Instruction: Generate impression based on findings.

Input: 51 year old woman with SLE, new heart failure referred for evaluation of myocarditis. Left VentricleThe left ventricle is mildly dilated with moderately reduced systolic function. The overall LV ejection fraction is 33%, the LV end diastolic volume index is 103 ml/m2 (normal range: 65+/-11), the LVEDV is 168 ml (normal range 109+/-23), the LV end systolic volume index is 69 ml/m2 (normal range 18+/-5), the LVESV is 112 ml (normal range 31+/-10), the LV mass index is 63 g/m2 (normal range 67+/-11), and the LV mass is 103 g (normal range 114+/-24). LV dysfunction is global with regional variation. There is extrinsic compression of the lateral wall by heavily stool filled loops of bowel in the abdomen. On T2 STIR and early post-gadolinium T1 BB imaging are unremarkable. The extracellular volume fraction is 28%, which is within the normal range. These findings (T2, early gadolinium enhancement imaging, and ECV) suggest that there is no active diffuse inflammation. The interventricular septum myocardial T1 time is 1201ms (blood cavity 1729ms) which is significantly abnormally elevated, which suggests the presence of an underlying fibrosing or infiltrative process. There is an area of patchy late gadolinium enhancement in the basal to mid inferolateral wall. The pattern is atypical for myocardial infarction and also suggests the presence of an underlying fibrosing or infiltrative process. Left AtriumThe left atrium is normal in size.Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 42%, the RV end diastolic volume index is 76 ml/m2 (normal range 69+/-14), the RVEDV is 124 ml (normal range 110+/-24), the RV end systolic volume index is 44 ml/m2 (normal range 22+/-8), and the RVESV is 72 ml (normal range 35+/-13). Right AtriumThe right atrium is mildly dilated Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a "psuedo-bovine" brachiocephalic branching pattern (normal variant). The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is a small to moderate pericardial effusion located posteriorly.Extracardiac FindingsThere are mild bilateral pleural effusions with atelectasis or consolidation of both lungs. 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 mildly dilated with moderately reduced systolic function. The overall LV ejection fraction is 33%. 2. The interventricular septum myocardial T1 time is 1201ms which is abnormally elevated and there are areas of patchy late gadolinium enhancement in the basal to mid inferolateral wall in a pattern atypical for myocardial infarction. These findings suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. Based on T2-weighted imaging, early gadolinium enhancement, and ECV fraction, there is no evidence of diffuse active inflammation. 3. The right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 42%.4. There is a small to moderate pericardial effusion, posterior located.5. See extra cardiac findings above.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Chiari malformation: headaches. The cerebellar tonsils are mildly pointed and extend up to 5 mm inferior to the foramen magnum. In addition, there is crowding of the tissues at the foramen magnum with diminished flow of cerebrospinal fluid posteriorly, but the flow of cerebrospinal fluid is preserved anteriorly. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The conus medullaris is positioned at the L1-2 level. There is no evidence of fibrofatty filum. The paravertebral soft tissues are unremarkable.

Output: 1. The cerebellar tonsils extend up to 5 mm inferior to the foramen magnum with other feature of Chiari 1 malformation.2. No evidence of syringohydromyelia.


Instruction: Generate impression based on findings.

Input: Evaluate ventriculoperitoneal shunt. Nonenhanced head CT:Examination demonstrates a right-sided ventricular catheter entering from the right paramedian high convexity frontal lobe, traversing the right frontal lobe, entering the dilated right frontal horn, traversing the midline and the tip in the left dilated frontal horn. The position of the shunt has not change since prior head CT.Dilated supratentorial ventricular system is again noted. Compared to prior MRI and head CT no definitive appreciable interval change.Periventricular low-attenuation white matter a similar to increased signal intensity noted on prior MRI.No evidence of intracranial hemorrhage, edema or midline shift.

Output: 1.Dilated supratentorial ventricular system with no appreciable interval change since prior exam.2.No change in position of right-sided ventricular catheter.3.No evidence of any new acute intracranial findings.


Instruction: Generate impression based on findings.

Input: 56 year old female with history of occult right breast cancer with right axillary metastases (1/35 node positive, ER/PR-) status post right axillary lymph node dissection, chemotherapy and radiation therapy in 2/2010. History of benign left breast biopsy. There is heterogeneous amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.Stable small non-mass enhancement in the posterior right breast at the level of the nipple. No new or suspicious enhancement.Stable multiple non-uniquely enhancing foci in the left breast. Biopsy artifact and clip artifact in the left central breast from prior benign left breast biopsy. No new or suspicious enhancement.Postsurgical changes of the right axilla. No abnormal lymph node in either axillary region.

