area of encephalomalacia is noted which is believed to represent an area of old ischemic stroke. To exclude other possibilities an MRI examination is recommended.Cortical sulci, ventricular system and all CSF cisterns are within normal limits for patient's stated age.Slight prominence of the folia of the cerebellum and the vermis may represent minimal underlying parenchymal volume loss. Calvarium, paranasal sinuses and mastoid vessels are unremarkable.

Output: 1.Small area of increased density suspected for minimal hemorrhage and less likely calcification in this gyrus of the right parietal lobe as detailed above.2.Additional areas of suspected ischemic change of indeterminate age.3.Further evaluation for confirmation of the above findings and to exclude other possibilities an MRI is recommended.


Instruction: Generate impression based on findings.

Input: 18 year-old patient with somnolence and bilateral DVTs. The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma. No abnormal enhancing lesions are appreciated intracranially.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.Within the pituitary fossa and there is some some enhancement and around the infundibulum of the pituitary gland . correlating with the recent MRI this may represent a small pituitary fossa with horizontal orientation of the infundibulum, however, imaging is nonspecific for pituitary.

Output: The infundibulum of the pituitary gland appears mildly thickened. Please correlate with for clinical symptoms related to to the pituitary. If thought clinically appropriate, an MRI of the pituitary may be of benefit in assessing this area.


Instruction: Generate impression based on findings.

Input: Family history of breast cancer in her mother diagnosed at the age of 75, sister at age 52 and two aunts. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally. Motion limits the initial T2 images, but not the repeat T2 images.No suspicious enhancement is seen in either breast. A few scattered foci are present, similar to prior studies, none of which are suspicious. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Swelling, warmth, pain. Abscess, deep space infection of left Syme stump? The patient has undergone a Syme-like amputation through the ankle, with the associated expected postoperative changes. There is irregularity of the skin surface along the lateral aspect of the ankle suggesting ulceration. The underlying subcutaneous fat is replaced with heterogeneous signal intensity compatible with edema and scarring. There is perhaps a small, elongated thin collection of fluid within the soft tissues superficial to the fibula, but this is difficult to determine with certainty in the absence of contrast enhancement. I see no frank drainable abscess. Bone marrow signal intensity of the fibula is within normal limits, without evidence of osteomyelitis. The distal end of the stump representing the plantar "heel pad" appear slightly edematous, but largely maintains normal fat signal intensity. Between the heel pad and the distal ends of the tibia and fibula is a heterogeneous collection of tissue representing a surgically created muscular flap which shows high signal intensity on T2-weighted images that may reflect edema, although such signal can also be a normal finding in muscular flaps. This is admixed with low signal intensity that I suspect represents a combination of scar tissue, heterotopic ossification and residual tendinous structures. Increased signal intensity on T2WI deep to the musculature along the inferomedial aspect of the distal tibia may represent edema or perhaps a phlegmon, but I see no well-defined fluid collection to confirm an abscess. Multiple foci of signal void represent metallic susceptibility artifact from the surgery, as I see no gas density on the radiographs. There is mild periosteal reaction along the distal tibia that I suspect is chronic in etiology, as mild periosteal reaction is seen on ankle radiographs dating back to 2013. There is also mild edema-type signal within the medial aspect of the remaining distal tibia; although I cannot exclude osteomyelitis, the overlying cortical bone appears relatively preserved and hence this may simply represent reactive edema.

Output: Postoperative changes of Syme amputation with soft tissue ulceration and inflammation as described above. There is an equivocal thin elongated fluid collection underlying the lateral ulcer, as well as poorly defined increased signal intensity on T2WI between the muscular flap and the distal tibia medially that could represent a phlegmon, but I see no well-developed abscess given the limitations of a nonenhanced study. Mild edema of the bone marrow of the medial aspect of the distal tibia is nonspecific and while I cannot exclude osteomyelitis this may simply represent reactive edema associated with adjacent soft tissue inflammation.


Instruction: Generate impression based on findings.

Input: Do not resuscitate [Z66], Reason for Study: ^Reason: eval for microvascular disease, explain etiology of AMS History: AMS Significant motion artifact degraded exam quality.There are couple of high signal intensities on DWI including left side corpus callosum mid-body and posterior body. However, there is no definitive evidence of restricted diffusion on ADC map. Thus, these lesions could be late subacute ischemic lesions or could be T2 shine through from focal encephalomalacia.There are multiple T2/FLAIR high signal intensity lesions on the right frontal,parietal and posterior temporal lobes but further characterization is challenging due to significant patient's motion. These lesions represent chronic ischemic infarction related encephalomalacia most likely comparing to prior CT scan.The ventricles, sulci and cisterns are unremarkable. The paranasal sinuses are clear.Bilateral mastoid air cells show fluid collections.

Output: 1. No definitive evidence of acute ischemic or hemorrhagic lesion though a couple of DWI high signal intensity lesions as described above.2. Multifocal most likely on the right hemispheric chronic ischemic infarction with encephalomalacia.


Instruction: Generate impression based on findings.

Input: 57-year-old male. Status post OHT, worsening left hip pain. Evaluate for infection, fluid collection, and avascular necrosis. Images are degraded by motion artifact, which limits evaluation. No evidence of avascular necrosis. Bone marrow signal intensity is within normal limits. Mild to moderate osteoarthritis of the left hip. No fluid collection or abscess is identified. The acetabular labrum and cartilage cannot be assessed on these motion degraded images. No hip joint effusion. Diffuse mild atrophy of the left hip musculature.

Output: Mild to moderate osteoarthritis of the left hip. No evidence of an abscess or avascular necrosis as clinically questioned.


Instruction: Generate impression based on findings.

Input: Evaluate for structural abnormalities History of syncope. Cousin has TS The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: MRI of the brain is within normal limits


Instruction: Generate impression based on findings.

Input: Clinical question: Lumbar stenosis and L4 -- 5. Signs and symptoms: Bilateral leg pain right worse than left. Nonenhanced lumbar MRI:T11 -- T12 demonstrate mild degenerative changes without spinal stenosis or neural foraminal compromise.T12 -- L1 demonstrate mild degenerative changes without spinal stenosis or neural foramina compromise. A well-demarcated focus of T1 and T2 hyperintensity within the vertebral body of L1 consistent with a hemangioma with no clinical significance.L1 -- L2 demonstrate mild disk disease and moderate bilateral ligamentum flavum hypertrophy and mild facet disease. No spinal stenosis or neural foraminal compromise.L2 -- L3 demonstrate mild degenerative changes without spinal stenosis or neural foraminal compromise.L3 -- L4 demonstrate mild degenerative changes without spinal stenosis or neural foraminal compromise.L4 -- L5 demonstrate a very large central and left sided disk extrusion result in significant central spinal stenosis however on neural foraminal compromise. Moderate disk disease and moderate to severe bilateral facet and ligamentum flavum hypertrophy contributes to spinal stenosis at this level as well. L5 -- S1 demonstrate mild disk disease with moderate facet and mild ligamentum flavum hypertrophy. No spinal stenosis or neural foraminal compromise. Hypertrophic changes of the right ligamentum flavum however results in mild right lateral recess compromise.

