Instruction: Generate impression based on findings.

Input: 41-year-old male with phase vasculitis, hypertension, drug abuse, and chronic pancreatitis status post pancreatic stent in November 2014. Presents with abdominal pain and acute kidney injury and likely acute on chronic pancreatitis. Markedly limited study due to extensive motion artifact on MRCP sequences. Patient refused additional sequences.ABDOMEN:LUNG BASES: Cardiomegaly.LIVER, BILIARY TRACT: No significant abnormality noted. No focal hepatic lesions. No biliary ductal dilation.SPLEEN: No significant abnormality noted. PANCREAS: Moderate parenchymal atrophy and diffusely decreased T1 signal intensity compatible with chronic pancreatitis. There is a new 2.7 cm ovoid cystic lesion in the uncinate process, likely representing a acute pancreatic fluid collection/pseudocyst depending on the timeframe of patients symptoms. The pancreatic duct is irregular and dilated up to 8 mm, unchanged. No pancreatic soft tissue mass is identified. There is a small amount of peripancreatic fluid near the tail, without associated loculation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts. Otherwise, no abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1.Chronic pancreatitis with a small amount of peripancreatic fluid at the tail, likely representing concurrent acute pancreatitis.2.New cystic lesion in the uncinate process compatible with an acute pancreatic fluid collection/psuedocyst (based on revised Atlanta classification), depending on timeframe of patients symptoms.


Instruction: Generate impression based on findings.

Input: Achondroplasia. Brain: There are stigmata of achondroplasia involving the skull, including frontal bossing, hypoplasia of the skull base, and narrowing of the foramen magnum, which measures a minimum of 9 mm in the anteroposterior dimension. However, there is no compression of the cervicomedullary structures and cerebrospinal flow is preserved anteriorly across the foramen magnum. There is susceptibility effect in the bilateral occipital lobe peritrigonal white matter, as well as gyriform or sulcal susceptibility effect in the occipital lobe. There is no evidence of intracranial mass or acute infarct. There are prominent subarachnoid spaces overlying the bilateral frontal convexities and the ventricular system is borderline prominent, along with a cavum velum interpositum. There is no midline shift or herniation. The major cerebral flow voids are grossly intact. The orbits, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Cervical Spine: There is diffuse congenital narrowing of the cervical spinal canal, but no compression of 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. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: 1. Stigmata of achondroplasia involving the skull with foramen magnum stenosis, but no compression of the cervicomedullary structures.2. Prominent subarachnoid spaces overlying the bilateral frontal convexities and the ventricular system is borderline prominent, which could indicate underlying impedence to cerebrospinal fluid resorption.3. Susceptibility effect in the bilateral occipital lobe peritrigonal white matter, as well as gyriform or sulcal susceptibility effect in the occipital lobe likely represents sequela of remote hemorrhage.


Instruction: Generate impression based on findings.

Input: Clinical question: Neck pain. Signs and symptoms: Neck pain. Nonenhanced cervical MRI:Images at the level of foramen magnum demonstrate herniation of the cerebellar tonsils are approximately 11.5 mm with expected flattening deformity of the tonsils and effacement of subarachnoid space. Finding consistent with Chiari malformation.There is also moderately expansile syrinx involving the entire cervical cord and extending to the upper most visualized thoracic cord to T5 level. Follow-up with dedicated MRI of thoracic and lumbar spine is recommended for further assessment.The syrinx is more expanded from C3-C4 disc level to C6-C7 disc level. It measures maximum of approximately 10 x 5.7 mm in transaxial dimensions at C5-C6 disc level. The signal intensity of the expanded cord beyond the syrinx remains within normal.The signal intensity and alignment of vertebral column is unremarkable and there is no evidence of spinal canal or neural foraminal compromise at any level.

Output: 1.Chiari malformation with 11.5 mm herniation of cerebellar tonsils and expected flattening deformity of the tonsil and effacement of subarachnoid space.2.Syrinx of entire cervical cord and extending to the upper most visualized thoracic spine to T5 level as detailed/measured above.3.Follow-up with MRI of thoracic and lumbar spine and CSF flow study at the level of foramen magnum is recommended.


Instruction: Generate impression based on findings.

Input: 22 day old female ex-24 week premature with abnormal head ultrasound. No acute intracranial hemorrhage.Again seen is a low attenuation it least partially extra-axial fluid collection overlying the superior right frontal lobe as was seen on multiple previous sonogram examinations. Additionally there appears to be a low density component within the parenchyma of the right frontal lobe which may reflect a parenchymal component. This collection is causing a mass effect with a left of midline shift of approximately 3 mm. Given the limitations of brain CT in newborns further characterization is limited. MRI could be obtained for further characterization of this abnormality.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. Right frontal extra-axial and intraparenchymal collection causing left of midline shift as detailed above. Given the limitations of brain CT newborns, further characterization could be obtained with MRI.


Instruction: Generate impression based on findings.

Input: 16 day old male evaluate for bleed or mass. Signs and symptoms: Seizure No evidence of hemorrhage, edema, mass-effect, midline shift or hydrocephalus. This examination is essentially within normal limits for patient's stated age of 16 days. Follow-up with an MRI is recommended. Calvarium is unremarkable. Mastoid air cells are been pneumatized.

Output: Negative CT of brain without the infusion.


Instruction: Generate impression based on findings.

Input: Evaluate for focal finding to explain partial epilepsy. Episodes of drooling with right face droop, and nighttime generalized tonic-clonic seizures, EEG previously suggested right central/temporal seizure onset. The hippocampi are unremarkable and there is no evidence of heterotopia. 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, and scalp soft tissues are grossly unremarkable. There is scattered paranasal sinus mucosal thickening.

Output: 1. No discernible seizure foci.2. Findings suggestive of sinusitis.


Instruction: Generate impression based on findings.

Input: Pain in left knee, evaluate meniscus MENISCI: There is blunting of the free edge of the body of the medial meniscus as well as the posterior horn near its root. There is also a defect of the undersurface of the inner half of the posterior horn of the medial meniscus. There is a small focus of low signal intensity situated beneath the periphery of the body of the medial meniscus between the MCL and the underlying tibial plateau. These findings indicate a complex tear of the medial meniscus with displacement of meniscal tissue into the medial gutter. The anterior horn of the medial meniscus appears intact. The lateral meniscus also appears intact.ARTICULAR CARTILAGE AND BONE: There is edema within the medial tibial plateau beneath the torn meniscus. We suspect this is degenerative in etiology although this finding could conceivably represent a developing subchondral stress fracture. We see no fluid-filled articular cartilage defects involving the medial tibiofemoral articular compartment. There is full thickness degeneration of the articular cartilage of the femoral trochlea centrally and inferiorly with a cleft extending through the articular cartilage of the medial facet of the femoral trochlea. There is perhaps mild thinning of the articular cartilage of the patella inferiorly. Mild heterogeneity of the articular cartilage of the lateral tibial plateau posteriorly suggesting mild degeneration.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is within normal limits.ADDITIONAL

Output: Complex tear of the medial meniscus with displaced flap fragment and other findings as described above.


Instruction: Generate impression based on findings.

Input: Female, 8 days old, ex-35 weeker, with prenatal ultrasound concerning for Dandy-Walker malformation, presenting with abnormal leg movements. Sibling with Dandy-Walker. The foramen of Magendie is slightly wide as visualized in the sagittal plane. This can represent normal variation or mild inferior vermian hypoplasia. The vermis is not upturned and the cerebellar hemispheres are normally formed. The posterior fossa is not enlarged.As appreciated in the sagittal plane, the tectum appears mildly prominent and the dorsal pons mildly thinned. These findings are not as conspicuous when viewed in the axial plane.The cerebral hemispheres are fully formed and demonstrate normal gyration for gestational age. No areas of signal abnormality or edema are seen. No generalized mass effect is detected. There are no findings to suggest acute intracranial hemorrhage or any abnormal extra-axial fluid collections. Diffusion-weighted images are within normal limits.The pituitary region is within normal limits. The corpus callosum is fully formed and unremarkable. The pattern of white matter myelination is appropriate or even somewhat advanced for the corrected gestational age.

Output: 1.No evidence of a classic Dandy-Walker malformation is seen. At most, the inferior vermis may be mildly hypoplastic but this could also reflect normal variation.2.As appreciated in the sagittal plane, the tectum appears mildly prominent and the dorsal pons mildly thinned. These findings are not as conspicuous on axial images which calls into question their validity. If real, such findings could reflect a mild midbrain patterning anomaly.3.Cerebral morphology is otherwise unremarkable. No focal or acute lesions are identified.


Instruction: Generate impression based on findings.

Input: Clinical question: Progressive ataxia. Please perform Dr.Javed's multiple sclerosis protocol. Signs and symptoms: Progressive ataxia. Nonenhanced cervical MRI:There is normal signal intensity and alignment of the vertebral column.There is no detectable spinal stenosis or neural foraminal compromise at any level.There is normal signal intensity and caliber of the cervical and upper most visualized thoracic cord. There is no finding to suggest demyelinating disease.Unremarkable images at the level of foramen magnum.

Output: 1.Unremarkable nonenhanced cervical MRI.2.No evidence of demyelinating disease of the cervical or upper most visualized thoracic cord.


Instruction: Generate impression based on findings.

Input: 61-year-old female with history of aneurysm presents with left-sided tingling. There is no evidence of intracranial hemorrhage, mass or edema. Small punctate focus of hyperdensity in posterior parietal cortex with a convexity consistent with cavernoma seen on previous MRI.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Normal brain CT.


Instruction: Generate impression based on findings.