Output: No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: 34 years Female (DOB:1/26/1982)Reason: h/o cervical cancer s/p chemoradiation, assess for metastatic disease and spinal fractures History: back painReferring Attending: SEIKO DIANE YAMADA Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. No abnormal enhancing lesions are appreciated in the lumbar spine.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.No compromise to lumbar spinal canal or neural foramina.2.No evidence for spinal metastases.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate stenosis. Signs and symptoms: Neck pain. No unenhanced cervical MRI:Examination demonstrates normal anatomical alignment of vertebral column and stable since prior study.Foramen magnum is unremarkable and stable since prior exam.C2-C3 demonstrate moderate disc disease and loss of disc height and minimal ligamentum flavum hypertrophy. Mild central spinal stenosis, significant bilateral (L>R)neural foraminal compromise without significant change since prior exam.C3-C4 demonstrate advanced disc disease and loss of disc height, significant broad-based bulging disc without spinal stenosis however with significant bilateral neural foraminal compromise and stable since prior study. There is evidence of posterior laminectomy at this level similar to prior exam.C4-C5 demonstrate advanced disc disease with significant loss of disc height, prior posterior laminectomy and expansion of thecal sac without spinal stenosis. Significant bilateral neural foraminal compromise without change since prior exam.C5-C6 demonstrate advanced disc disease and loss of disc height, prior posterior laminectomy, expansion of thecal sac and no central spinal stenosis similar to prior study. Significant bilateral neural foraminal compromise similar to prior exam.C6-C7 demonstrate moderate disc disease and loss of disc height, large central disc protrusion with resultant mass effect and posterior displacement of the cord and severe central spinal stenosis with interval worsening since prior study. There is no convincing evidence of cord signal abnormality at this level. C7-T1 demonstrate mild disc disease and hypertrophic changes of posterior elements without spinal stenosis however moderate bilateral neural foraminal compromise is present.There is revisualization of a stable localized myelomalacia of the cord and decreased cord caliber at C5 level.Upper most visualized thoracic cord and spine is unremarkable.

Output: 1.Degenerative changes at C6-C7 with resultant severe central spinal stenosis and interval worsening since prior exam. Bilateral neural foraminal compromise as detailed.2.Stable focus of cord myelomalacia at C5 and no detectable focus of signal abnormality of the cord otherwise.3.Mild Central spinal stenosis at C2-C3 without change since prior exam.4.Stable postoperative changes of multilevel laminectomy at C3 to C6 levels with expansion of the spinal canal and no central spinal stenosis.5.Multilevel bilateral neural foraminal compromise (mostly of significant degree) without significant change since prior exam.


Instruction: Generate impression based on findings.

Input: 51-year-old female with cervical cancer. Restaging cervical cancer prior to brachytherapy. PELVIS:UTERUS, ADNEXA: There is interval improvement in the previously described left-sided cervical-vaginal lesion (axial series 3 image 19). This lesion is not well delineated on the current exam with slight decrease in size, loss of the previously described suspicious intermediate T2 signal intensity, and lack of diffusion-weighted signal. Mild motion artifact is noted at this level. There are changes in technique compared to the prior exam with the use of the vaginal gel on the current study. Mild stranding of fat on the right side is unchanged.Multiple small uterine fibroids are again noted.BLADDER: Intraluminal air within the urinary bladder is felt to be due to recent intervention. Clinical correlation is needed.LYMPH NODES: No pelvic lymphadenopathy.BOWEL, MESENTERY: As noted on the prior PET/CT exam, there is a peritoneal dialysis catheter coiled in the pelvis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Interval improvement in the previously described left-sided cervical-vaginal lesion with loss of the suspicious intermediate T2 signal intensity and lack of diffusion-weighted signal. This could represent nonviable tumor versus scarring.


Instruction: Generate impression based on findings.

Input: cT4a N2c right oral tongue squamous cell carcinoma treated with induction chemo and TFHX on protocol 12-1712. There are post-treatment findings in the upper neck, with diffuse swelling of the supraglottic tissues and suggestion of mucositis. There is no evidence of residual measurable right oral tongue tumor. There is also interval decrease in size of a necrotic left level 1B lymph node, which measures 7 x 9 mm in axial cross-section, previously 10 x 12 mm a left level 4 lymph node measures 7 x 10 mm, previously 9 x 12 mm, and a right level 2A lymph node measures 5 x 7 mm, previously 10 x 24 mm, for example. There is a punctate left thyroid cyst. The salivary glands, orbits, and imaged intracranial structures are unremarkable. There are small posterior disc-osteophyte complexes at C5-6 and C5-6 and reversal of the usual cervical lordosis.

Output: Post-treatment findings without evidence of gross measurable residual right oral tongue tumor or residual significant cervical lymphadenopathy.


Instruction: Generate impression based on findings.