Output: 1.Large central and leftward disk extrusion and extensive hypertrophic changes of posterior elements at L4 -- L5 results in significant central spinal stenosis as detailed. No neural foraminal compromise.2.Mild to moderate degenerative changes at other levels however without central spinal stenosis or neural foraminal compromise.3.Mild right lateral recess compromise at L5 -- S1 secondary to right-sided ligamentum flavum hypertrophy.


Instruction: Generate impression based on findings.

Input: There is a new 11 x 9 mm area of T2/FLAIR hyperintensity and T1 hypointensity in the right parietal lobe. Other scattered white matter T2/FLAIR hyperintense lesions are redemonstrated and appear similar in size since 12/21/2015. These include lesions in the right middle cerebellar peduncle, adjacent to the posterior ramus of the right sylvian fissure, left cingulate gyrus, left temporal lobe, and right centrum semiovale.The ventricles and sulci are within normal limits. The basal cisterns remain patent. There is no midline shift or mass effect. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits.

Output: New T2/FLAIR hyperintense and T1 hypointense white matter lesion in the right parietal lobe. Relatively small number of other T2/FLAIR hyperintense lesions scattered elsewhere throughout the brain are unchanged.


Instruction: Generate impression based on findings.

Input: Knee pain and instability. The standard high-resolution coil was not used presumably due to patient body habitus; a larger coil was used which results in slightly suboptimal image quality.MENISCI: The medial and lateral menisci are intact.ARTICULAR CARTILAGE AND BONE: There is near full-thickness cartilage loss along the inferior most aspect of the lateral patellar facet with additional milder cartilage degeneration more superiorly with articular cartilage clefts and underlying subchondral cysts. Additional foci of increased signal intensity within the articular cartilage of the weightbearing portion of the lateral tibial plateau also indicates degeneration. The remaining bone marrow signal intensity is within normal limits.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1.No evidence of meniscal tear.2.Findings suggestive of patellofemoral instability with cartilaginous degeneration along the lateral patellar facet as described above.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate lesion in right cerebellar hemisphere. Signs and symptoms: As above. Pre and post enhanced brain MRI:No diffusion-weighted abnormalities.Examination demonstratesTwo small wedge shaped foci of T2 hyperintensity and FLAIR hyperintensity in the right cerebellum which have the appearance of chronic right superior cerebellar artery territory ischemic strokes and unremarkable images through posterior fossa.Images of the supratentorial space demonstrate normal signal intensity and morphology of cerebral cortex, cortical sulci, ventricular system, CSF spaces and the brain myelination for age and without detectable abnormal enhancement.The signal void of major intracranial arterial branches are identified.The signal intensity of intracranial venous sinuses are within normal and with normal pattern of enhancement.Unremarkable calvarium and orbits without abnormal enhancement.All paranasal sinuses and bilateral mastoid air cells and middle ear cavities demonstrate normal pneumatization signal pattern.

Output: 1.No acute intracranial process.2.2 small wedge shaped foci of T2 hyperintensity in right posterior cerebellum although nonspecific they're highly suggestive of chronic strokes.3.Unremarkable pre and post enhanced brain MRI otherwise. Please see above comments.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for hemorrhage. Signs and symptoms: Headaches and dysarthria. CT of brain without infusion:High density material within the right internal carotid artery is consistent with prior embolization and coil placement.A slightly high density loculated and calcific tissue surrounding the basal cistern and within the cavernous sinuses is consistent with patient's known significant atherosclerotic disease with ectasia and tortuosity of the vasculature. These findings appear similar to prior CT and MRI examinations.Extensive areas of encephalomalacia of the right cerebral hemisphere with ex vacuo dilatation of the right lateral ventricle remain identical to prior studies. Few small foci of low-attenuation likely small vessel strokes in the left hemisphere are also noted and stable.No evidence of hemorrhage, edema, mass-effect, midline shift or hydrocephalus.

Output: No evidence of acute findings and stable exam since prior study.


Instruction: Generate impression based on findings.

Input: Diarrhea, abdominal pain, evaluate enteritis ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Wall enhancement involving approximately 8 to 10 cm of the distal/terminal ileum with associated stricturing and surrounding fibrofatty proliferation in the right lower quadrant (series 2601, image 103 and 91). The ileocecal valve and cecum are normal in appearance. Mild wall thickening of the rectosigmoid with associated prominence of the vasa recta and regional lymph nodes suggestive of acute colitis (series 3001, image 18). No evidence of abscess or fistula. BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: See above.BONES, SOFT TISSUES: No significant abnormality noted.

Output: Acute on chronic inflammatory changes in the terminal ileum and acute colitis affecting the rectosigmoid. Findings are suggestive of inflammatory bowel disease.


Instruction: Generate impression based on findings.

Input: Reason: any plexiform tumor noted to left thumb area History: large fibroma to top of left thumb/wrist area, limited mobility, pain. Exam slightly limited by patient motion artifact on several sequences. Along the radial aspect of the distal first metacarpal, there is a lobulated T2 hyperintense, T1 hypointense, homogeneously enhancing mass measuring 2.8 x 1.6 x 2.3 cm (Obl AP x Obl TR x Obl CC) compatible with a plexiform neurofibroma given this patient's history. Smaller plexiform neurofibroma within the hypothenar subcutaneous fat measures 0.6 x 0.4 x 0.2 cm (Obl AP x Obl TR x Obl CC) and additional scattered small neurofibromas. Positive ulnar variance. T2 hyperintense, T1 hypointense, enhancing foci within the lunate and triquetrum likely due to impaction and inflammation related to positive ulnar variance.The remainder of the bones and soft tissues are within normal limits.

Output: 1.Scattered plexiform neurofibromas with the largest along the first metatarsal bone. 2.Positive ulnar variance with findings likely related to impaction involving the lunate and triquetral bones.


Instruction: Generate impression based on findings.

Input: Meningiomas. Status post resection. Assess for recurrent/growth. Since the previous examination, the patient did have resection of the left anterior parietal convexity meningioma. There is a small focus (measuring 7 mm in diameter) of somewhat linear contrast enhancement in the treatment bed which may reflect the leptomeningeal scarring. The diffusion characteristics in the treatment plan and are difficult to assess given artifact related to the overlying craniotomy. However, there is no sizable effusion obstruction. Ureteral thickening underlying the craniotomy flap than expected.T1-hypointense, T2 hyperintense signal without mass-effect in the underlying anterior parietal white matter (including the postcentral gyrus) probably reflect gliosis. This is where the edema-like signal was present on the preoperative examination. The remainder of the brain shows unchanged tiny subcortical and deep white matter foci in the frontal lobes that probably reflect chronic microvascular ischemia. There is mild expansion of the ventricle system and the other CSF-containing spaces which is unchanged.The orbits are normal. The mastoid air cells and the paranasal sinuses are clear.