Input: The exam is mildly motion degraded. The right cerebellar tonsil is slightly low-lying without meeting strict criteria for Chiari I malformation. There is no acute infarct, mass effect, or cerebral edema. The ventricles and basal cisterns are normal in size and configuration with slight asymmetric diffuse prominence of the right lateral ventricle as compared to the left, which is felt to be within normal limits of variation. There is no midline shift or herniation. There is trace bilateral maxillary sinus mucosal thickening. There are nonspecific prominent cervical several lymph nodes and posterior nasopharyngeal adenoidal soft tissue, likely reactive in this age group, although correlation with direct inspection is recommended. The skull and extracranial soft tissues are otherwise unremarkable.

Output: Low-lying right cerebellar tonsil without meeting strict criteria for Chiari I malformation. Otherwise, unremarkable exam.


Instruction: Generate impression based on findings.

Input: 72-year-old female with GBM. Expected postoperative findings of right temporal and frontal craniotomy related to subtotal resection of tumor. Within the right temporal lobe there is redemonstration of remaining tumor which demonstrates predominantly T1 hypointense/T2 hyperintense signal with surrounding T2/FLAIR hyperintensity likely representing residual necrotic tumor. There is surrounding T2/FLAIR hyperintensity compatible with vasogenic edema which is decreased in extent from prior study. Post contrast images of tumor demonstrates rim enhancement and the mass measures 4.8 cm x 4.0 cm (series 12, image 17) which is increased in size from prior study. However there is decreased mass effect upon the temporal horn of the right lateral ventricle with decreased effacement of the CSF spaces including the ambient and quadrigeminal cistern.Within the right frontal lobe there is an additional necrotic tumor demonstrating predominantly T1 hypointense signal centrally and heterogeneous T2 signal compatible with necrosis. The tumor demonstrates irregular rim enhancement on postcontrast images and measures 3.0 cm x 1.8 cm (series 12, image 10) minimally decreased from prior study. In the interval a new collection immediately lateral to the tumor has developed which demonstrates predominantly homogeneous T1 and T2/FLAIR hyperintensity with surrounding rim of low T2/FLAIR intensity and no enhancement; this likely represents blood products in the chronic stage and measures 2.6 cm x 2.3 cm (series 12, image 10). There is T2/FLAIR hyperintensity predominantly surrounding the tumor which is decreased in extent from prior study with resultant decrease in mass effect and effacement of the right lateral ventricle; there is a leftward midline shift of 5 mm on the current study, previously 8 mm.On the perfusion images, there is increased signal predominantly along the peripheral posterior lateral aspect of the right temporal lobe lesion and along the peripheral anteromedial aspect of the right frontal lobe lesion. This may represent viable tumor versus compressed brain parenchyma. No increased central signal is identified however within the lesions compatible with necrosis. No new intracranial mass lesions are noted. Scattered subcortical and periventricular white matter T2/hyperintense foci are similar to prior study compatible with chronic small vessel ischemic disease.The paranasal sinuses and mastoid air cells are clear. The orbits are unremarkable.

Output: 1. Mixed interval change in size of intra axial lesions, specifically, slightly increasing size of the necrotic portion of the right temporal lobe however with decreasing mass effect and vasogenic edema and decreased size of the necrotic tumor in the superior aspect of the right basal ganglia with decreasing mass effect and midline shift. 2. There has been interval development of a new collection immediately lateral to the lesion which most likely represents chronic hemorrhage.3. Increased signal on the perfusion images along the peripheral aspect of the lesions may represent viable tumor versus compressed brain parenchyma. There is no increased signal centrally within the lesion compatible with necrosis.


Instruction: Generate impression based on findings.

Input: Epilepsy, unspecified, not intractable, without status epilepticus: Rule out structural lesion. There is no evidence of intracranial hemorrhage or mass. There is no evidence of grey matter heterotopia and the hippocampi are unremarkable, aside from punctate left hippocampal sulcus remnant cysts. The grey-white matter differentiation appears to be intact. The ventricles and basal cisterns are normal in size and configuration. There are scattered prominent perivascular spaces, particularly in the basal ganglia. There is no midline shift or herniation. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No evidence of acute intracranial hemorrhage or mass.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Female, 65 years old, with bilateral hearing loss, right more than left, subacute. Images are distorted by artifact arising from the scalp and from motion. Within this limitation, the following observations are made.No definite evidence of restricted diffusion is seen, though the diffusion weighted images are particularly degraded superiorly.Patchy periventricular T2 hyperintensity is demonstrated in a bilateral symmetric pattern. No mass-effect or parenchymal edema is seen. No evidence of acute intracranial hemorrhage is detected, though again, susceptibility weighted images are particularly degraded.Without the benefit of IV contrast, the internal auditory canals are normal in caliber and the cochleas show relatively normal morphology. The remainder of the inner ear structures are not well appreciated due to artifact. The cranial nerves arising from the brain stem are also not well visualized.

Output: 1. Limited examination due to distortion along the scalp and motion.2. No definite evidence of an acute intracranial abnormality is seen. Patchy white matter signal abnormality is nonspecific but may reflect chronic small vessel ischemic disease.3. Dedicated imaging of the inner ear structures is fairly limited due to the artifact noted above. The internal auditory canals and cochleas seem to be normal. The remainder of the inner ear structures are not adequately visualized, nor are the brainstem cranial nerves.


Instruction: Generate impression based on findings.

Input: Low back pain, evaluate for spinal stenosis. Seven views of the lumbar spine are provided. Alignment is within normal limits. We see no frank instability between neutral, flexion, and extension views. Severe multilevel degenerative disc disease is present throughout the lumbar spine most severe at L4-L5 and L5-S1. Multilevel mild facet joint osteoarthritis is also present. Atherosclerotic calcifications are noted within the abdominal aorta.

Output: Degenerative disc disease as described above.


Instruction: Generate impression based on findings.

Input: Male, 63 years old, with brain tumor, GBM, planning for tumor resection. Left cranial postoperative findings are again seen. A resection cavity within the left superior temporal lobe is unchanged. A nodule of enhancement along the anterior margin of the resection cavity is redemonstrated showing perhaps a slight interval increase in size from the prior examination, now measuring 17 x 15 mm, previously 15 x 12 mm. Contiguous enhancement which extends into the anterior left temporal lobe is unchanged. Somewhat contiguous enhancement which extends posteriorly along the left ventricular atrial margin is slightly more conspicuous as well.Additional enhancing lesions are seen. Ex vacuo dilatation of the left lateral ventricle is unchanged. Incidental hypoplasia of the right cerebral hemisphere is also redemonstrated.

Output: Enhancing nodule along the anterior margin of the left temporal resection cavity, and infiltrative enhancement along the left ventricular atrium, are redemonstrated and appear to be somewhat more conspicuous than on the prior exam. Enhancement within the anterior left temporal lobe is unchanged. Additional postoperative findings are unchanged.


Instruction: Generate impression based on findings.

Input: 48-year-old female with injury to the rotator cuff. ROTATOR CUFF: Again demonstrated is the diffuse thinning of the supraspinatus tendon with fraying/degeneration longitudinally along the inferior aspect, likely representing chronic tearing from prior surgery. However, the proximal aspect of the tendon may be followed to its insertional site and we see no full-thickness tear. Again demonstrated are findings compatible with tendinosis and atrophy, not significantly advanced from prior examination. The infraspinatus tendon also demonstrates increased signal, especially along its inferior surface compatible with fraying and tendinosis with mild atrophy of the muscular belly. There is no full-thickness tear of the infraspinatus tendon. Mild tendinosis also affects the subscapularis tendon, but the muscle body appears within normal limits. Multiple suture anchor tracks are again noted within the humeral head, not significant change from prior examination.Minimal amounts of contrast visualized. The rotator cuff tendons, which likely sequelae of contrast injection and mild extravasation, however we see no frank full thickness rotator cuff tear.SUPRASPINATUS OUTLET: Deformity of the clavicle and acromion is again demonstrated, likely sequela of prior surgery.GLENOHUMERAL JOINT AND GLENOID LABRUM: Surgical changes about the superior labrum are unchanged. Severe degenerative tearing and degeneration most severe at the posterior, inferior labrum appears similar to prior study. BICEPS TENDON: Postsurgical appearance from biceps tenodesis.ADDITIONAL

Output: 1. Postsurgical changes of rotator cuff repair, acromioclavicular joint resection, biceps tenodesis. There is thinning and degeneration of the distal aspects of the supraspinatus, infraspinatus, and subscapularis as specifically outlined above. However we see no complete rotator cuff tear. Small amounts of contrast visualized superior to the rotator cuff likely secondary to injection and small amounts of extravasation.2. Severe degeneration of the glenoid articular surface as outlined above.


Instruction: Generate impression based on findings.

Input: Headaches. Evaluate for structural lesion. Brain parenchyma appears within normal limits. No intracranial mass or mass effect. No evidence of infarct or hemorrhage. No hydrocephalus or extra-axial collections. Sella and orbits are grossly normal. Major flow-voids are preserved. There is partial opacification of the left anterior ethmoid air cells. Bone marrow signal is within normal limits.

Output: Unremarkable brain MRII personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Reason: 62 yo with stable cysti in body and tail of pancreas representing possible side branch IPMN; please evaluate for any abnormalities and or changes History: pancreas cyst ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: Cystic lesion within the pancreatic body measuring 6 mm (3/41) is unchanged and likely represents a side branch IPMN. Smaller cystic lesion in the pancreatic tail (3/75) is also unchanged. No suspicious features on postcontrast images.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left renal cyst is unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Small cystic lesions within the pancreas, the largest measuring up to 6 mm, are stable and likely represents side branch IPMNs.


Instruction: Generate impression based on findings.