Input: Right hand numbness in ulnar 2 digits. Evaluate for nerve root compression, especially C8. Examination is motion degraded. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. There is minimal retrolisthesis of C5 on C6. Alignment is otherwise maintained. Bone marrow signal is within normal limits. The cervical spinal cord has normal signal characteristics and overall morphology.Degenerative changes are seen in the cervical spine as described below:C2-3: There is bilateral facet arthropathy with moderate right and mild left neural foraminal stenosis. No significant spinal canal stenosis.C3-4: Minimal disc osteophyte complex and uncovertebral hypertrophy and facet arthropathy. No significant spinal canal or neural foraminal stenosis.C4-5: Small disc osteophyte complex with partial effacement of the ventral thecal sac. No significant spinal canal stenosis. No significant right neural foraminal stenosis. Mild left neural foraminal stenosis. Left-sided facet arthropathy.C5-6: Small disc osteophyte complex, ligamentum flavum thickening, and uncovertebral hypertrophy without significant spinal canal stenosis. There is severe right and mild to moderate left neural foraminal stenosis related to uncovertebral hypertrophy. C6-7: Minimal disc osteophyte complex and ligamentum flavum thickening. No significant compromise to the spinal canal or neural foramina.C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: Multilevel degenerative changes in the cervical spine as detailed above. There is up to severe right C5-C6 neural foraminal stenosis. No appreciable compression of the C8 nerve root in the C7-T1 neural foramen is appreciated.


Instruction: Generate impression based on findings.

Input: Female 73 years old Reason: cuff tear History: pain ROTATOR CUFF: There is a full-thickness tear of the supraspinatus tendon from its insertion with approximately 1.5 cm of proximal retraction. This full-thickness tear is approximately 1.5 cm in AP dimension and involves the anterior fibers. There is a delaminating undersurface tear of the remaining supraspinatus tendon more posteriorly with a thin set of bursal surface fibers extending to the greater tuberosity. There is tendinosis and interstitial tearing of the retracted supraspinatus tendon. This tear extends posteriorly to involve the anterior fibers of the infraspinatus tendon. The remainder of the infraspinatus tendon is abnormally thickened indicating tendinosis and there is interstitial tearing more proximally within the tendon that extends through the bursal surface fibers. There is mild fatty infiltration of the supraspinatus and infraspinatus muscles. No significant abnormality of the teres minor muscle or tendon. No significant abnormality of the subscapularis muscle or tendon.SUPRASPINATUS OUTLET: Mild osteoarthritis of the acromioclavicular joint. There is a small amount of fluid in the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is normal. The labrum and articular cartilage appear normal for age. There is a small amount of fluid in the glenohumeral joint without large effusion.BICEPS TENDON: The biceps tendon is normal for age. There is fluid within the biceps tendon sheath which may represent extension of fluid from the joint. ADDITIONAL

Output: Rotator cuff tear and other findings as detailed above.


Instruction: Generate impression based on findings.

Input: Right knee pain. Question of right knee ACL tear. MENISCI: There is linear signal intensity with vertical and horizontal components within the body of the lateral meniscus along with vertical signal abnormality within the anterior horn compatible with complex tearing. Additionally there is increased fluid signal adjacent to the anterior horn and body of the lateral meniscus compatible with parameniscal cyst formation. The medial meniscus is intact.ARTICULAR CARTILAGE AND BONE: The articular cartilage is intact. Bone marrow signal is within normal limits.LIGAMENTS: There is complete rupture of the anterior cruciate ligament. The posterior crucial ligament is intact. The collateral ligaments are intact.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1. Complete tear of the anterior cruciate ligament.2. Complex tearing of the anterior horn and body of the lateral meniscus.


Instruction: Generate impression based on findings.

Input: 42-year-old female with a known cavernoma. Please evaluate for CCMs. There is a 4 x 6 mm T1 and T2 hypointense lesion in the left pons that demonstrates susceptibility abnormality. There is some peripheral enhancement which enhances faintly in the periphery surrounding the central hypointensity indicating an anomalous draining vein. These findings are unchanged compared to the prior exam and are compatible with a small cavernous malformation.There is no evidence of acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is mild right greater than left maxillary sinus and scattered ethmoid air cell mucosal thickening. The orbits, skull, and scalp soft tissues are grossly unremarkable.

Output: Small cavernous malformation of the left pons and adjacent small anomalous draining vein without significant change compared to the brain MRI from 2/19/2016. There are no new enhancing lesions in the brain.


Instruction: Generate impression based on findings.

Input: Following a discussion of the procedure with the patient and/or family, including its risks, benefits, alternatives and steps to prevent infection, informed written consent was obtained and documented in the patient's chart. The time-out form was completed to confirm patient identity and side/type of procedure. All operators present for the case performed standard preprocedural prep including hand washing, sterile gloves, mask and cap. The patient was prepped and draped in the usual aseptic fashion. Local anesthesia over the target area was obtained by 1% lidocaine. Localizing ultrasound examination demonstrates a heterogeneously hypoechoic oval encapsulated mass along the inferolateral aspect of the right knee, corresponding to the findings seen on recent MRI examination. There is internal and peripheral vascularity on Doppler interrogation. A 16-gauge Achieve core biopsy needle was advanced into the lesion using ultrasound guidance. Four 16-gauge core biopsy specimens were obtained and placed in formalin.The core biopsy specimens were hand carried to the Surgical Pathology labThe patient tolerated the procedure well without immediate complication. Routine post procedure instructions were communicated to the patient.ESTIMATED BLOOD LOSS: Less than 5cc. An adhesive bandage was placed on the patient’s skin.