Output: 1.The patient did have resection of the left parietal paramedian convexity meningioma. 2.Seven millimeter focal contrast enhancement in the resection bed likely represent leptomeningeal scarring rather than residual tumor. However, follow-up MRI can more reliably rule out minimal residual tumor though.


Instruction: Generate impression based on findings.

Input: Poorly differentiated lung adenocarcinoma with a solitary brain metastasis resected on 7/20/2011. There are post-treatment findings in the left frontal lobe region. There is unchanged patchy T2 hyperintensity surrounding the treatment bed and diffusely elsewhere in the cerebral and pontine white matter without associated abnormal intracranial enhancement. There is a chronic lacunar infarct in the left corona radiata. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles are unchanged 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 unchanged.

Output: Stable post-treatment findings without evidence of tumor recurrence.


Instruction: Generate impression based on findings.

Input: Multiple MRI sequences are significantly motion degraded. There are unchanged postoperative findings related to biopsy of a right basal ganglia lesion with T2 hyperintensity and susceptibility effect along the biopsy tract. There is unchanged ill-defined mild T2 hyperintensity within the left basal ganglia, with minimal if any nodular enhancement along its medial aspect. No new enhancement or mass effect to suggest recurrent tumor. There is also unchanged gliosis and cystic encephalomalacia within the anterior right superior frontal gyrus. There is minimal unchanged nonspecific periventricular T2 hyperintensity.There is no evidence of acute intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is minimal paranasal sinus mucosal thickening and mild fluid within the bilateral mastoid air cells.

Output: No evidence of recurrent tumor.


Instruction: Generate impression based on findings.

Input: 49-year-old female with history of meningioma, evaluate for progression. No acute intracranial process and negative diffusion weighted series. Redemonstrated is a stable small meningioma in right anterior frontal along the inner table of the skull again measuring 8 x 9 mm in transaxial dimensions. As before, there is no associated mass effect or edema of the adjacent parenchyma. The cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination is otherwise within normal and stable. There is no abnormal parenchymal or leptomeningeal enhancement other than aforementioned meningioma. The paranasal sinuses, bilateral mastoid air cells, and middle ear cavities are clear. Expected vascular flow voids are demonstrated.

Output: 1.No acute intracranial process.2.Stable small 8 x 9 mm right frontal convexity meningioma.


Instruction: Generate impression based on findings.

Input: Mesenchymal chondrosarcoma of the left maxillary sinus; completed radiation therapy in March 2013 and chemotherapy in May 2013. There are post-treatment findings in the left maxillary sinus and nasal cavity region. There is mild mucosal thickening within the remaining portions of the left maxillary sinus, but no specific evidence of measurable mass lesions to suggest tumor recurrence. There are also persistent small retention cysts within the right maxillary sinus and scattered mucosal thickening within the ethmoid sinuses. The facial soft tissues are unremarkable. There is no significant cervical lymphadenopathy. The partially imaged intracranial structures and orbits are grossly unremarkable.

Output: Post-treatment findings in the left sinonasal region without evidence of measurable locoregional tumor recurrence.


Instruction: Generate impression based on findings.

Input: Alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign. The cervical and upper thoracic cord are normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.C2/3: Unremarkable and unchangedC3/4: Mild posterior osteophyte disc complex and right-sided uncinate hypertrophy. There is new mild right neural foraminal stenosis.C4/5: Left paramedian disc herniation causing anterior cord flattening without intrinsic cord signal abnormality. There is no resulting central stenosis. These findings are unchanged.C5/6: Posterior osteophyte disc complex and uncinate hypertrophy (right greater than left). There is mild right neural foraminal stenosis, unchanged. There is no significant central or left foraminal stenosis.C6/7: Posterior osteophyte disc complex asymmetric to the left and left uncinate hypertrophy. There is mild left neural foraminal stenosis. These findings are unchanged.C7/T1: Mild posterior osteophyte disc complex without resulting stenosis, unchanged.

Output: 1.C3/4: New mild right neural foraminal stenosis.2.C4/5: Stable left paramedian disc herniation causing anterior cord flattening without intrinsic cord signal abnormality.3.C5/6: Mild right neural foraminal stenosis, unchanged.4.C6/7: Mild left neural foraminal stenosis, unchanged.


Instruction: Generate impression based on findings.

Input: Pain in right shoulder. Evaluate for SLAP tear vs PASTA lesion (rotator cuff tear.) ROTATOR CUFF: The rotator cuff appears normal.SUPRASPINATUS OUTLET: The acromioclavicular joint appears normal. There is trace fluid within the subacromial/subdeltoid bursa. We see no gadolinium within the bursa to indicate a full-thickness rotator cuff tear.GLENOHUMERAL JOINT AND GLENOID LABRUM: Alignment of the glenohumeral joint appears normal. The labrum appears normal.BICEPS TENDON: The biceps tendon appears normal. ADDITIONAL

Output: No evidence of labral tear, rotator cuff tear, or other findings to account for the patient's pain.


Instruction: Generate impression based on findings.

Input: Ms. Konicek is a 60 year old female with a strong family history of breast cancer in six maternal cousins and BRCA1 mutation carrier. She has no current breast related complaints. There is scattered fibroglandular tissue in both breasts. Mild background parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. 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 bladder cancer status post cystectomy. ABDOMEN:LIVER, BILIARY TRACT: The liver demonstrates normal signal intensity and enhancement. Several scattered T2 hyperintense lesions are not significantly changed and are compatible with cysts. The hepatic vasculature appears patent.Cholelithiasis. No biliary ductal dilatation.SPLEEN: No significant abnormality noted. Accessory splenule unchanged.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: The kidneys demonstrate normal enhancement without focal lesions. No hydronephrosis or hydroureter. Status post cystectomy and ileal conduit.RETROPERITONEUM, LYMPH NODES: Small benign-appearing retroperitoneal/left paraaortic nodes similar to prior study.BOWEL, MESENTERY: Right lower quadrant ileal conduit without evidence of complication. BONES, SOFT TISSUES: Unchanged small widemouthed periumbilical hernia. PELVIS:PROSTATE/SEMINAL VESICLES: Status post cystoprostatectomy.BLADDER: Status post cystoprostatectomy.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Bilateral fat containing inguinal hernias. Sclerotic focus within the left iliac bone not significantly changed and compatible with bone island.OTHER: No significant abnormality noted.

Output: Stable examination with no evidence of metastatic disease.


Instruction: Generate impression based on findings.

Input: 20-year-old male with ulnar-sided wrist pain, evaluate for TFCC tear LIGAMENTS: Contrast is noted within the radiocarpal joint. The scapholunate and lunotriquetral ligaments are intact. No contrast is noted in the mid carpal joint space.TRIANGULAR FIBROCARTILAGE COMPLEX: The TFCC is intact without evidence of tear. No contrast is noted within the distal radioulnar joint.TENDONS: No significant abnormality noted. BONES: No abnormal marrow signal. No fracture is evident.ADDITIONAL

Output: 1.No evidence of TFCC tear.2.High T2 signal intensity, cystic appearing lesion in the distal ulna may represent an enchondroma. This may be better evaluated with CT.