Input: Female, 28 years old, with T2 N0 right oral tongue squamous cell carcinoma status post CRT completed in 6/2009, status post salvage right partial glossectomy in 10/2009 with recurrent right oral tongue tumor. Findings are redemonstrated compatible with right hemiglossectomy and soft tissue flap repair, resection of the right coronoid process, and right neck dissection.Ill-defined enhancement seen previously along the right glossectomy margin is again seen, measuring up to 10 mm in the coronal plane (image 17 series 801), previously 13 mm. Nodular enhancement and T2 signal abnormality within the left oral tongue has significantly diminished in conspicuity. The dominant lateral tongue lesion now measures up to 14 mm (image 23 series 901), previously 23 mm.Reticulation and ill-defined signal abnormality within the subcutaneous tissues of the neck is likely a posttreatment response. No pathologic adenopathy is detected. The parotid and left submandibular glands are unremarkable. The right submandibular gland has likely been surgically excised. Lobular mucosal thickening in the right maxillary sinus has changed morphology but is not significantly larger than before. Marrow signal characteristics are unremarkable. Artifact from orthopedic instrumentation is partially visualized at the cervicothoracic junction.

Output: 1.Interval decrease in size of nodular enhancing tissue along the right glossectomy margin.2.Significant interval decrease in the size of nodular enhancement and signal abnormality within the left oral tongue.3.Demonstration of findings related to prior surgery and therapy.4.No definite pathologic adenopathy is observed.


Instruction: Generate impression based on findings.

Input: 69-year-old male with worsening cognitive impairment likely secondary to cerebral changes after right MCA aneurysm repair and subdural hematoma. Postoperative changes of right frontotemporal craniotomy for MCA aneurysm clipping again seen. Susceptibility artifact limits evaluation of the brain parenchyma adjacent to the clip. There are several scattered foci of T2/FLAIR hyperintensity in the bilateral periventricular and subcortical white matter which are nonspecific but compatible with mild chronic small vessel ischemic changes and stable to minimally worse since 5/3/2013. There is no intracranial mass or mass effect. There is no evidence of acute ischemia or hemorrhage. No extra-axial collections. There is prominence of the right temporal horn which is at least partly related to the slightly greater volume loss in the right temporal lobe, but unchanged since 5/3/2013. There is volume loss involving the hippocampi which does not appear to be grossly disproportional to the generalized mild brain parenchymal volume loss.There is opacification of the mastoid air cells, right worse than left. Paranasal sinuses demonstrate minimal scattered opacification.

Output: 1. No significant change since prior MRI brain dated 5/3/2013 including postoperative changes related to right MCA aneurysm clipping as well as fairly mild chronic small vessel ischemic changes. 2. No significant change in asymmetric enlargement of the right temporal horn which is at least in part related to volume loss.


Instruction: Generate impression based on findings.

Input: Reason: assess pancreatic and cbd duct. please use gadolinium and secretin. History: rlq pain ABDOMEN:LIVER, BILIARY TRACT: Punctate T2 hyperintensities, likely cysts. Cholecystectomy.Mild intrahepatic biliary ductal dilatation. Dilatation of the common bile duct to the level of the ampulla up to 1.7 cm. There is likely ampullary stricturing. No obstructing lesion or stone.SPLEEN: No significant abnormality noted.PANCREAS: The main pancreatic duct is dilated to 7 mm.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral T2 hyperintense lesions, likely cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postsurgical changes of gastric bypass.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Dilatation of the common bile duct and main pancreatic duct proximal to an ampullary stricture, most likely benign. No obstructing lesion or stone is evident.


Instruction: Generate impression based on findings.

Input: 55 years, Male, Reason: prostate cancer History: prostate cancer. 9 cores of prostate cancer in multiple parts of the prostate including Gleason 4+3=7 with clinical stage T1c PELVIS:PROSTATE:Prostate Size: 4.7 x 2.6 x 3.4 cmPeripheral Zone: Multiple lesions in the left mid gland to apex which are low intensity on T2/ADC, suspicious for adenocarcinoma. A lesion in the left apex measures 1.3 x 1.9 cm (804/244). There is extensive disease in the right peripheral zone extending from the base to apex. There is abutment of the lateral capsule bilaterally, however no definite extracapsular extension is identified.Central Gland: No significant abnormality notedSeminal Vesicles: Not involved.Extracapsular Extension: There is abutment of the lateral capsule bilaterally, however no definite extracapsular extension is identified.BLADDER: No significant abnormality noted.LYMPH NODES: No lymphadenopathy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Extensive bilateral foci suspicious for prostatic adenocarcinoma.2.No lymphadenopathy.


Instruction: Generate impression based on findings.

Input: 16-year-old male with pain. Evaluate for scapholunate ligament tear. LIGAMENTS: The scapholunate interval is slightly widened relative to the remainder of the carpal intervals, measuring approximately 3 mm on the arthrogram images. However, contrast remains within the midcarpal joint without extension into the radiocarpal joint to confirm a lunotriquetral or scapholunate ligament tear. TRIANGULAR FIBROCARTILAGE COMPLEX: The triangular fibrocartilage complex appears intact.TENDONS: Gadolinium extends along several of the extensor tendons which we suspect is iatrogenic.BONES: There is edema within the distal radial epiphysis with a thin linear band of abnormal signal intensity extending from the physis to the articular surface, indicating a nondisplaced fracture. The remainder of the bone marrow signal intensity appears normal.

Output: 1. Nondisplaced fracture of the distal radial epiphysis extending to the articular surface.2. Slight widening of the scapholunate interval without contrast extension into the radiocarpal joint to indicate confirm a tear.


Instruction: Generate impression based on findings.

Input: Pain and decreased range of motion of the right shoulder, evaluate for rotator cuff injury. ROTATOR CUFF: There is intermediate signal of the supraspinatus tendon, indicating tendinopathy/tendinosis. There is no evidence of a rotator cuff tear.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is fluid in the acromioclavicular joint and subacromial bursa, likely due to degenerative changes. The labrum appears normal.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: Tendinopathy of the supraspinatus without evidence of rotator cuff tear.


Instruction: Generate impression based on findings.

Input: Neck pain, radiculopathy Craniovertebral junction appears within normal limits with small amount of retro-odontoid soft tissue thickening without significant spinal stenosis. The cervical vertebral bodies are appropriate in height. There is loss of cervical lordosis. There is grade 1 anterolisthesis of C4 on C5 and approximately 3 mm retrolisthesis of C5 on C6. Alignment is otherwise maintained. Bone marrow signal is benign.Abnormal T2 signal is noted within the bilaterally at the C5-C6 level. No abnormal signal seen within the remainder of the cord.There are multilevel degenerative changes, individual levels as below:C2-3: Small central disc protrusion and mild left-sided facet arthropathy. No significant compromise to the spinal canal or neural foramina. C3-4: Small central protrusion and left-sided facet arthropathy. No significant compromise to the spinal canal or neural foramina. C4-5: Small central protrusion and bilateral facet arthropathy. Mild spinal canal narrowing with partial effacement of the ventral and dorsal thecal sacs. There is also mild bilateral neural foraminal stenosis.C5-6: There is loss of disc height, bilateral paracentral disc protrusion and bilateral uncovertebral hypertrophy. There is moderate to severe spinal canal stenosis including indentation on the ventral cord. There is abnormal T2 signal in the cord just inferior to this level. Moderate to severe left and moderate right neural foraminal stenosis. Bilateral facet arthropathy.C6-7: There is a central disc protrusion with mild spinal canal stenosis. There is there is minimal right and no significant left neural foraminal stenosis. Bilateral facet arthropathy.C7-T1: No significant compromise to the spinal canal or neural foramina. Bilateral facet arthropathy, worse on the left.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: Multilevel degenerative changes in the cervical spine, worst at the C5-C6 level where there is moderate to severe spinal canal stenosis, abnormal cord signal likely representing myelomalacia, and moderate to severe left and moderate right neural foraminal stenosis. Additional levels as above.


Instruction: Generate impression based on findings.

Input: Chiari decompression with dura patch, syrinx, still with symptoms: neck pain. There are postoperative findings related to Chiari decompression. There is a fluid collection overlying the duraplasty that measures up to 6 mm in thickness, previously 12 mm. There is a holocord syrinx that measures up to 8 mm in width. CSF flow is present across the anterior and posterior aspects of the neo-foramen magnum. 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.

Output: Interval evolution of postoperative findings related to Chiari decompression with decrease in size of the pseudomeningocele, but persistent holocord syrinx.


Instruction: Generate impression based on findings.

Input: Female 63 years old Reason: evaluate sacral osteomyelitis History: sacral wound Large soft tissue defect in the left posterior pelvis with tract extending to the left ischium appearing similar to prior exam. Confluent low T1 signal involving the left ischium and left inferior acetabulum compatible with osteomyelitis. There is increased T2 signal and enhancement on postcontrast images throughout the adjacent soft tissues, similar in distribution compared to prior exam, representing soft tissue inflammation. Diffuse atrophy throughout the visualized musculature.

Output: Decubitus ulceration with adjacent soft tissue inflammation and findings compatible with chronic osteomyelitis, which appears similar to prior examination.


Instruction: Generate impression based on findings.

Input: 69 year old female with retropharyngeal abscess. Worsening clinical symptoms. Increasing neurological symptoms. Evaluate for spread. CT of the soft tissues of the neck.Images through the skull base including cavernous sinuses remain within normal limits.Images through the soft tissues of the neck demonstrate a prevertebral edema enhancing fluid collection which also contains air and is consistent with patient's diagnosis of prevertebral abscess in comparison with the prior exam no definitive evidence of interval change is noted however on this the study extension of the abscess to the level of left neural foramina at C6- C7 is better visualized. Prior MRI of cervical spine also demonstrate ventral epidural spread of infection at this level. There may be slight increase in the size of prevertebral abscess. Images through the apices of the lungs demonstrate significant bilateral pleural effusions that appears more pronounced (on the right side) since prior examination.CT of brain with infusion.No evidence of any abnormal enhancement of brain parenchymal or the leptomeninges is identified to suggest intracranial spread of infection. No evidence of edema, mass effect, midline shift, hydrocephalus is detected. Cortical sulci, ventricular system and all CSF cisterns remain within normal limits.If worsening of neurological symptoms are relevant to the spine repeat MRI examination of cervical and thoracic spine is recommended.