Output: Ultrasound-guided biopsy of right knee soft tissue mass.


Instruction: Generate impression based on findings.

Input: Vertebral body heights are preserved. Again seen is severe levoscoliosis of the lumbar spine with apex at the L1-L2 level which can be better assessed on radiographs. There is mild rightward subluxation of T12 on L1 and L1 on L2. Bone marrow signal is benign. A small 11 mm left S2 Tarlov cyst is again noted. Multilevel degenerative changes are again seen. Differences in axial planes related to scoliosis makes comparison difficult.L1/2: There is disk bulge eccentric to the right. There is effacement of the right lateral recess and severe right neural foraminal stenosis. There are severe endplate changes on the right with mild right lateral subluxation of L1 on L2. No significant central spinal canal or left neural foramina narrowing.L2/3: There is disk bulge eccentric to the right with partial effacement of the right lateral recess and severe right neural foraminal stenosis. There is hypertrophy of the ligamentum flavum and facet joint on the right side, contributing to the right neural foraminal narrowing. No significant spinal canal stenosis. There is minimal left neural foramina narrowing related to disk bulge.L3/4: There is mild diffuse disk bulge with severe right neural foramina stenosis. There is mild left neural foramina stenosis. No significant spinal canal stenosis.L4/5: Diffuse disk bulge asymmetric to the left with severe left neural foramina stenosis again demonstrated. There is prominent left-sided facet arthropathy which also contributes. There is mild central spinal canal stenosis related to ligamentum flavum thickening. L5/S1: Mild central disk protrusion. No significant spinal canal stenosis or foraminal narrowing.

Output: 1. Multilevel degenerative changes with severe levoscoliosis of the lumbar spine with apex at the L1-L2 level.2. There is no high-grade spinal canal stenosis at any level.3. Severe neural foramina stenosis at right L1-L2, right L2-L3, right L3-L4, and left L4-L5 levels.


Instruction: Generate impression based on findings.

Input: MRI brain: There is no restricted diffusion to suggest acute infarct. Redemonstrated is right greater than left encephalomalacia in the ACA-MCA watershed territory and encephalomalacia in the inferior left cerebellar hemisphere, consistent with chronic infarcts. There right cerebral hemispheric volume loss with mild ex vacuo dilatation of the right lateral ventricle. There is decreased caliber of the vessels in the right cerebral hemisphere. There are punctate and curvilinear foci of susceptibility artifact in the left cerebellar hemisphere, consistent with hemosiderin deposition from chronic hemorrhagic infarct. There is also a small focus of susceptibility artifact in the left temporal lobe, consistent with hemosiderin deposition. There is a small retention cyst in the right maxillary sinus. There is diffuse thickening of the skull, which is likely related to sickle cell disease.MRA brain: There is marked narrowing of the intracranial right internal carotid artery and right middle cerebral artery. The right M1 and right A1 segments are not visualized. The right ACA distal to the right A1/A2 junction is normal in caliber. The left ICA and M1 segments are normal in caliber. The left anterior cerebral artery is also diminished in caliber. There are multiple prominent lenticulostriate, right greater than left, as well as transcallosal and pericallosal collateral vessels. There is asymmetrically diminished caliber of the right MCA cortical branches. The right distal ACA, PCOM and PCA and left MCA and PCA and their distal branches are mildly dilated in caliber. The basilar artery and imaged portions of the vertebral arteries appear unremarkable. There is no evidence of cerebral aneurysms.

Output: 1. Findings compatible with Moya Moya disease in the setting of sickle cell anemia, more severely affecting the right sided cerebral vasculature. No significant change since 1/29/2014.2. No evidence of acute infarct. Chronic infarcts in the ACA-MCA watershed territories, right greater than left, and left PICA territory.


Instruction: Generate impression based on findings.

Input: Clinical question: History of lung cancer, compare to prior exam and provide measurements. Signs and symptoms: None. Pre-and post-enhanced brain MRI:No diffusion weighted abnormalities.Examination demonstrates significant interval improvement of metastatic lesions of cerebral and cerebellar hemispheres since prior exam.Several of the very small infra and supratentorial lesions are no longer detected.There is a tiny 2.5-mm metastatic lesion in the superior aspect of right cerebellar which has decreased in size from prior study measurement of approximately 4.4 mm. The other in cerebellar metastatic lesions are no longer detected.There is age remaining left basal ganglia enhancing metastatic lesion measuring 2.4-mm compared to prior density measurements of 9.9-mm.There is a left posterior temporal 1 mm focus of enhancing metastatic tumor which has decreased in size since prior study measurement of 5.3 mm.A right frontal enhancing metastatic lesion measuring 2.4-mm compared to prior study measurement of 6.8. Several additional small previously noted metastatic lesions are cerebral hemispheres are no longer identified.Stable nonspecific patchy foci of flair hyperintensity (left greater than right) could represent chronic small vessel ischemic strokes and likely with overlapping post treatment/radiation change. Ventricular system remains stable in size and maintained midline.