Instruction: Generate impression based on findings.

Input: Hereditary hemorrhagic telangiectasia [I78.0], Reason for Study: ^Reason: 3T scanner, please assess for cerebral AVMs, hx of HHT History: HHT, at risk for cerebral AVMs Brain MRINo evidence of acute ischemic or hemorrhagic lesion.No evidence of abnormal enhancement.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal.

Output: 1. Normal brain MRI.2. Normal brain MRA


Instruction: Generate impression based on findings.

Input: Pain, posterior medial tibia junction lower third and middle third. History stress fracture, stress reaction or signs of shin splints: The posterior cortex of the mid tibial diaphysis subjectively appears slightly thickened, but this may simply represent normal anatomy for this patient as I see no periosteal edema or marrow edema to indicate stress fracture, stress reaction, or "shin splints". The musculature of the leg appears normal. I see no specific findings to account for the patient's pain.

Output: No signal abnormality to suggest stress fracture, stress reaction, or "shin splints". I see no specific findings to account for the patient's pain.


Instruction: Generate impression based on findings.

Input: Female, 60 years old, with severe back pain and difficulty with ambulation. A grade 1 retrolisthesis of L5 relative to S1 is seen, and there is also a grade 1 anterolisthesis of L4 relative to L5. Vertebral body heights are preserved. Marrow signal characteristics are within normal limits.The visualized distal spinal cord and conus are within normal limits. Details of the cauda equina are discussed below. Prominence of the dorsal epidural fat is seen beginning at T12 and continuing through L4. Otherwise, no epidural abnormalities are identified.T11-12 and T12-L1: Mild disc bulging. No significant compromise of the spinal canal or neural foramina.L1-2: Mild facet arthropathy. Ligamentum flavum thickening. Disc bulging. Mild spinal canal stenosis with slight crowding of the cauda equina. No significant foraminal narrowing. L2-3: Facet arthropathy. Ligamentum flavum thickening. Disc bulging with a right paracentral superiorly directed extrusion. Severe spinal canal stenosis with crowding and likely impingement of the cauda equina. Mild bilateral foraminal narrowing. L3-4: Facet arthropathy. Ligamentum flavum thickening. Disc bulging. Moderate spinal canal stenosis. Mild bilateral foraminal narrowing. L4-5: Advanced facet arthropathy. Disc bulging and disc uncovering. Severe spinal canal stenosis with crowding and probably impingement of the cauda equina. Mild bilateral foraminal narrowing. L5-S1: Evidence of left laminotomy is seen. Advanced facet arthropathy. Disc bulging and osteophytic ridging. Moderate spinal canal narrowing particularly affecting the left lateral recess where there may be a disc protrusion, scarring or focal osteophytic ridging. The left S1 nerve root is potentially impinged. Moderate bilateral foraminal narrowing.

Output: Multilevel level disc and posterior element degeneration. This results in severe spinal canal stenosis at L2-3, moderate stenosis at L3-4, and severe stenosis at L4-5. At L5-S1, there is evidence of prior surgery. The left lateral recess is effaced with possible impingement of the S1 nerve root.


Instruction: Generate impression based on findings.

Input: 32 year old female with palpable mass right breast 12:00 position, biopsy-proven fibroadenoma. There is extreme amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.Right breast: Large lobulated homogenously enhancing mass in right breast 12:00 position currently measures 16 x 20 x 18 mm, previously 15 x 15 x 17 mm (AP X ML X SI). There is clip artifact along the medial aspect of this mass. Two anterosuperior small adjacent satellites measure 6 and 8 mm each, previously 5 and 7 mm, and an adjacent posterior satellite measuring 6 mm, previously 4 mm, are noted. The mass abuts the pectoralis muscle. In right breast 8:00 position there is a lobular mass with homogenous enhancement that currently measures 15 x 10 x 14 mm, previously 15 x 9 x 12 mm (AP X ML X SI), and is located 1 cm inferolateral to the above mentioned palpable mass.Left breast: A round homogenously enhancing mass in left breast 10:00 position currently measures 6 x 7 x 7 mm, previously 6 x 6 x 9 mm (AP X ML X SI). Multiple enhancing foci seen in left breast, stable. Axillae: No abnormal lymph nodes are identified in either axilla.

Output: Stable known fibroadenomas bilaterally. Recommend ultrasound in one year to confirm stability.BIRADS: 2 - Benign finding.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Reason: evaluate for etiology of ulnar sided wrist pain History: ulnar sided wrist pain, no trauma LIGAMENTS: The scapholunate and lunotriquetral ligaments appear intact. No intra-articular gadolinium traverses either ligament nor is there any contrast identified within the mid carpal joint on T1-weighted images.TRIANGULAR FIBROCARTILAGE COMPLEX: The triangular fibrocartilage complex appears intact. There is no intra-articular gadolinium extension into the distal radioulnar joint to suggest a tear. There is a small amount of fluid within the distal radioulnar joint which is of questionable clinical significance.TENDONS: The flexor and extensor tendons appear intact. BONES: No bone marrow signal abnormality is identified.ADDITIONAL

Output: No findings to account for the patient's pain. The triangular fibrocartilage complex appears intact. No findings to suggest scapholunate or lunotriquetral ligament disruption.


Instruction: Generate impression based on findings.

Input: 55 year-old woman with sickle cell disease, mild pulmonary hypertension with exercise associated hypoxia, diastolic dysfunction and renal disease. Resting echocardiogram suggested mildly reduced LVEF and wall motion abnormalities. Stress MRI ordered to rule out ischemia and to assess for iron overload MEDICATIONS: ASA and Furosemide First Pass PerfusionDuring hyperemia, no perfusion defects were present. Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable.Left VentricleThe left ventricle is moderate-severely dilated with low normal systolic function. The overall LV ejection fraction is 53%, the LV end diastolic volume index is 119 ml/m2 (normal range: 65+/-11), the LVEDV is 200 ml (normal range 109+/-23), the LV end systolic volume index is 56 ml/m2 (normal range 18+/-5), the LVESV is 93 ml (normal range 31+/-10), the LV mass index is 86 g/m2, and the LV mass is 144 g. There tardokinesis of the basal inferior and inferolateral walls. T2* (myocardium) = 43ms. T2* (liver) = 4.6 ms.Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is is mildly dilated with normal systolic function. The overall RV ejection fraction is 62%, the RV end diastolic volume index is 109 ml/m2 (normal range 69+/-14), the RVEDV is 183 ml (normal range 110+/-24), the RV end systolic volume index is 41 ml/m2 (normal range 22+/-8), and the RVESV is 69 ml (normal range 35+/-13). Right AtriumThe right atrium is mildly dilated. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is mild pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThere is evidence of iron overload in the liver. Interstitial changes noted in both lungs. There is axillary adenopathy. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. No perfusion defects/ "ischemia" present during hyperemia.2. No prior myocardial infarction. The entire myocardium is viable.3. Moderate-severely dilated LV with low normal systolic function (LVEF 53%). There tardokinesis of the basal inferior and inferolateral walls. 4. T2* (myocardium) = 43ms. T2* (liver) = 4.6 ms. This is consistent with iron overload of the liver but no evidence of myocardial iron overload.5. Mildly dilated RV with normal systolic function (RVEF 62%).6. Moderately dilated left atrium. Mildly dilated right atrium.