Output: 1.Negative CT of brain with infusion.2.Redemonstration of prevertebral abscess with possible slight interval increase in its size.


Instruction: Generate impression based on findings.

Input: Reason: obstructive vs neoplastic process History: with gallbladder and common bile duct dilation, h/o weight loss. undergoing LVAD workup ABDOMEN:LIVER, BILIARY TRACT: Gallbladder is mildly distended without evidence of cholecystitis. Common bile duct measures 9 mm in diameter, smoothly tapering at the ampulla. No choledocholithiasis or obstructing lesions are evident.SPLEEN: No significant abnormality noted.PANCREAS: Main pancreatic duct is mildly prominent. No focal pancreatic lesions.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right kidney is atrophic. Right-sided T2 hyperintensity likely represent cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Diverticulosis without evidence of diverticulitis. ABONES, SOFT TISSUES: No significant abnormality noted.OTHER: Moderate bilateral effusions, similar to the prior CT.

Output: 1.Mild dilatation of the gallbladder and common bile duct, smoothly tapering to the ampulla, may suggest a benign structure.2.Atrophic right kidney.3.Moderate bilateral effusions.


Instruction: Generate impression based on findings.

Input: Lower lip weakness. There is no evidence of intracranial hemorrhage or acute infarct. There is an eccentric right pineal cyst that measures up to 18 mm, with flattening of the adjacent right thalamus. The brain parenchyma otherwise appears unremarkable. There is no abnormal intracranial enhancement. The ventricles are normal in size and configuration. However, the cerebellar tonsils a low-lying, extending up to 7 mm inferior to the foramen magnum, and have a pointed configuration. There is no midline shift. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. Eccentric right pineal cyst measures up to 18 mm, with flattening of the adjacent right thalamus. 2. The cerebellar tonsils a low-lying, extending up to 7 mm inferior to the foramen magnum, and have a pointed configuration, which may represent Chiari 1 malformation.


Instruction: Generate impression based on findings.

Input: 75 years old, Female, Reason: 75 yo female with thyroid nodule on CT. History: thyroid nodule RIGHT LOBE MEASUREMENTS: 5.0 x 1.2 x 1.4 cmLEFT LOBE MEASUREMENTS: 5.8 x 1.2 x 2.1 cmISTHMUS MEASUREMENTS: 0.5 cmRIGHT LOBE: Subcentimeter isoechoic heterogeneous thyroid nodule with internal vascularity measuring 0.4 x 0.4 by 0.5 cm.LEFT LOBE: At least two nodules are present in the left thyroid lobe. The more superior nodule is solid and heterogeneous in appearance with internal vascularity measuring 1.3 x 1.2 x 0.8 cm. The inferior left thyroid nodule measures 1.2 x 0.8 x 1.1 cm and is spongiform appearance.ISTHMUS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.

Output: 1.Left mid pole heterogeneous solid nodule with internal vascularity measuring up to 1.3 cm is amenable to biopsy if clinically warranted.2.Left inferior pole spongiform nodule.


Instruction: Generate impression based on findings.

Input: Leg and buttock pain The bone marrow signal intensity of the pelvis and proximal femora is normal. There is perhaps minimal osteoarthritis of the hips which otherwise appear normal for the patient's age. The sacroiliac joints appear normal. The muscles of the pelvis appear normal for the patient's age.There is degenerative disc disease of the lower lumbar spine with postoperative changes including dorsal soft tissue edema and enhancement. Please refer to corresponding MRI of the lumbar spine for further details.

Output: No findings within the pelvis to account for the patient's leg/buttock pain. There is degenerative disc disease and postoperative change of the lower lumbar spine but please refer to corresponding MRI of the lumbar spine for further details.


Instruction: Generate impression based on findings.

Input: 43-year-old male with history of chronic bilateral back pain and leg pain. Evaluate for possible abscess versus disc disease. Please note this study is technically limited. Five lumbar type vertebral bodies are presumed to be present for the purposes of numbering. Vertebral body heights are within normal limits. There is loss of disc height at L3-4, L4-5, and most severely at L5-S1. There is abnormal T2 signal within the L4-5 and L5-S1 disc space. There are suspected inflammatory changes in the paraspinous soft tissues at L4-5 and L5-S1 raising suspicion for infection. There is a tiny T2 hyperintense lesion in the right psoas muscle which could represent a small abscess. There are endplate marrow signal changes at L4-5 and L5-S1 which are difficult to evaluate due to artifact. There is diffuse low T1 signal in the marrow which may be related to chronic anemia. The conus medullaris is normal in position terminating at L1. Alignment is within normal limits. Innumerable bilateral renal cysts are present compatible with end-stage renal disease.Multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: Mild disc bulge with no significant spinal canal or neuroforaminal stenosis. Moderate facet hypertrophy.L3-L4: Mild disc bulge with left paracentral disc protrusion which results in mild to moderate left neuroforaminal narrowing. No significant spinal canal stenosis. Moderate facet hypertrophy.L4-L5: There is near complete loss of disc height especially along the right aspect of the disc. There is a mild left paracentral disc protrusion resulting in mild to moderate left neuroforaminal stenosis and mild right foraminal stenosis. No significant spinal canal stenosis. Moderate facet hypertrophy.L5-S1: There is near complete diffuse loss of disc height. Mild bilateral neuroforaminal narrowing. No significant spinal canal stenosis. Moderate facet hypertrophy. Bilateral facet effusions.

Output: 1. Study is technically degraded due to artifacts and poor signal. There is abnormal T2 hyperintense signal within the L4-5 and L5-S1 disc space. There are mild inflammatory changes suspected in the paraspinous soft tissues at L4-5 and L5-S1 raising suspicion for infection. There is a tiny T2 hyperintense lesion in the right psoas muscle (axial T2 image 7/50 series 601) which could represent a small abscess. No epidural collections. As patient can not receive gadolinium, recommend repeat MRI spine study with conventional sequences, axial T2 fatsat, and diffusion. CT lumbar spine with contrast can also be considered.2. Multilevel degenerative disc disease with near complete loss of disc height at L4-5 and L5-S1 which may be related to degenerative disease versus infection. There are endplate marrow changes which are difficult to evaluate due to artifact. 3. No significant spinal canal stenosis. Mild to moderate left L4-5 and L5-S1 neural foraminal stenosis.4. Multilevel facet arthropathy especially at L5-S1.5. Diffuse low T1 marrow signal which is nonspecific and can be seen in conditions such as chronic anemia.Findings including recommendation for repeat study were discussed with Dr. Garza at 1600 hrs on 2/28/2015.


Instruction: Generate impression based on findings.

Input: 56-year-old female. PVT, and dysplastic nodules. Follow-up both while awaiting OLT. Cirrhosis. ABDOMEN: LUNG BASES: Stable appearance of T2 hyperintense lesion in the right cardiophrenic angle consistent with a pericardial cyst.LIVER, BILIARY TRACT: Cirrhotic liver morphology with diffuse lattice-like fibrosis. Numerous regenerative nodules. T1 hyperintense and T2 iso/hypointense, nonenhancing nodule in the hepatic dome is 1.1 x 1.1 cm, previously 1.1 x 1 cm (series 801, image 414). A second similar nodule just above the gallbladder fossa is 1.2 x 1 cm (series 801, image 284), previously 1.1 x 1 cm. These are most suggestive of dysplastic nodules. No new suspicious hepatic mass.The main portal vein is patent but markedly attenuated from the portosplenic confluence to the right and left intrahepatic branches, unchanged. Large perisplenic varices, unchanged. Cholelithiasis.SPLEEN: Stable splenomegaly measuring 18 cm.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right renal scarring and cortical thinning, unchanged. RETROPERITONEUM, LYMPH NODES: Prominent periportal lymph nodes, unchanged. BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Stable two hepatic nodules most suggestive of dysplastic nodules. No new suspicious hepatic mass.2.Attenuated but patent portal vein and findings of portal hypertension.


Instruction: Generate impression based on findings.

Input: 63-year-old male with history of prostate cancer. Evaluate extent of disease. PELVIS:PROSTATE:Prostate Size: 4.6 x 2.3 x 3.3 cmPeripheral Zone: There are multiple lesions within the peripheral zone which demonstrate T2 hypointensity, corresponding low ADC signal, and without evidence of enhancement compatible with suspicious prostatic lesions. Right base lesion measures 5 x 5 mm (series 801, image 19).Right mid gland lesion measures 3 x 3 mm (series 801, image 16)Left mid gland lesion measures 10 x 6 mm (series 801, image 20)Left apex lesion measures 4 x 4 mm (series 801, image 14)Central Gland: Mildly nodular compatible with BPH.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: No evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Multiple suspicious peripheral zone lesions as detailed without evidence of extracapsular extension or seminal vesicle invasion.


Instruction: Generate impression based on findings.

Input: Enlarging liver cysts and shoulder pain. ABDOMEN:LIVER, BILIARY TRACT: Hepatomegaly measuring 25 cm in craniocaudal dimension secondary to innumerable small cystic foci and large hepatic dome cystic lesions. The largest is a septated lesion in the mid liver measuring 14.1 x 10.3 x 16.7 cm. An adjacent predominantly right hepatic lobe lesion measures 10.5 x 7.2 cm. An adjacent left hepatic lobe lesion measures 8.5 x 7.6 cm and contains complex fluid. In the periphery of segment 3 there is a 4.2 x 4.0 cm cystic lesion. The remaining cystic lesions measure less than 2 cm. There is no internal or mural nodular postcontrast enhancement of these lesions.No intrahepatic biliary ductal dilatation.SPLEEN: Normal splenic size without a focal lesion.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Hepatomegaly with regional mass effect secondary to several very large cystic lesions without suspicious internal or mural enhancement, likely giant hepatic cysts. Given their size cystadenoma cannot be excluded.


Instruction: Generate impression based on findings.