Output: 1.Significant interval improvement of metastatic disease since prior exam.2.Several of the smaller previously known supratentorial and infratentorial metastatic lesions are no longer visible on this study.3.Few remaining metastatic lesions all demonstrate interval decreased size as detailed/measured above.


Instruction: Generate impression based on findings.

Input: BRAIN: There are multiple patchy foci of T2 hyperintensity within the supratentorial white matter, including the juxtacortical and periventricular white matter. There are no identified infratentorial lesions. Some of the larger lesions demonstrate T1 hypointensity although none enhance. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull and scalp soft tissues are unremarkable. There is mild paranasal sinus mucosal thickening and a right maxillary sinus retention cyst. CERVICAL SPINE: The spinal cord displays normal signal and morphology. There is no evidence of intraspinal mass or abnormal enhancement. 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 paravertebral soft tissues are unremarkable. There are mild degenerative changes within the mid to lower cervical spine with mild uncovertebral joint arthropathy and small disc osteophyte complexes mainly at the C3 through C6 levels without spinal canal or neural foramen stenosis.

Output: Multiple non-enhancing supratentorial juxtacortical and periventricular white matter lesions compatible with history of MS. No enhancing lesions and no infratentorial or cervical spinal cord lesions.


Instruction: Generate impression based on findings.

Input: Clinical question: Encephalopathy? Patient altered status post extubation history of multiple myeloma. This extrahepatic; upward going Babinski; areflexia. Nonenhanced brain MRI:No acute intracranial process and negative diffusion weighted series.Examination demonstrate scattered tiny foci of FLAIR and T2 hyperintensity in the subcortical and periventricular white matter which are nonhemorrhagic and nonspecific. This appearance however in this age group is often result of microvascular ischemic changes. Minimal similar signal changes in the basal ganglia is also noted.The cerebral cortex and cortical sulci as well as ventricular system and CSF spaces are within normal restaging age and maintained midline.The signal void of major intracranial branches are identified. Unremarkable images through the orbits.Bilateral mastoid air cells demonstrate extensive opacification however without detectable opacification of middle ear cavities.Paranasal sinuses remain well pneumatized and only a small retention cyst in the left chamber of the sphenoid sinus is noted.

Output: 1.No acute intracranial process.2.Mild chronic small vessel ischemic strokes as detailed and unremarkable exam otherwise.3.Opacification of bilateral mastoid air cells.


Instruction: Generate impression based on findings.

Input: Patient used prophylactic antibiotics before and after the procedure as prescribed. The patient received antibiotic prophylaxis with oral Ciprofloxacin 500mg and Vantin 200mg. The patient took 1 tablet of Ciprofloxacin 500mg the night before and morning of the procedure. The patient also took 2 tablets of Vantin 200mg the morning of the procedure. After the procedures, the patient will take 2 tablets of Ciprofloxacin 500mg and 2 tablets of Vantin 200mg.Following the discussion of the risks, benefits, and alternatives of the procedure, informed consent was obtained. DynaCad was used to localize the left base peripheral zone of the prostate at the site of the T2 hypointense lesion. Using the Dynatrim guidance system an 18-gauge MR- compatible needle was inserted into the left side of the prostate. Upon confirmation of the tip of the needles close to the suspected lesion, MR guided biopsy using an 18 gauge biopsy needle was performed and 3 cores were obtained.The cores were hand delivered to the pathology lab.The patient tolerated the procedure well and was discharged without any immediate complications.ESTIMATED BLOOD LOSS: Less than 5 cc.

Output: 1. Successful core-biopsies of the left base prostate gland peripheral zone lesion.


Instruction: Generate impression based on findings.

Input: Multiple enhancing lesions are again identified. A right post central gyrus lesion (series 401, image 142) appears smaller than the prior examination with decreased enhancement and internal signal compatible with necrosis. The degree of surrounding vasogenic edema also appears decreased on the current examination. Small enhancing nodules in the right frontal lobe, right basal ganglia, and left cerebellum appear smaller. The ventricles and sulci are normal in size. There is no susceptibility artifact to indicate intracranial hemorrhage. Flow voids are present within the major vessels indicating patency.

Output: Multiple intracranial metastases as described above appearing smaller than the prior examination with slightly decreased edema.


Instruction: Generate impression based on findings.