Instruction: Generate impression based on findings.

Input: Pain and swelling, history of MVA. MENISCI: There is a radial tear of the body of the lateral meniscus. The tear itself does not appear to extend through the entire width of the meniscus; however, it may communicate with an intrameniscal cyst within the body and anterior horn of the meniscus, which in turn communicates with a large para-meniscal cyst that extends along the entire anterior horn and body of the meniscus, deep to the iliotibial band and lateral collateral ligament proper. This para-meniscal cyst measures approximately 6 cm in oblique AP dimension and is approximately 1 cm in width at the joint line adjacent to the meniscal body. The medial meniscus appears intact.ARTICULAR CARTILAGE AND BONE: The articular cartilage appears intact. I see no bone marrow abnormalities.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: Incomplete radial tear of the body of the lateral meniscus, which may communicate with an intrameniscal cyst that in turn communicates with a large para-meniscal cyst, as described above.


Instruction: Generate impression based on findings.

Input: Possible unilateral facet fusion and spinal stenosis on MRI in 2010: back pain. There is right hemilumbarization of S1. There is straightening of the lumbar spine alignment in the sagittal plane, but no evidence of spondylolisthesis. There is mild loss of disc space height and fluid signal at L4-5 and L5-S1 associated with mild disc bulges and facet hypertrophy that results in up to moderate spinal canal and mild bilateral neural foraminal narrowing at L5-S1. The vertebral body heights are preserved. There is patchy fatty infiltration the bone marrow of the lower lumbar vertebrae. The imaged portions of the spinal cord are unremarkable. The paravertebral soft tissues are unremarkable.

Output: 1. Right hemilumbarization of S1. 2. Degenerative spondylosis in the lower lumbar spine with up to moderate spinal canal and mild bilateral neural foraminal narrowing at L5-S1.


Instruction: Generate impression based on findings.

Input: There are scattered foci of T2 hyperintensity within periventricular and subcortical white matter without mass effect or restricted diffusion. There are also 7-8 scattered foci of susceptibility hypointensity which do not reside in locations of T2 hyperintensity. The ventricles and sulci are unremarkable. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. Fluid is present within left mastoid air cells. The paranasal sinuses and right mastoid air cells are clear. There is no abnormal enhancement within the brain. Note is made of cervical spondylosis involving the upper cervical spine with probable mild central stenosis at C4/5 and C5/6.

Output: 1.There are scattered foci of T2 hyperintensity within periventricular and subcortical white matter without mass effect or restricted diffusion most likely representing chronic small vessel ischemic disease. 2.There are also 7-8 scattered foci of susceptibility hypointensity which do not reside in locations of T2 hyperintensity and thus most likely represent remote microhemorrhages of uncertain etiology.3.Fluid is present within left mastoid air cells.4.Note is made of cervical spondylosis involving the upper cervical spine with probable mild central stenosis at C4/5 and C5/6. If the patient has symptoms referable to the cervical spine, an MRI could further characterize these stenoses, if deemed clinically beneficial.


Instruction: Generate impression based on findings.

Input: MRI thoracic spine: There is no evidence of abnormal enhancement in the spinal cord. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The paravertebral soft tissues are unremarkable.MRI lumbar spine: The spinal cord displays normal signal signal and morphology, without abnormal enhancement. However, there are partially imaged fusiform enhancing lesions involving multiple sacral nerve roots, the largest of which measures 15 mm in diameter in the left S2-3 neural foramen. There is mild anterolisthesis of L4 on L5, where a disc bulge in conjunction with posterior element hypertrophy results in marked spinal canal stenosis and bilateral neural foraminal stenosis. There is also a central disc extrusion at L1-2 and a small disc bulge at L5-S1, which results in mild spinal canal and mild right and moderate left neural foraminal stenosis. The vertebral body heights are preserved. The vertebral bone marrow signal is unremarkable.

Output: 1. No evidence of enhancing lesions in the thoracic and lumbar spinal cord.2. Multiple partially imaged fusiform enhancing lesions involving multiple sacral nerve roots may represent inflammatory demyelinating polyneuropathy or peripheral nerve sheath tumors.3. Multilevel degenerative spondylosis of the lumbar spine, which is most pronounced at L4-5.


Instruction: Generate impression based on findings.

Input: 18 years Female (DOB:8/22/1997)Reason: Please evaluate for acute transverse myelitis History: weaknessPROVIDER/ATTENDING NAME: EBELE N CHINWUBA ENZO J GARCIA MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a T2 signal hyperintense lesion present in the right paramedian genu of the corpus callosum measuring 8 x 11 mm axial dimensions. This was not present on the 4/8/2016 exam. It is not associated with diffusion restriction.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. This cervical spinal cord is enlarged with a posterior and centrally centered signal hyperintensity from the level of the medulla inferiorly into the thoracic cord down to the T3 level. This appears to be slightly more extensive on the current versus the prior exam.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.Thoracic spine:The thoracic vertebral bodies are appropriate in the overall alignment and height. There is no compromise of thoracic spinal canal or exiting nerve roots. There is extension of signal hyperintensity within the central portion of the spinal cord from the visualized cervical cord down to the T3 level. There is more subtle cord enlargement and a 5 x 2 mm sagittal dimension signal hyperintensity at the T11 level along the posterior aspect of the spinal cord. Another smaller T2 hyperintense lesions present within the posterior aspect of the thoracic spinal cord at the T10 level measuring 4 mm x 1 mm sagittal dimensions.Lumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. At L5-S1 there is no significant compromise to spinal canal or neural foramina.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.There is fluid within the uterus.

Output: 1.There is abnormal signal and enlargement of the cervical spinal cord which is suspected represent an inflammatory myelitis. This has mildly progressed when compared to the prior exam.2.A couple small lesions are present in the distal thoracic spinal cord. These are nonspecific and unchanged since the prior exam. One possibility is that these are foci of demyelination given the patient's clinical history.3.There is a new lesion present within the genu of the corpus callosum. This is nonspecific but could represent a focus of demyelination given the patient's clinical history.


Instruction: Generate impression based on findings.

Input: Elevated PSA. No pathology report available. PELVIS:PROSTATE:Prostate Size: 4.8 x 6.7 x 6.1 cmPeripheral Zone: The peripheral zone is relatively thinned due to the patient's benign prostatic hyperplasia. There is a 6 mm focus of ADC abnormality (series 603/4 84) in the right medial mid-gland with subtle associated mild T2-weighted hypointensity.Central Gland: Changes of benign prostatic hyperplasia.Seminal Vesicles: No evidence of seminal vesicle invasionExtracapsular Extension: No evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.6 mm abnormal focus in the medial right mid gland peripheral zone may represent a site of prostatic adenocarcinoma.2.No extraprostatic extension of tumor.