Input: Asymmetric sensorineural hearing loss and tinnitus. The bilateral cranial nerve 7 and 8 complexes are intact. There is no evidence of mass lesions. The inner ear structures, including the cochlea, vestibule, endolymphatic duct, and semicircular canals, appear unremarkable. The bilateral mastoid air cells and middle ears also appear unremarkable. There is an incompletely outpouching along the medial aspect of the right supraclinoid internal carotid artery that measures at least 5 mm in width. There an enhancing lesion in the left nasal cavity that measures up to 12 x 25 mm, adjacent to the left middle turbinate. There is relatively focal prominence of the median adenoids with intact striations, which likely represents hyperplasia.

Output: 1. No evidence of inner ear or retrocochlear lesions.2. An enhancing lesion in the left nasal cavity that appears intimately associated with the left middle turbinate, which may represent a neoplasm. Dedicated sinus imaging or endoscopic examination may be useful for further characterization.3. An incompletely imaged outpouching along the medial aspect of the right supraclinoid internal carotid artery that measures at least 5 mm in width likely represents an aneurysm. Dedicated vascular imaging can be performed for further evaluation. Discussed with Maureen Crowley at 4PM on 7/22/15.


Instruction: Generate impression based on findings.

Input: Please refer to the subsequent MRI report for further information.Exposure time: 26 seconds

Output: Successful right midcarpal joint space arthrogram.


Instruction: Generate impression based on findings.

Input: Female, 73 years old, with memory loss. Amaranth study subject, Alzheimer's disease clinical trial. Image quality is slightly limited by motion artifact. Moderately extensive scattered periventricular foci of FLAIR hyperintensity are seen. No restricted diffusion is seen. No edema or mass effect is detected. No evidence of intracranial hemorrhage or any abnormal extra-axial fluid collection is seen. Ventricular size and morphology are within normal limits. Brain parenchymal volume is relatively well preserved. Diffuse paranasal sinus mucosal thickening is seen. In particular, the maxillary sinuses are completely opacified and there is polypoid-like mucosal protrusion through the left ostiomeatal unit.

Output: 1.Scattered foci of periventricular FLAIR hyperintensity are nonspecific but statistically most likely represent chronic microvascular ischemia.2.Brain parenchymal volume is relatively well-preserved.3.Extensive paranasal sinus mucosal thickening.


Instruction: Generate impression based on findings.

Input: 60-year-old female recently managed for acute subdural bleed status post PEA arrest during MRI after administration. Global aphasia and generalized hyperreflexia. There is no evidence of new intracranial hemorrhage, mass or edema. The previously described epidural bleed with some adjacent mass effect appears slightly smaller than before. Within the left high convexity there is a possible subdural hygroma which exerts mass effect on the adjacent parenchyma. This may be further evaluated with MRI as clinically warranted.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Slightly smaller appearing epidural hemorrhage and a new adjacent left subdural hygroma which exerts mass effect on adjacent parenchyma and may be further evaluated with MRI as clinically warranted.


Instruction: Generate impression based on findings.

Input: Images of the thoracic spine are significantly limited by patient motion and are near nondiagnostic. Currently, sagittal postcontrast images through the thoracic spine are not available. Axial images of the lumbar spine are also partially nondiagnostic due to patient motion.Trace grade 1 anterolisthesis of L4 on L5 is noted which appears degenerative in nature. The spine is otherwise in normal alignment. There is mild reversal the normal cervical lordosis. The vertebral body heights are well-maintained. There is scattered multilevel disc narrowing, especially along the lower cervical spine where it is moderate in degree. There is also diffuse disc desiccation to the lumbar spine. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and grossly of normal signal. The spinal cord and conus are within normal limits with the conus terminating at the L1-L2 level. There is no pathological enhancement.There are multilevel cervical spondylotic changes, slightly progressed since prior exam, especially along the mid to lower cervical spine. At C3-C4, there is right greater than left uncovertebral hypertrophy with a diffuse posterior osteophyte disc complex abutting and moderate-severe bilateral foraminal narrowing and mild to moderate central spinal canal stenosis. There is also a prominent central/right paracentral disc protrusion at C6-C7 which indents the ventral thecal sac and flattens the ventral cord with perhaps moderate bilateral foraminal narrowing at this level due to exuberant uncovertebral hypertrophy.At L3-L4, there is a mild disc bulge with right root of the left foraminal prominence resulting in mild to moderate right foraminal narrowing.At L4-L5, there is a mild disc bulge with tiny central annular fissure suggested as well as uncovering of the disc.At L5-S1, there is a mild disc bulge with superimposed left paracentral to foraminal disc protrusion. This impinges on the exiting left L5 nerve root with slight encroachment upon the left lateral recess and abutment of the descending left S1 nerve roots as well.There is prominent bilateral lower lumbar facet arthropathy.There is a small retropharyngeal effusion which measures up to 4 mm in greatest thickness, likely relating to posttreatment changes. There is also mild diffuse wall thickening of the esophagus with edema and ill-defined appearance. There is a small left-sided pleural effusion.

Output: 1.No MR evidence of spinal metastatic disease, although exam is significantly motion limited.2.Slight progression of cervical spondylosis with moderate-severe bilateral foraminal narrowing at C3-C4.3. Minimal degenerative grade 1 anterolisthesis of L4 on L5, with more focal disc pathology at L5-S1 where there is a left paracentral/foraminal disc protrusion impinging on the exiting left L5 nerve root and abutting the descending left S1 nerve root.


Instruction: Generate impression based on findings.

Input: 58-year-old male with pain and weakness. Rule out rotator cuff pathology. ROTATOR CUFF: There is undersurface tearing of the supraspinatus tendon, of varying depth, but involving greater than 50% of the tendon thickness anteriorly. The bursal surface fibers appear to be spared, although there are small cysts along the anterolateral aspect of the greater tuberosity that may reflect a small full-thickness defect of the anterior-most fibers that is not appreciable on this study. Alternatively, the cysts may represent a small ganglion. There are small cysts within the underlying greater tuberosity as well. The aforementioned tear extends posteriorly to involve the infraspinatus tendon and measures approximately 3 cm in the AP dimension. We see no frank tendon retraction. There is increased signal intensity within the remainder of the supraspinatus indicating moderate tendinosis with an additional small interstitial tear along the myotendinous junction more proximally. There are also interstitial tears along the myotendinous junction of the infraspinatus. The supraspinatus and infraspinatus muscles appear intact. There is an intramuscular lipoma within the teres minor measuring just under 4 cm in length, 3 cm in the craniocaudal dimension and just over 1 cm in width. Otherwise the teres minor muscle and tendon appear intact. There is increased signal within the distal subscapularis tendon indicating tendinosis and probable undersurface fraying. The subscapularis muscle appears intact.SUPRASPINATUS OUTLET: Note is made of an os acromiale that is perhaps partially fused. Additionally, there is mild to moderate osteoarthritis affecting the acromioclavicular joint. There is no significant fluid within the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral alignment is within normal limits. There is no evidence of a glenohumeral joint effusion. There is increased signal intensity within the labrum including the superior labrum and posterior inferior labrum suggesting degeneration/degenerative tearing.BICEPS TENDON: There may be mild tendinosis of the intra-articular portion of the long head of the biceps, but we see no frank tear. ADDITIONAL

Output: 1. Tearing of the supraspinatus and infraspinatus tendons predominantly involving the undersurface with additional interstitial rotator cuff tears and tendinosis as described above.2. Acromioclavicular joint osteoarthritis, labral degeneration and tearing as well as other findings as described above


Instruction: Generate impression based on findings.

Input: Cervical spine:The left cerebellar tonsil extends 7 mm below the level of the foramen magnum, and the right 6 mm, consistent with Chiari I malformation. There is minimal morphologic distortion with slight pointing. The cervical cord is normal in signal. A suggestion of cord hyperintense signal posterior to C6 on sagittal T2 technique is not reproduced with sagittal STIR or axial T2 and is thus felt to be artifactual. A small flash of biphasic CSF flow is noted posteriorly at the level of the cerebellar tonsils.There is slight reversal of upper cervical curvature. There are no fractures or subluxations. The marrow signal is benign, including a benign hemangioma within the C6 vertebral body. The cervical cord is normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.C2/3: UnremarkableC3/4: UnremarkableC4/5: Mild posterior osteophyte disc complex causing minimal anterior cord flattening. There is no resulting stenosis.C5/6: Mild posterior osteophyte disc complex causing minimal anterior cord flattening. There is no resulting stenosis.C6/7: UnremarkableC7/T1: UnremarkableThoracic spine:There is a smooth, physiologic thoracic kyphotic curve. The vertebral body heights and disc spaces are maintained. Marrow signal intensity is benign, including a benign hemangioma within the T6 vertebral body. The spinal cord is without focal atrophy, signal abnormality, or myelomalacia. There are no masses. Incidental note is made of a right pulmonary azygos lobe.T1/2 demonstrates a tiny left paramedian disc protrusion without cord encroachment.T2/3 demonstrates no significant disc bulge or cord encroachment. T3/4 demonstrates no significant disc bulge or cord encroachment. T4/5 demonstrates no significant disc bulge or cord encroachment. T5/6 demonstrates no significant disc bulge or cord encroachment.T6/7 demonstrates no significant disc bulge or cord encroachment. T7/8 demonstrates no significant disc bulge or cord encroachment. T8/9 demonstrates no significant disc bulge or cord encroachment. T9/10 demonstrates no significant disc bulge or cord encroachment.T10/11 demonstrates no significant disc bulge or cord encroachment. T11/12 demonstrates no significant disc bulge or cord encroachment. T12/L1 demonstrates no significant disc bulge or cord encroachment.

Output: 1.The left cerebellar tonsil extends 7 mm below the level of the foramen magnum, and the right 6 mm, consistent with Chiari I malformation. 2.There is no syrinx.3.Mild degenerative changes of the cervical spine without resulting stenosis.4.T1/2 demonstrates a tiny left paramedian disc protrusion without cord encroachment.