Input: Ms. Woodward is a 43 year old female with a personal history of Li Fraumeni syndrome. She is status post bilateral nipple sparing mastectomy. Evaluate for residual breast tissue. Patient is status post bilateral nipple sparing mastectomy with bilateral implant-based reconstruction. There is no residual breast tissue bilaterally. The left reconstructed breast demonstrates moderate skin thickening and parenchymal edema. In addition, there are two linear enhancing areas identified in the left lower inner breast, that measure 1.0 and 1.5 cm respectively. These enhancing areas abut against the implant. There is no abnormal enhancement in the right reconstructed breast. No abnormal lymph nodes are identified in either axillary or internal mammary region.

Output: (1) No residual breast tissue identified bilaterally.(2) Two linear enhancing lesions in the left lower inner breast along with moderate skin thickening/parenchymal edema. Based on the patient's EMR, a prior MRI was obtained in 2014. Recommend submission of this MRI to evaluate for stability of these findings. If not available, then an MR-directed ultrasound should be performed of the left lower inner breast along with clinical correlation of patient's medical records to clarify the etiology behind the MR findings. (3) No MRI evidence for malignancy in the right reconstructed breast.BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: O - Old Study For Comparison.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Right knee pain. MENISCI: There is a bucket handle tear of the medial meniscus with displacement of meniscal tissue centrally. The lateral meniscus appears normal.ARTICULAR CARTILAGE AND BONE: Articular cartilage and bone appear normal.LIGAMENTS: Cruciate and collateral ligaments are intact. Small amount of fluid between the iliotibial band and the lateral femoral condyle may reflect friction syndrome. EXTENSOR MECHANISM: Extensor mechanism is intact.ADDITIONAL

Output: Bucket handle tear of the medial meniscus and other findings as above.


Instruction: Generate impression based on findings.

Input: Brain: There is diffuse global parenchymal volume loss. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. Punctate focus of susceptibility in the left parietal lobe versus adjacent sulcus is nonspecific, but may reflect a chronic microhemorrhage. Small T1 hyperintense, T2 hypointense focus in the left frontal sinus compatible with a proteinaceous cyst. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. Mild mucosal thickening in the maxillary sinuses and ethmoid air cells. Fluid in the mastoid air cells bilaterally. There is no abnormal enhancement within the brain. Orbits: No abnormal mass or abnormal enhancement is seen. No abnormal signal intensity is evident. The optic nerves are normal in size and signal intensity, and are symmetric bilaterally. No retrobulbar mass, chiasmatic mass, or parasellar abnormality is seen. Extraocular muscles are unremarkable.

Output: No specific findings in the MRI of the brain or orbits to account for the patient's diplopia.


Instruction: Generate impression based on findings.

Input: History of hydrocephalus, neurogenic bladder, neurogenic dysphagia, vocal tremor, cerebral cyst, Chiari malformation with decompression, syrinx, ataxia, headache, falls, complicated UTI, hypothyroidism, and VA shunts. Brain: There are postoperative findings related to complex Chiari decompression surgery with extensive encephalomalacia and punctate foci of susceptibility effect in the medial portions of the cerebellum and left middle cerebellar peduncle. There is interval involution of the cystic cavity in the left cerebellomedullary angle cistern, while the cystic compartment in the right cerebellomedullary angle cistern persists, measuring 9 x 12 mm in axial cross-section. There is interval decreased T2 hyperintensity and swelling of the bilateral medullary olives. There is no evidence of acute infarct. There is a left transparietal ventricular shunt catheter that terminates in the right frontal horn. The third and lateral ventricles are nearly collapsed. There is linear encephalomalacia that traverses the body of the corpus callosum into the bilateral centrum semiovale. There is also a prior left transfrontal catheter track. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are unremarkable.Spine: There are postoperative findings related to complex Chiari decompression surgery with a persistent transverse low signal band that kinks the anterior aspect of the upper spinal cord at the level of the dens. There is persistent extensive central T2 hyperintensity throughout the cervical and upper thoracic spine. There is persistent lack of the usual cervical lordosis. The rest of the vertebral column alignment is otherwise anatomic. There is prominence of the epidural venous plexus in the anterior craniocervical junction region. There are scattered extramedullary intrathecal foci of low signal intensity throughout the spinal canal, particularly posteriorly. There also appears to be clumping of the lower cauda equina nerve roots. There is a small posterior disc-osteophyte complex at the C6-7 level, but no significant degenerative spondylosis in the thoracic and lumbar spine. The vertebral body heights are preserved.