Instruction: Generate impression based on findings.

Input: Male; 35 years old. Reason: CD, perianal abscess History: Perianal pain PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Subcentimeter but rounded perirectal lymph nodes are most likely reactive. These nodes are not pathologically enlarged by size criteria.BOWEL, MESENTERY: Mild submucosal fat deposition in the visualized rectosigmoid colon, similar to prior CT and most compatible with chronic inflammatory bowel disease changes. No evidence of active inflammatory bowel disease.BONES, SOFT TISSUES: There is a thin, curvilinear tract of high T2 signal with enhancement extending from the left proximal anus at the 3 o'clock position to the skin surface at the left medial gluteal cleft, most compatible with perianal fistula (series 7/65-88). There is a small, thin focus of high T2 signal extending anteriorly from the right proximal anus at the 11 o'clock position, with appearance most suspicious for blind-ending sinus tract (series 4/35). No evidence of perianal abscess.OTHER: No significant abnormality noted.

Output: 1. Left-sided perianal fistula as detailed above. Probable right-sided perianal sinus tract. No perianal abscess.2. No active inflammatory bowel disease.


Instruction: Generate impression based on findings.

Input: 65-year-old female with new daily headaches and nausea. Possible abnormality on head CT. Brain parenchyma appears within normal limits for age. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size. Left lateral ventricle is minimally larger compared to the right with slight coaptation involving the right frontal horn surfaces, finding which is a normal variant. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: MRI of the brain is within normal limits. No evidence of ischemia, intracranial mass, or abnormal enhancement.


Instruction: Generate impression based on findings.

Input: Clinical question: Chronic headache, history of left mastoidectomy. Signs and symptoms: Chronic headaches. Pre-and post-enhanced brain MRI:Unremarkable diffusion weighted series.Examination demonstrates a normal anatomical development/morphology brain parenchyma. There is normal signal intensity brain parenchyma on all MRI sequences. Unremarkable cortex, cortical sulci, ventricular system, CSF spaces and brain myelination.Post enhanced images are negative for any abnormal parenchymal, leptomeningeal or calvarial enhancement. There is however a visualization of enhancement of the right frontal small developmental venous anomaly without interval change since prior exam.There is interval significant improvement of post operative changes are left-sided mastoidectomy.Normal signal intensity of all paranasal sinuses, right mastoid air cells and bilateral middle ear cavities. Pre-and post enhanced MRV:The examination demonstrates normal intracranial venous sinuses without evidence of abnormal caliber or in the regions of concern. Bilateral internal cerebral veins, vein of Galen, bilateral veins of Labbe and overall the entire superficial cortical veins remain within normal.

Output: 1.Pre-and post enhanced brain MRI demonstrate no evidence of any acute or new finding since prior exam. Unremarkable exam and with revisualization of a small right frontal mental venous anomaly. Interval improvement of post operative changes left mastoidectomy.2.Negative for pre-and post enhanced MRV.


Instruction: Generate impression based on findings.

Input: History of pituitary adenoma. Status post radiation treatment. Visual field defect. There are changes of previous transsphenoidal surgery. The contrast-enhancing sellar mass has increased in size since the previous examination, measuring craniocaudally 16 mm compared to 13 mm previously, while it otherwise remains unchanged measuring 21 mm anteroposteriorly and 15 mm in transverse. There is focal subtle relative T1 shortening in the left superior lateral aspect of the mass which correlates with poor contrast enhancement. This is new since the previous examination and may represent hemorrhage within the mass.The mass now abuts the right prechiasmatic optic nerve as it passes underneath the right A1 segment. The optic apparatus remains mildly deformed, with unchanged increased T2 signal abnormality within the right optic nerve. The pituitary infundibulum is displaced to the left and the mass only partially encases the horizontal cavernous segment of the right internal carotid artery by 180 degrees, which is unchanged.Limited images of the brain demonstrate no evidence of acute ischemia. There is perhaps very mild restriction in the area of the known adenoma. Scattered foci of T2 signal abnormality in the periventricular and subcortical white matter likely represent chronic small vessel ischemic disease given the patient's age. There is minimal mucosal thickening in the paranasal sinuses which is nonspecific.

Output: 1.Minimal increase in the size of the pituitary adenoma since March 2015 examination with increased upper margin convexity, now abutting the optic apparatus. This may, at least in part, relate to interval mild subacute hemorrhage within the mass as described above.2.Other post treatment findings remain unchanged.


Instruction: Generate impression based on findings.

Input: Clinical question: Numbness in left hand. Signs and symptoms: Numbness in left hand. Unenhanced cervical MRI:There is normal anatomical alignment of the home. There is unremarkable signal intensity of the vertebral column other than changes related to degenerative disease.There is normal signal intensity and caliber of the cervical and uppermost visualized thoracic cord.Foramen magnum is unremarkable.C2 -- C3 demonstrate mild degenerative changes resulting in mild right neural foramina. There is a tiny centrally located disk protrusion which partially effaces the ventral subarachnoid space thereC3 -- C4 demonstrate mild degenerative disk disease and mild facet and ligamentum flavum hypertrophy. There is a tiny central disk protrusion is appreciated on axial T2 series 5 image 17. There is mild bilateral (right greater than left) neural foraminal compromise and no central spinal stenosis.C4 -- C5 demonstrate moderate disk disease and loss of disk height and mild (left greater than right) ligamentum flavum hypertrophy. Changes result in moderate left neural foramina compromise and no central spinal stenosis.C5 -- C6 demonstrate moderate disk disease and loss of disk height, mild (left greater than right) ligamentum flavum hypertrophy and mild (greater than right) facet degenerative changes. Changes results in moderate to severe bilateral neural foraminal compromise and no central spinal stenosis.C6 -- C7 demonstrate moderate to advanced disk disease and loss of disk height, mild facet and ligamentum flavum hypertrophy. Changes results in significant bilateral (right greater than left) neural foraminal compromise and mild central spinal stenosis.C7 -- T1 demonstrate mild degenerative changes which results in moderate left neural foramina compromise and unremarkable otherwise.

Output: 1.Degenerative changes of the cervical spine results in multilevel bilateral neural foraminal compromise (some significantly) as detailed per level above. There is mild central spinal stenosis at C6 -- C7 level.2.There is normal signal intensity and caliber of the cervical and uppermost visualized thoracic cord.


Instruction: Generate impression based on findings.