Instruction: Generate impression based on findings.

Input: Clinical question:? Cervical myelopathy. Signs and symptoms: LU weakness and UE hyperreflexia. Nonenhanced MRI:Examination is nondiagnostic due to fairly extensive motion artifact. The signal intensity of the cord cannot be assessed secondary to severely degraded images. The alignment of the column appears anatomical. There is moderate degenerative changes of the cervical spine which appears to be more pronounced at C3 -- C4 level. No significant central spinal stenosis is detected. Repeat exam is highly recommended when patient's condition permits.

Output: Nondiagnostic nonenhanced MRI of the cervical spine due to significant motion artifact as detailed


Instruction: Generate impression based on findings.

Input: Streptococcus pneumoniae meningitis. Intermittent right-sided ptosis, concerning for abducens nerve palsy, static on the right intermittent on the left, versus abscess. BRAIN MRI:Brain demonstrates no abnormal diffusion restriction or susceptibility effect. There is no contrast-enhancing or other space-occupying brain lesion. The CSF-containing spaces, including the ventricles, are normal in size and there is no abnormal extra-axial fluid collection. On FLAIR sequences, there is incomplete attenuation of the signal from the sulci and interfolial spaces. This is not associated with abnormal contrast enhancement and while this may relate to the known meningitis, it may also in part relate to the patient being sedated and on mechanical ventilation. While this study is not dedicated for cranial nerve assessment, there is suggestion of mild asymmetric fullness and increased T2 signal in the left Meckel's cave, which is associated with mildly increased peripheral contrast enhancement, most prominent on the delayed orbital postcontrast coronal image #10 (of series #2801). However, the cisternal segment of the trigeminal nerves show no abnormal signal/enhancement or thickening. Additionally, there is subtle apparent asymmetric contrast enhancement in the fundus of the right internal auditory canal. This, however, may relate to the increased slice thickness and patient obliquity. These equivocal findings are probably better assessed with follow-up dedicated cranial nerve MRI with contrast.The above-described left Meckel's cave asymmetry is also associated with focal noncontrast enhancement in the left cavernous sinus medial to the internal carotid artery, best seen on the coronal postcontrast fat-saturated T1 sequence of the orbits (series number 2801, image #11). The cavernous segment of the left internal carotid artery is slightly smaller than the right but this is due to developmental variation. Superior ophthalmic veins demonstrate normal flow-voids.Minimal linear contrast enhancement in the right prepontine cistern in expected level of cranial nerve VI is probably related to a vessel, again incompletely assessed.There is fluid signal and peripheral contrast enhancement involving the left mastoid air cells and middle ear cavity. The inferior portion of the opacification is associated with mild diffusion restriction. There is diminutive flow-void associated with the left transverse and sigmoid sinuses. However, this is probably related to a congenital variation of either very small or absent left transverse sinus and subsequently small left sigmoid sinus there are rather than thrombosis. The remainder of the dural venous sinuses demonstrate well visualized flow voids. The major intracranial arterial flow voids are also preserved.The right mastoid air cells are clear. There is mucosal thickening in the paranasal sinuses.ORBITS MRI:There is minimal asymmetric STIR hyperintense edema and contrast enhancement involving the medial right preseptal soft tissues without abscess. This may represent cellulitis but is better assessed clinically. The lateral left preorbital/preseptal soft tissues as well as the left lateral facial soft tissues show mild swelling and contrast enhancement, which can be dependent. There is no intraorbital abnormality or fat stranding. There is no subperiosteal abscess.CERVICAL SPINE MRI:Minimal reversal of the normal cervical lordosis probably related to position. Alignment is otherwise anatomic. Vertebral bodies and intervening discs show normal signal and morphology. There is no spinal canal stenosis. The cervical and included upper thoracic spinal cord shows normal signal and shape.Small lymph nodes are symmetric along both sides of the neck.

Output: 1.There is no intracranial abscess. Subtle but apparent asymmetric contrast enhancement and fullness in the left Meckel's cave and questioned in the fundus of the right internal auditory canal are equivocal and incompletely assessed due to lack of thin section dedicated cranial nerve imaging. This could be obtained on follow-up exam as clinically indicated. No overt leptomeningeal enhancement to suggest meningitis, with at most subtle FLAIR hyperintensity within the sulci and along the cerebellar folia which may in part relate to artifact. 2.Mild cavernous sinus asymmetry and focal decreased contrast enhancement in the left cavernous sinus medial to the internal carotid artery is nonspecific, and could represent focal heterogeneity, although clinical correlation is recommended to exclude the possibility of early thrombosis. Superior ophthalmic veins appear within normal limits.3.There is minimal asymmetric swelling and contrast enhancement involving the medial right preorbital/preseptal soft tissue without abscess, most likely representing cellulitis. The lateral left preorbital/preseptal soft tissues as well as the left lateral facial soft tissues show mild swelling and contrast enhancement which could be dependent in nature.4.Severe left mastoid and middle ear opacification with nonspecific enhancement in very minimal diffusion restriction. This is not associated with subperiosteal abscess. Please correlate clinically. Attenuated flow in the left transverse and sigmoid sinuses is almost certainly congenital, rather than from thrombosis related to the presumed mastoiditis.5.There is no cervical spine abnormality.Dr. Monther Qandeel discussed the above findings and recommendations with Dr. Reem Nubani over the phone on January 2, 2016 at 1030 hours. The radiology on-call resident also discussed the findings with the care team at the time of the examination on the day prior.


Instruction: Generate impression based on findings.

Input: MRI BRAIN: There is a 4 mm diameter enhancing lesion in the inferior medial aspect of the left cerebellar tonsil. There are no additional areas of abnormal signal or pathological enhancement. There is no evidence of intracranial hemorrhage acute infarct. There are probable terminal zones of myelination in the bilateral parietal lobes. The supratentorial brain parenchyma otherwise appears unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is redemonstration of postoperative changes in the right globe, including silicone oil injection and scleral buckling.MRI CERVICAL SPINE: There is an expansile cystic intramedullary lesion in the left ventral aspect of the cervical spinal cord at the level of the C2 vertebral body, which measures up to 18 mm, previously 10 mm. There are two punctate nodular enhancing foci along the anterior aspect of the cyst, which appear unchanged and another punctate focus of enhancement along the posterior aspect of the left spinal cord at approximately the same level, which appears to be larger. In addition, there is mild edema is the spinal cord superior to the cyst. The cervical vertebral bodies are intact and there is no spondylolisthesis. The bone marrow signal is within normal limits. There are no significant degenerative changes are present. The vertebral artery flow voids appear to be intact. The paraspinous soft tissue structures appear within normal limits.

Output: 1. No significant interval change in the inferior medial enhancing cerebellar hemangioblastoma.2. Findings consistent with spinal cord hemangioblastomas at the C2 level with interval increase in size of the cystic component and posterior enhancing lesion, as well as mild edema in the surrounding spinal cord.3. Post-treatment findings in the right globe.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Diagnosis: Radiculopathy, lumbar regionClinical question: lumbar radiculopathySigns and Symptoms: radiculopathy Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is mild bilateral facet hypertrophy at this level. There is disc desiccation at this level. There is a diffuse disc bulge at this level.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is some disc desiccation at this level. There is a moderate to marked degree of facet hypertrophy present which is worse on the left compared to the right side. Lung the inferior aspect of the left facet joint and superficial to it there is a synovial cyst present. There is mild effacement of fat surrounding the left-sided exiting nerve roots at this level. There is mild anterior subluxation of L4 and L5.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: There are degenerative changes present in the lower lumbar spine worse at L4-5 where there is marked facet hypertrophy and mild subluxation resulting in encroachment of the nerve roots within the left neural foramen.


Instruction: Generate impression based on findings.

Input: Female, 77 years old. Reason: CT showed cord compression History: Ataxia THORACIC SPINE:The thoracic vertebral bodies are appropriate in the overall alignment and height. Disc space heights are preserved.There multiple osseous metastatic lesions involving the thoracic spine, including vertebral body metastases at T1, T3, T7, and T12, with additional scattered punctate areas of enhancement throughout the vertebral bodies which likely reflect metastatic foci.A large expansile metastasis centered on the left T9 pedicle appears increased from the prior CT exam dated 07/13/2015, measuring 2.7 x 2.4 cm, extending into the epidural space with associated moderate to severe spinal canal stenosis and rightward cord displacement. There is no focal intrinsic cord signal abnormality at this level. This lesion also encroaches on the left T8-9 foramen with associated marked narrowing.There are additional scattered metastatic lesions involving the posterior elements and posterior ribs throughout the thoracic spine, including an approximately 2 cm lesion involving the right eighth costovertebral joint and an approximately 1.5 cm lesion involving the left seventh costovertebral joint, with associated neuroforaminal narrowing at these levels.There is no intrinsic cord signal abnormality elsewhere in the thoracic spine to suggest acute cord compression.CORD COMPRESSION:Examination of the remainder of the spine is limited to the exclusion of cord compression only and does not exclude more subtle lesions such as intrinsic cord abnormalities. The vertebral bodies are appropriate in the overall alignment and height. At the cervical and lumbar levels, the spinal cord has normal signal characteristics and overall morphology. There is no compromise of the spinal cord at these levels.The above described metastatic lesions in the thoracic spine are redemonstrated, with additional vertebral body metastases identified in the cervical and lumbar spine, including a large L3 metastasis. There is no significant central canal stenosis at the cervical and lumbar levels.

Output: 1. Multiple metastatic lesions involving the vertebral bodies and posterior elements of the thoracic spine, including a large left T9 pedicle metastasis with moderate to severe associated canal stenosis and cord displacement but no associated cord signal abnormalities. No additional areas of significant spinal canal stenosis are suspected.2. No evidence of acute cord compression at the cervical and lumbar levels on the provided screening examination.


Instruction: Generate impression based on findings.