Output: 1. Postoperative findings related to complex Chiari decompression surgery with persistent encephalomalacia and punctate foci of chronic hemorrhage in the medial portions of the cerebellum and left middle cerebellar peduncle and a cystic compartment in the right cerebellomedullary angle cistern, but interval involution of the cystic cavity in the left cerebellomedullary angle cistern. 2. Persistent extensive central T2 hyperintensity throughout the cervical and upper thoracic spine, which may represent a combination of edema and myelomalacia, perhaps aggravated by a persistent apparent fibrotic band that kinks the upper spinal cord at the level of the dens.3. Scattered extramedullary intrathecal foci of low signal intensity throughout the spinal canal and apparent clumping of the lower cauda equina nerve roots, which may be related to arachnoiditis incited be chronic hemorrhage. 4. The shunted third and lateral ventricles are nearly collapsed. 5. Interval evolution of hypertrophic olivary degeneration, which is now less conspicuous.


Instruction: Generate impression based on findings.

Input: New onset migraine with visual aura. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are a few punctate foci of T2 hyperintensity in the bilateral frontal lobe white matter. The brainstem, cerebellum, and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Orbits: The bilateral globes, optic nerves, orbital fat, extraocular muscles, and lacrimal glands are unremarkable. There is no evidence of intraorbital mass lesions.

Output: 1. A few punctate foci of T2 hyperintensity in the bilateral frontal lobe white matter are nonspecific, but may potentially be associated with migraine disorder. Otherwise, no evidence of intracranial hemorrhage, mass, or acute infarct. 2. No evidence of orbital lesions.


Instruction: Generate impression based on findings.

Input: Other abnormalities of gait and mobility [R26.89] / Repeated falls [R29.6] / Malignant neoplasm of right ciliary body [C69.41], Reason for Study: ^Reason: melanoma, falls for 3 months. History: as above No evidence of acute ischemic or hemorrhagic lesion.Scattered T2/flair high signal intensity lesions on bilateral white matter are seen, these lesions are nonspecific and likely represent small vessel ischemic disease. Comparing to prior scan, grossly the number and size of which lesions are unchanged except left lateral ventricle frontal horn area periventricular white matter lesion which is slightly more prominent than before. Again this finding is nonspecific.There is no evidence of abnormal enhancement.The ventricles, sulci and cisterns are unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Grossly unchanged multifocal bilateral white matter T2/FLAIR high signal intensity lesions since prior scan, likely represent nonspecific small vessel ischemic disease.2. No evidence of abnormal enhancement.3. No evidence of acute ischemic or hemorrhagic lesion.


Instruction: Generate impression based on findings.

Input: Male, 4 years old. Gunshot wound through left arm with wrist drop concerning for biceps tear or nerve damage. A linear area of fluid signal corresponding with the bullet tract courses through the distal upper arm soft tissues, tracking through the volar skin and subcutaneous soft tissues, the flexor compartment musculature including the biceps brachii and brachioradialis muscle bodies, lateral to the distal humerus, through the long head of the triceps muscle, and through the dorsolateral subcutaneous tissues.The tendons appear normal without evidence of rupture. No discrete fluid collection is identified.The underlying osseous structures are normal.

Output: The bullet tract traverses multiple muscles as detailed above. No tendon rupture, fracture, or fluid collection.


Instruction: Generate impression based on findings.

Input: 34 year old female with history of one episode of acute pancreatitis approx 3 years ago, EUS 11/16/12 showed focal inflammation. Follow up MRI/MRCP w/ gad and secretin to assess parenchyma and ducts. ABDOMEN:LIVER, BILIARY TRACT: Liver enhances homogeneously without focal lesion. Gallbladder is unremarkable.SPLEEN: No significant abnormality noted.PANCREAS: Previously seen inflammatory changes involving the pancreatic tail have resolved. No focal pancreatic lesion is identified. There is no pancreatic ductal dilatation. ADRENAL GLANDS: No significant adrenal nodularity or thickening.KIDNEYS, URETERS: Kidneys enhance symmetrically. No focal suspicious renal mass. No hydronephrosis or hydroureter.RETROPERITONEUM, LYMPH NODES: No significant retroperitoneal lymphadenopathy.BOWEL, MESENTERY: Bowel is normal in caliber without evidence of obstruction or ileus.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No evidence of pancreatic pathology. Given interval resolution of inflammatory changes of the pancreas without underlying lesion or ductal dilatation, prior findings are favored to have represented acute pancreatitis.


Instruction: Generate impression based on findings.

Input: Left cervical radicular symptoms Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained. Bone marrow signal is within normal limits. The cervical spinal cord has normal signal characteristics and overall morphology.Degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: No significant compromise to the spinal canal or neural foramina.C4-5: No significant compromise to the spinal canal or neural foramina.C5-6: There is a small disc osteophyte complex including uncovertebral hypertrophy as well as mild ligamentum flavum thickening contributing to mild spinal canal stenosis at this level. There is also mild bilateral neural foraminal stenosis.C6-7: There is a small disc osteophyte complex including uncovertebral hypertrophy as well as mild ligamentum flavum thickening contributing to mild spinal canal stenosis at this level. There is mild to moderate right and mild left neural foraminal stenosis. C7-T1: No significant compromise to the spinal canal or neural foramina.Mild generalized facet arthropathy. The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits. Small left thyroid nodule.