Input: Neurofibromatosis type II. New daily persistent headache. The study is mildly to moderately limited by patient motion.BRAIN:There are postoperative findings related to right frontal meningioma resection. In addition, there has been chronic evolution of the associated right frontal infarct, developing into encephalomalacia and associated ex vacuo enlargement of the frontal horn of the right lateral ventricle. An irregular band of contrast enhancement along the surgical margin, superficial to the infarct and deep to the craniotomy flap, is slightly more pronounced. There is minimal dural thickening underlying the craniotomy flap with trace residual extra-axial fluid. The soft tissue nodule in the left lateral ventricular atrium is unchanged, measures up to 15 mm, and may represent a small meningioma. The left frontal lobe parafalcine meningioma with suggestion of involvement of the anterior part of the superior sagittal sinus is unchanged as well as the associated involvement of the inner table of the skull. The dural sinuses are otherwise patent. The smaller meningioma involving the right greater wing of the sphenoid is unchanged.The contrast-enhancing mass along the cisternal segment of the left trigeminal nerve is unchanged, compatible with a schwannoma. Also, the contrast-enhancing masses involving the internal auditory canals/cerebellopontine angle cisterns are not significantly changed with the larger right one measuring up to 2.6 cm x 1.5 cm compared to 2.5 cm x 1.5 cm previously. The tiny contrast-enhancing nodule along the left cerebellomedullary junction is unchanged.The subcortical T2-hyperintensity in the medial aspect of the right frontal lobe is unchanged. In addition to the above-described ex vacuo enlargement of the frontal horn of the right lateral ventricle, the ventricular system is slightly larger than on the prior examination but there is no transependymal edema.There are findings related to previous posterior fossa surgeries. The right maxillary sinus is significantly smaller which might reflect prior chronic sinusitis or trauma. The orbits are grossly unremarkable.CERVICAL SPINE:The central, contrast-enhancing spinal cord lesion at C1-C2 level which measures up to 8 mm is unchanged. Also, the associated surrounding T2-hyperintensity and cord expansion are is unchanged. The cervical spinal alignment is preserved. There is no significant spinal canal stenosis. There are shallow ventral indentations of the thecal sac by the disc-osteophyte complexes, which is unchanged. There are numerous small soft tissue nodules on both sides of the neck, which follow the expected distribution of lymph nodes. THORACIC SPINE:There is incomplete fusion with minimal associated kyphosis between T10 and T11 vertebral bodies. The respective facets are poorly developed. The spinal cord assumes mild but sharp angulation at this level which is associated with mild expansion of the central canal. These findings are unchanged since the previous examination. There is no abnormal spinal cord signal, otherwise. The spinal canal is also otherwise preserved. The vertebral bodies are preserved in height and there is no suspicious marrow signal abnormality. Multiple contrast-enhancing nodules are present along the surface of the caudal thoracic spinal cord and along the cauda equina roots, as described below.LUMBAR SPINE:Of note, there is a variant segmentation with partial sacralization of L5. Numerous intradural, extramedullary contrast-enhancing nodules on the surface of the caudal spinal cord and along the cauda equina roots are grossly unchanged since the previous examination. The largest measures up to 7 mm and is present on the left side of the conus at T11-T12 level.The vertebral bodies are preserved in alignment and morphology and there is no suspicious marrow lesion. The spinal canal is also preserved. There is mild degenerative disc bulge at L4-L5 associated with mild biforaminal stenosis.Small mildly T1-hyperintense, T2-hyperintense lesion in the right kidney is unchanged since the previous examination.Focal expansion of the right S1 nerve root with associated expansion of the sacral foramina remain unchanged.

Output: 1.Expected evolution of the now chronic right frontal encephalomalacia and other postoperative changes.2.The contrast enhancement along the right frontal resection margin, superficial to the infarct and deep to the craniotomy flap, is more pronounced compared to the previous examination. Continued follow-up is recommended.3.Other stigmata of neurofibromatosis type II including meningiomas and schwannomas remain unchanged.4.Intramedullary upper cervical spinal lesion is unchanged and may represent ependymoma. 5.Multiple grossly stable contrast-enhancing intradural, extramedullary lesions along the surface of the distal spinal cord and cauda equina are also not grossly changed since the previous examination.6.Small right kidney lesion with atypical signal characteristics can be better assessed by ultrasound but could represent a proteinaceous/hemorrhagic cyst.


Instruction: Generate impression based on findings.

Input: Limited MRI of the brain for pre-op planning demonstrates no intracranial mass. There are unchanged scattered punctate foci of high T2 foci in the cerebral white matter that likely represent chronic small vessel ischemic change. There is no abnormal intracranial enhancement. 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. There is minimal mucosal thickening of the bilateral frontal, ethmoid and sphenoid sinuses. There are scattered subcentimeter T2 hyperintense foci within the bilateral parotid glands, left greater than right.

Output: 1. Limited MRI of the brain for pre-surgical planning.2. Scattered incompletely characterized T2 hyperintense lesions within the bilateral parotid glands, left greater than right, which may represent benign lymphoepithelial lesions in the setting of HIV, Sjogren's disease or Warthin's tumor. Please correlate clinically.


Instruction: Generate impression based on findings.

Input: 53 year-old female. Cirrhosis. Screen for HCC. ABDOMEN:LIVER, BILIARY TRACT: Liver contour: Nodular with widened fissures consistent with a cirrhotic morphology. Features of portal hypertension: Esophageal varices, ascites, and mild splenomegaly. Portal vein: Diffuse mild attenuation of the intrahepatic portal vein with maintained patency. Hepatic veins: Patent.Hepatic artery: Patent.Heterogenous diffuse arterial enhancement of the peripheral right hepatic lobe, likely a perfusion abnormality. No focal arterially enhancing mass with washout to suggest HCC. SPLEEN: Mild splenomegaly measuring 12.6 cm.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: Diffuse small bowel dilatation, favored to be from an ileus, though incompletely evaluated as the pelvis is not imaged.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Large amount of abdominal ascites. Nonspecific subcentimeter focus of diffusion restriction in the region of the right rib cage in the upper abdomen (series 708, image 608); no correlating abnormality on other sequences.

Output: 1. No suspicious hepatic mass. Cirrhotic liver and findings consistent with portal hypertension.2. Nonspecific subcentimeter focus of diffusion restriction along the right lower rib cage, of unclear etiology, special attention on follow-up exams to confirm stability.


Instruction: Generate impression based on findings.

Input: 59-year-old male with medial joint line pain, McMurray's sign, knee effusion. Evaluate for medial meniscus tear. MENISCI: No evidence of a meniscal tear.ARTICULAR CARTILAGE AND BONE: No bone marrow edema. There is generalized thinning of the hyaline cartilage of the undersurface of the patella. The medial and lateral femoral fibrocartilage compartments are intact.LIGAMENTS: The cruciate and collateral ligaments are intact.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: Small knee joint effusion without evidence of a meniscal tear or ligamentous injury.


Instruction: Generate impression based on findings.

Input: 76-year-old woman with INR greater than 15.2 who presents status post fall. There is no evidence of intracranial hemorrhage or mass. Old left occipital and left cerebellar strokes with relative sparing of the medial temporal lobe. Ex vacuo dilatation of the ventricles consistent with ischemic volume loss. No cortical stroke. Extensive small vessel disease anteriorly, age indeterminate. If there is clinical concern for acute ischemia, an MRI may be considered. The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Chronic ischemic changes as described above. If there is clinical concern for acute ischemia, an MRI may be considered.


Instruction: Generate impression based on findings.