Input: 47 year old male with history of CML with possible intracardiac mass seen on transthoracic echocardiogram. Cardiac MRI done to further evaluate character of possible mass. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 66 %, the LV end diastolic volume index is 72 ml/m2 (normal range: 74+/-15), the LVEDV is 220 ml (normal range 142+/-34), the LV end systolic volume index is 24 ml/m2 (normal range 25+/-9), the LVESV is 75 ml (normal range 47+/-19), the LV mass index is 57 g/m2 (normal range 85+/-15), and the LV mass is 172 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.There is a 4 x10 mm, mass that appears on the basal lateral wall just below the posterior leaflet of the mitral valve. The mass is likely adherent to the myocardium and appears to extend out onto the basal portion of the MV posterior leaflet. The mass does not appear to be cystic and is not composed of fat. There is no late gadolinium enhancement of the mass and has vascularity similar to the myocardium.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 55 %, the RV end diastolic volume index is 87 ml/m2 (normal range 82+/-16), the RVEDV is 268 ml (normal range 142+/-31), the RV end systolic volume index is 39 ml/m2 (normal range 31+/-9), and the RVESV is 121 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThere are trace bilateral pleural effusions. Splenomegaly is noted. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size and systolic function (LVEF 66%)2. The right ventricle is normal in size and systolic function (RVEF 55%)3.There is a 4 x10 mm, mass that appears on the basal lateral wall just below the posterior leaflet of the mitral valve. The mass is likely adherent to the myocardium and appears to extend out onto the basal portion of the MV posterior leaflet. The mass does not appear to be cystic and is not composed of fat. There is no late gadolinium enhancement of the mass and it has vascularity similar to the myocardium, which suggests it is not thrombus. Its location is atypical for vegetation. Mitral annular calcification can present in this way, however there are no clinical predispositions to this (age, ESRD etc). Prior chest imaging (CT or MRI) or prior TTE may be helpful to review if available.


Instruction: Generate impression based on findings.

Input: 76 years, Male, Reason: prostate cancer, please evaluate the prostate and regional nodes History: prostate cancer. Biopsy 1/7/2015: Left base cancer. Right lateral base to apex cancer. Gleason 7. PELVIS:PROSTATE:Prostate Size: 5.3 x 3.9 x 4.3 cm.Peripheral Zone: There is a lesion in the right peripheral zone measuring approximately 1.1 x 0.9 cm (703/444) extending from the right base to mid prostate which is low signal on ADC/T2 with early enhancement, suspicious for prosthetic adenocarcinoma.Additional foci of intrinsic T1 shortening likely represents hemorrhage from prior biopsy.Central Gland: Scattered well-defined nodules suggest benign prosthetic hypertrophy.Seminal Vesicles: No involvementExtracapsular Extension: Lesion abuts the right aspect of the lateral capsule without definite extensionBLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Bilateral fat containing inguinal hernias.

Output: 1.Lesion extending from the right base to mid gland with signal characteristics suspicious for prostatic adenocarcinoma.2.No lymphadenopathy.


Instruction: Generate impression based on findings.

Input: 46-year-old female with pain and extremely limited range of motion. Evaluate for severe arthrofibrosis. ROTATOR CUFF: There is moderate tendinosis of the supraspinatus tendon with intermediate signal intensity along the undersurface fibers suggesting fraying. There is a 3-4 mm focus of high signal intensity along the undersurface fibers of the supraspinatus seen on image 9 of series 9 which may represent a small articular surface tear. The aforementioned tendinosis extends to involve the anterior fibers of the infraspinatus. There is also focal fluid signal intensity separating the infraspinatus at its insertion on the greater tuberosity indicating a tear. The tear involves the majority of the thickness of the tendon likely disrupting the bursal surface fibers, but probably sparing the articular surface fibers, measuring approximately 4 mm in AP dimension. There is minimal retraction. There is a small focus of signal intensity along the proximal fibers of the infraspinatus along the myotendinous junction which may represent additional tearing. There is mild fatty infiltration along the myotendinous junction of the supraspinatus and infraspinatus. The subscapularis and teres minor muscles and tendons appear intact.SUPRASPINATUS OUTLET: Moderate to severe osteoarthritis affects the acromioclavicular joint with inferior osteophytes. There is a small amount of fluid within the subacromial-subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is increased intermediate signal intensity within the superior labrum compatible with degeneration, but we see no fluid-filled tear within the limitations of a non arthrogram study. The glenohumeral joint alignment is within normal limits. Small glenohumeral joint osteophytes indicate mild osteoarthritis.BICEPS TENDON: The extra-articular portion of the long head of the biceps tendon appears intact. There is intermediate signal intensity within the intra-articular portion of the long head of the biceps suggesting mild tendinosis. ADDITIONAL

Output: 1. Tendinosis and partial thickness rotator cuff tearing.2. Moderate to severe osteoarthritis of the acromioclavicular joint with a small amount of fluid within the subacromial-subdeltoid bursa.3. Mild osteoarthritis of the glenohumeral joint. No specific features of adhesive capsulitis.4. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Diagnosis: Disorientation, unspecifiedClinical question: Altered mental status The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Multiple foci of punctate signal loss on SWI are present in the brainstem, right thalamus and subcortical (predominantly temporal but also elsewhere) white matter.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: 1.No evidence for acute ischemic cerebral infarction.2.Periventricular and subcortical white matter lesions of a moderate degree are nonspecific. At this age they are most likely vascular related. 3.Mild degree of old microhemorrhages are present in the brainstem and thalami as well as the subcortical white matter.


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: UnremarkableC3/4: UnremarkableC4/5: Posterior osteophyte disc complex, left uncinate hypertrophy, ligamentum flavum thickening, and left facet hypertrophy. There is minimal central and mild left neural foraminal stenosis.C5/6: There is a right paracentral disc protrusion causing anterior right hemicord flattening without intrinsic cord signal abnormality. There is also ligamentum flavum thickening. There is mild central stenosis, however there is no neural foraminal stenosis.C6/7: Posterior osteophyte disc complex and ligamentum flavum flavum thickening. There are no significant stenoses.C7/T1: Unremarkable

Output: 1.C4/5: Minimal central and mild left neural foraminal stenosis.2.C5/6: There is a right paracentral disc protrusion causing anterior right hemicord flattening without intrinsic cord signal abnormality. There is mild central stenosis, however there is no neural foraminal stenosis.


Instruction: Generate impression based on findings.

Input: 33-year-old male with a history of dislocation. ROTATOR CUFF: There is thickening and intermediate signal intensity within the supraspinatus indicating mild tendinosis. The supraspinatus muscle and tendon appear intact. The infraspinatus muscle and tendon appear intact. The teres minor and subscapularis muscles and tendons appear intact.SUPRASPINATUS OUTLET: There is no fluid within the subacromial subdeltoid bursa. The acromioclavicular joint is normal in appearance.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is branching linear increased signal abnormality within the superior labrum posterior to the insertion of the biceps anchor suspicious for a tear. Additionally the inferior glenoid labrum is not well visualized and appears to be displaced medially along the inferior aspect of the glenoid suspicious for an ALPSA lesion. There is deformity of the posterior aspect of the superior lateral humeral head consistent with Hill-Sachs fracture deformity. There is no increased signal abnormality on fluid sensitive sequences suggesting that this is chronic in etiology. There is a partial-thickness articular cartilage fissure affecting the articular cartilage of the glenoid situated at the 3 o'clock position. There is no bone marrow signal abnormality on fluid sensitive sequences.BICEPS TENDON: The tendon of the long head of the biceps appears intact. ADDITIONAL

Output: 1. Findings consistent with a chronic Hill-Sachs deformity of the humeral head. Findings suspicious for an ALPSA lesion as described above. 2. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Female; 65 years old. Reason: concern for mets unknown primary History: incidental liver hypodensities on CT ABDOMEN:LIVER, BILIARY TRACT: Numerous, diffuse hepatic hypodensities seen on prior CT chest correspond with numerous lesions seen demonstrating signal drop out on opposed phase imaging, compatible with multifocal hepatic steatosis. No corresponding signal abnormality is seen on T2 weighted images, diffusion weighted images, or postcontrast images.Scattered subcentimeter hepatic cysts. Cholelithiasis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter right renal cysts, one which demonstrates high T1 signal, most compatible with proteinaceous/hemorrhagic cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Multifocal hepatic steatosis diffusely in the liver.


Instruction: Generate impression based on findings.

Input: 22-year-old male with primary sclerosing cholangitis and ulcerative colitis ABDOMEN:LIVER, BILIARY TRACT: No suspicious liver lesions. No intrahepatic or extrahepatic biliary ductal dilatation. Mild contour irregularity of the bile duct at the confluence of the left and right intrahepatic bile ducts, unchanged. Mild narrowing of the mid common bile duct may be related to tortuosity. No enhancing lesion is identified.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Unchanged cyst in the interpolar left kidney.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Stable mild contour irregularity of the bile duct at the confluence of the left and right intrahepatic bile ducts.2.No enhancing or suspicious lesion is identified.


Instruction: Generate impression based on findings.

Input: Knee effusion MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: There is diffuse thinning of the articular cartilage of the lateral compartment with areas of near full-thickness loss particularly of the femoral condyle anteriorly. The articular cartilage of the medial compartment is intact. There is heterogeneity of the articular cartilage of the patellofemoral compartment without evidence of full-thickness defect.LIGAMENTS: The ACL is intact. There is increased signal and thickening of the posterior collateral ligament suggesting myxomatous degeneration without full-thickness tear. The collateral ligaments are intact. EXTENSOR MECHANISM: Minimal amount of nonspecific edema overlies the prepatellar soft tissues. There is a small joint effusion.ADDITIONAL

Output: 1. Myxomatous degeneration of the PCL. The remaining cruciate and collateral ligaments are intact.2. Diffuse thinning of the articular cartilage of the lateral compartment with near full-thickness loss of the femoral condyle anteriorly.3. Small joint effusion.