Input: Male 66 years old; Reason: Assess for bone metastases and progression History: Back pain Neck: Abnormal signal in the cervical spine suggestive of metastatic disease. No compression fracture is evident.Chest: Heart size is normal. No pericardial effusion. No mediastinal lymphadenopathy. Signal abnormality throughout the thoracic spine compatible with metastatic disease.Abdomen: Liver is normal in morphology. No biliary ductal dilatation. Spleen is normal in size.Adrenal glands are unremarkable.There is a cyst at the lower pole of the right kidney. Complex cystic mass in the lower pole of the left kidney measures 6.7 x 5.8 cm.There are small retroperitoneal lymph nodes. Small bowel is normal in caliber.Pelvis: Multiple foci of signal abnormality within the bony pelvis compatible with metastatic disease. There are similar foci within the proximal femora.

Output: 1.Multiple bony metastatic foci throughout the vertebral bodies , pelvis and proximal femora.2.Complex cystic left renal mass.


Instruction: Generate impression based on findings.

Input: Myelination is normal for age. Ventricular size is normal. No midline shift. No evidence of bleed, mass effect, or edema. There is no abnormal signal in the T2 and FLAIR images.There are no evidence of acute ischemic or hemorrhagic lesion on this scan.Flow voids of the cerebral and the visualized internal carotid arteries are within normal limits.

Output: No evidence of acute ischemic or hemorrhagic lesion on this scan.


Instruction: Generate impression based on findings.

Input: 53-year-old man with history of ischemic cardiomyopathy. Evaluate for viability. Left VentricleThere is moderate left ventricular enlargement with global moderate reduction in left ventricular ejection fraction with regional variation. Akinesis versus dyskinesis of the left ventricular apex. Relative thinning of the mid anterior, lateral, and inferior walls of the left ventricle as well as the apex of the left ventricle. There is late gadolinium enhancement within the LV myocardium: 1.Essentially transmural at the LV apex2. Up to 50% of the subendocardial LV wall thickness in the apical septal, inferior, and lateral walls3. Clearly less than 50% of the subendocardial LV wall thickness in the mid lateral wall.Small thrombus is noted at the apex of the left ventricle.Left AtriumThe left atrium is normal in size.. Right VentricleThe right ventricle is normal in size and functionRight AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsNo significant extracardiac findings. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. There is late gadolinium enhancement within the LV myocardium consistent with previous myocardial infarct: a. Essentially transmural at the LV apexb. Up to 50% of the subendocardial LV wall thickness in the apical septal, inferior, and .lateral wallsc. Clearly less than 50% of the subendocardial LV wall thickness in the mid lateral wall.2. Moderate left ventricular enlargement with global moderate reduction in left ventricular ejection fraction with regional variation. Akinesis versus dyskinesis of the left ventricular apex. 3. Relative thinning of the mid anterior, lateral, and inferior walls of the left ventricle as well as the apex of the left ventricle. 4. Small thrombus noted at the LV apex, as noted on recent echocardiogram.An addendum will be made to this report once quantitative measurements of the right ventricle and left ventricle are available.


Instruction: Generate impression based on findings.

Input: 12 years, Female, seizure. Brain parenchyma appears within normal limits. No intracranial mass or mass effect. No appreciable cortical dysplasia, gray matter heterotopia, or other findings to suggest seizure focus. Bilateral hippocampi are symmetric in size, signal characteristics, and with preserved internal architecture. No evidence of infarct or hemorrhage. Ventricles and sulci are within normal limits. Calvarium and extracranial soft tissues are grossly unremarkable.

Output: Examination appears within normal limits. No findings to suggest seizure focus are appreciated.


Instruction: Generate impression based on findings.

Input: Left tonsil cancer treated with induction chemotherapy: the recent CT was limited by dental artifact. Need to reevaluate oropharyngeal area for response. There is marked decrease in size of the left tonsil mass compared with the pre-induction CT. Indeed, the treated tumor now measures up to approximately 10 mm. There is no significant lymphadenopathy in the neck. The thyroid and major salivary glands are unremarkable. There is a left cerebellomedullary angle arachnoid cyst that measures up to 18 mm, with mild mass effect upon adjacent structures. There is mild bilateral maxillary sinus mucosal thickening. The orbits are unremarkable. There is a right apical lobe patchy consolidation and left apex tree-in-bud nodularity.

Output: 1. Marked decrease in size of the left tonsil mass compared with the pre-induction CT. Indeed, the treated tumor now measures up to approximately 10 mm. 2. No significant lymphadenopathy in the neck.3. A left cerebellomedullary angle arachnoid cyst measures up to 18 mm, with mild mass effect upon adjacent structures. 4. Right apical lobe patchy consolidation and left apex tree-in-bud nodularity may be related to sarcoidosis. Please refer to the recent chest CT report for additional details.


Instruction: Generate impression based on findings.

Input: Ms.Narine Kakosyan, 63 years old, submitted outside study for review. Patient is a BRCA2 gene carrier. She is asymptomatic.Images performed at Northwestern Medical Center submitted for review: MRI breast 6/13/2016Images submitted for comparison:None Multisequence MRI breast imaging with and without intravenous contrast ( 6 cc Gadavist) was performed as per outside MRI breast protocol. The breasts are composed of heterogeneous fibroglandular tissue. There is mild background parenchymal enhancement bilaterally. Kinetic analysis of these images was not possible. RIGHT BREAST:In the right breast, 3:00 position, approximately 3.5 cm from the nipple, there is a nonmass enhancement measuring 2.5 x 1 x 1.8 cm (AP x LR x SI). No additional suspicious enhancement is identified in the right breast.LEFT BREAST:No suspicious enhancement in the left breast.AXILLAE: No suspicious axillary lymph node.

Output: RIGHT BREAST: A 2.5 cm nonmass enhancement in the right medial breast, 3:00 position. MRI guided biopsy is recommended for tissue diagnosisLEFT BREAST:No MRI evidence of malignancyBIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for intracranial bleed and or obstructive hydrocephalus. No schizencephaly. Signs and symptoms: Emesis, irritability, I and head deviation to the left. CT of brain without infusion:There is significant interval increase in the size of fourth ventricle since prior examination. Prior MRI demonstrated normal size of the fourth ventricle. On the current exam expanded fourth ventricle upright mass effect on the pons and causes significant deformity of the quadrigeminal plate and appears to extend across the tentorium into the supra-tentorial space. Significant congenital deformity of bilateral schizencephaly with extensive extra axial CSF collection is again identified. There is bilateral larger extension of CSF into the extra-axial space with associated mass effect on the brain parenchyma since prior study.No evidence of hemorrhage is detected. Linear very high density material along the ependymal lining of the left temporal horn and occipital horn of the lateral ventricle are present calcification. These findings were noted on prior exam.

Output: 1.Significant interval enlargement of fourth ventricle since prior study.2.Larger amount of CSF in the extra-axial space with further increased mass effect on the brain parenchyma.3.Microcalcifications along the ependymal lining of the left lateral ventricle stable since prior study.4.No evidence of intracranial hemorrhage as clinically questioned.