Instruction: Generate impression based on findings.

Input: 8-month-old, ex-26 weeker, with history of right grade 3 and periventricular leukomalacia. There are periventricular cystic changes measuring up to approximately 20 mm with ex vacuo dilatation at the right lateral ventricle and minimal midline shift. The lateral and third ventricles are mildly prominent in size and the corpus callosum is diffusely thinned likely due to parenchymal volume loss. Likewise, there is right-sided Wallerian degeneration. There is scattered susceptibility effect along the margins of the bilateral lateral ventricles centered in the region of the caudothalamic grooves, right more than left. There is also mild prominence of the subarachnoid spaces, particularly along the frontal convexities. There is no evidence of intracranial mass or acute infarct. There is a normal myelination pattern for age. The skull and extracranial soft tissues are unremarkable.

Output: 1. Periventricular cystic changes with ex vacuo dilatation at the right frontal horn, consistent with periventricular leukomalacia likely related to a germinal matrix hemorrhage.2. Mild prominence of the subarachnoid spaces, particularly along the frontal convexities suggest benign enlargement of the subarachnoid spaces of infancy. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: There is an unchanged heterogeneously enhancing oval mass in the left inferior temporal gyrus measuring approximately 12 mm with mild stable surrounding vasogenic pattern T2 hyperintensity. This lesion again shows a thin rim of T2 hypointensity probably representing hemosiderin. There is no herniation or midline shift. The ventricles are unchanged. The flow-voids of the skull base are intact.

Output: Preoperative planning MRI as above.


Instruction: Generate impression based on findings.

Input: 41-year-old woman with history of Hodgkin lymphoma status post chemotherapy in 1996, now with incidentally noted splenic lesion. ABDOMEN:LIVER, BILIARY TRACT: A subcentimeter segment 4A cyst is identified. No focal hepatic lesions are seen. The gallbladder is normal.SPLEEN: A well-marginated 54 x 48 mm slightly T2 hyperintense lesion is seen in the spleen, previously 53 x 48 mm. This lesion demonstrates nodular peripheral enhancement with gradual increased central enhancement (i.e., centripetal progression of postcontrast enhancement) on the 3 minute delayed images. The spleen is normal in size.PANCREAS: The pancreas appears normal.ADRENAL GLANDS: The adrenal glands are normal.KIDNEYS, URETERS: A 12 x 11 mm right mid pole renal cyst is noted.RETROPERITONEUM, LYMPH NODES: No significant retroperitoneal or mesenteric lymphadenopathy is identified.BOWEL, MESENTERY: The partially visualized small bowel and colon are normal.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Lesion in spleen unchanged in size from the prior examination and most suggestive of an atypical hemangioma or hamartoma. Follow-up in approximately 6 months is recommended to confirm stability.


Instruction: Generate impression based on findings.

Input: 41 year-old female with right-sided weakness for 12 hours. Clinical question to be answered: Stroke No definitive evidence of hemorrhage, edema, mass-effect, midline shift or hydrocephalus. Cortical sulci, ventricular system and all CSF cisterns are unremarkable. Reevaluation with an MRI is recommended. Calvarium, paranasal sinuses and mastoid air vessels are also unremarkable.

Output: Negative CT of the brain.


Instruction: Generate impression based on findings.

Input: 62-year-old male with prostate cancer, repeat biopsy PELVIS:PROSTATE:Prostate Size: 5.4 x 3.7 x 5.2 cm.Peripheral Zone: There is a dominant T2 hypointense focus in the right apex peripheral zone measuring 8 x 6 mm (series 901, image 10) with corresponding restricted diffusion and early arterial enhancement.Central Gland: Moderate degree prostatic hypertrophy.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: No extracapsular extension is present.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.T2 hypointense focus in the right apex peripheral zone suspicious for malignancy.


Instruction: Generate impression based on findings.

Input: Clinical question: 66-year-old male with HCC, left eye proptosis, CT head negative, concern for possible metastases. Signs and symptoms: Left eye ptosis, headache. Nonenhanced brain MRI:No acute intracranial process and negative diffusion weighted series.Examination demonstrate mild patchy foci of periventricular and subcortical low-attenuation white matter which although nonspecific this appearance is often is secondary to microvascular ischemic changes.There is a small mass within the left aspect of the pituitary gland and apparent extension laterally into the left cavernous sinus as well as deviation of the pituitary stalk to the right. There is no associated bony changes with this finding on current brain MRI exam or prior head CT exam. This appearance is highly suggestive of a pituitary adenoma with invasion of the left cavernous sinus. The finding measures approximately 11 x 11 mm on coronal T2 weighted series 901 image 14. Remote possibility of metastases can also be considered. Lack of intravenous contrast reduces more precise evaluation of the lesion. The basal cistern remains widely patent and the left cavernous sinus demonstrate no decrease caliber secondary to tumor on this nondedicated exam.The signal intensity and anatomical morphology of the brain is otherwise within normal limits and with normal signal intensity on all MRI sequences.Calvarium demonstrate normal signal intensity.Images through the orbits are unremarkable. All paranasal sinuses and bilateral mastoid air cells and middle ear cavities remain well pneumatized.

Output: 1.No acute intracranial process.2.Negative diffusion weighted images and findings suggestive of mild chronic small vessel ischemic strokes only in the subcortical and periventricular white matter.3.Small pituitary adenoma on the left with invasion of the left cavernous sinus and subtle deviation of pituitary stalk to the right as detailed.4.Unremarkable nonenhanced brain MRI otherwise.5.Postcontrast images are recommended for more precise assessment.


Instruction: Generate impression based on findings.

Input: There is straightening of cervical spine. The osseous marrow signal is within normal limits for patient age. The cord signal is within normal limits.There is mild congenital narrowing of the cervical spine with mild superimposed degenerative findings as described below. C2-3: Minimal disk/endplate degenerative changes with no significant spinal canal or neural foramina stenosis. C3-4: Minimal disk/endplate degenerative changes with no significant spinal canal or neural foramina stenosis. C4-5: Mild bilateral facet arthropathy with no significant spinal canal or neural foramina stenosis. C5-6: Small disk osteophyte complex with no significant spinal canal or neural foramina stenosis. C6-7: Disk osteophyte complex with effacement of ventral CSF and no significant significant spinal canal or neural foramina stenosis. C7-T1: 2 mm anterolisthesis of C7 on T1 with uncovering of the disk and ventral CSF effacement with no significant spinal canal or neural foramina stenosis.

Output: Mild congenital narrowing of the cervical spinal canal with minimal degenerative changes as detailed above. No focal high grade spinal canal stenosis at any level. No significant neural foraminal stenosis.


Instruction: Generate impression based on findings.

Input: Right hip pain with history of labral repair 5 years ago. ACETABULAR LABRUM: There is rounding of the anterior superior aspect of the acetabular labrum which may reflect prior surgery. Gadolinium contrast enters the substance of the anterior superior labrum at approximately the 1:00 position suggesting a partial thickness tear. The posterior labrum appears intact.ARTICULAR CARTILAGE AND BONE: Small foci of signal abnormality within the anterior superior aspect of the acetabular dome may be postoperative in etiology or represent degenerative cysts. There is thinning of the overlying articular cartilage. Posteriorly, the articular cartilage appears intact. Focal scalloping along the anterior aspect of the femoral head/neck junction likely reflects prior osteotomy. Just above this defect, there is slight prominence of the anterior aspect of the head/neck junction with an alpha angle of approximately 55 degrees. There is also slight prominence of the lateral aspect with head neck junction with alpha angles measuring between 55 and 60 degrees. On the large field-of-view images, the sacroiliac joints appear normal. Minimal irregularity of the body of the left pubic bone along the symphysis may represent mild degenerative erosion. Aside from the aforementioned changes, bone marrow signal intensity is otherwise within normal limits.SOFT TISSUES: The ligamentum teres appears intact. The musculature of the hip and pelvis appears within normal limits.

Output: Findings suggestive of anterior superior labral tear with postoperative and degenerative arthritic changes of the anterior superior aspect of the hip joint and mild cam deformity as described above.


Instruction: Generate impression based on findings.

Input: 61 yo male with history of head of pancreas mass, follow-up. ABDOMEN:LIVER, BILIARY TRACT: Hepatic parenchymal signal is within normal limits. A subcentimeter cyst is present within segment 1. No suspicious focal hepatic lesions are identified. There is cholelithiasis without evidence of cholecystitis.SPLEEN: No significant abnormality noted.PANCREAS: A lobulated cystic structure in the head of the pancreas is mildly increased in size since the prior examination. It currently measures 1.5 x 1.2 x 2.3 cm (series 10, image 25 and series 9, image 19), previously 1.5 x 1.2 x 1.8 cm. The lesion contains fine internal septations but does not demonstrate suspicious features such as enhancement or nodularity. The lesion possibly communicates with the pancreatic duct. There is no significant pancreatic ductal dilatation. ADRENAL GLANDS: Circumscribed round right adrenal lesion demonstrates signal dropout on opposed phase imaging is most consistent with an adenoma and is not significantly changed.KIDNEYS, URETERS: Bilateral renal cysts of varying complexity without significant interval change.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Mild interval increase in size of a lobulated cystic structure in the pancreatic head. The lesion possibly communicates with the pancreatic duct and lacks suspicious features. Continued follow up is recommended. 2.Stable appearance of right adrenal adenoma and renal cysts.


Instruction: Generate impression based on findings.

Input: There is mild motion artifact degrading image quality. The cerebellar tonsils terminate above the foramen magnum. There is no acute infarct, mass effect or midline shift. The ventricles and basal cisterns are appropriate for patient age. There is no hydrocephalus. The flow-voids of the skull base are intact. There is mild left and trace right maxillary sinus mucosal thickening.

Output: No evidence of Chiari I malformation or other acute intracranial abnormality.