Output: Mild degenerative changes in the cervical spine at the C5-C6 and C6-C7 levels as described above. There is mild spinal canal and neural foraminal stenoses at these levels.


Instruction: Generate impression based on findings.

Input: Other disturbances of skin sensation [R20.8], Reason for Study: ^Reason: w/u for spinal cord lesions, ddx broad History: bilateral hand the foot numbness, subjective perianal and peroneal numbness Brain MRI:There is no evidence of acute ischemic or hemorrhagic lesion.There are multiple scattered high signal intensity lesion on FLAIR/T2 on bihemispheric white matter including periventricular white matter, centrum semiovale, left side midbrain, bilateral corpus callosum splenium, left putamen and the left middle cerebellar peduncle. On gadolinium enhancement, there are multiple punctate enhancing lesions including left superior parietal lobule, left side corpus callosum splenium and right angular gyrus (best seen on sagittal post enhanced scan).Constellation of above findings indicate underlying demyelinating disease such as multiple sclerosis with a couple of active plaques.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear.The right maxillary sinus show a retention cyst.Cervical and Thoracic spine MRI:There are multiple patchy high signal intensity lesions on cervical spinal cord at the level of C2, C3, C4, without definitive evidence of cord swelling. On post Gad enhanced images, there is focal nodular enhancement on the posterior aspect of the spinal cord lesion located at the level of C3.On thoracic cord, there is linear high signal intensity at the level of T56. Suspicious cord lesion with high signal intensity on STIR images was also seen at the level of T11, but was not definitively identified on axial scan.Cervical lordosis and thoracic kyphosis appear to be normal.The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The conus medullaris terminates at the level of T12L1.

Output: Multifocal intracranial and spinal especially cervical spinal white matter high signal intensity lesions with some nodular enhancing lesions. These findings suggest possibility of demyelinating disease such as multiple myeloma involving both brain parenchyme and spinal cord with some active plaques.


Instruction: Generate impression based on findings.

Input: Diagnosis: Compression of brain Headache CervicalgiaClinical question: Chiari malformation , yearly follow up , please do with CSF flow studySigns and Symptoms: headaches, neck pain MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. The patient is status post suboccipital craniotomy for Chiari decompression.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. A small syrinx measuring up to 1.5 mm is present at the C5 level approximately 1 cm in length.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina. There is a small central disc protrusion at this level.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.Lumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is a mild disc bulge present at this level.At L4-5 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.Status post Chiari I decompression. There is no obstruction at the level of the foramen magnum.2.Small syrinx is present in the cervical spinal cord at the C5 vertebral body level.3.There are minor degenerative changes present in the cervical and lumbar spine.


Instruction: Generate impression based on findings.

Input: 4 years, Male, partial seizures, intractable epilepsy, status post resection of left-sided seizure focus area.. Interval postsurgical changes of left temporoparietal craniotomy are seen with blood products/fluid containing resection cavity involving the left parietal lobe, left posterior temporal lobe including the hippocampus, as well as the lingual gyrus of the left occipital lobe. Expected postsurgical changes include restricted diffusion along the surgical cavity margin compatible with cytotoxic edema. There is small extra-axial collection on the left. There is a left-sided drainage catheter. Unchanged nodular focus of T2 hyperintensity involving the right frontal corona radiata. No large infarct, large hemorrhage, or significant mass effect is appreciated. No midline shift or herniation. No hydrocephalus. There is partial opacification of the left mastoid air cells.

Output: Expected postsurgical changes of epilepsy surgery with partial resection of the left temporal, parietal, and occipital lobes.


Instruction: Generate impression based on findings.

Input: A 74 year old male with history of hypertension, chronic kidney disease, coronary artery disease, s/p myocardial infarction and percutaneous coronary intervention to left circumflex and right coronary arteries, paroxysmal atrial fibrillation. Recently diagnosed with sarcoma in the left upper extremity. Due to intermittent low degree atrio-ventricular conduction defect (1st and Mobitz 2 degree AV block) was referred to cardiac MRI to rule out cardiac malignant involvement. Left VentricleThe left ventricle is normal in size with low-normal systolic function. The overall LV ejection fraction is 53%, the LV end diastolic volume index is 48 ml/m2 (normal range: 74+/-15), the LVEDV is 120 ml (normal range 142+/-34), the LV end systolic volume index is 23 ml/m2 (normal range 25+/-9), the LVESV is 56 ml (normal range 47+/-19), the LV mass index is 54 g/m2 (normal range 85+/-15), and the LV mass is 134 g (normal range 164+/-36). There is dyskinesis of the mid to apical inferior and infero-lateral walls. There is transmural late gadolinium enhancement and fatty replacement of the mid to apical inferior and infero-lateral walls . This findings is compatible with a transmural myocardial infarction and the affected segments are not viable. The remainder of the myocardium is viable and free of myocardial infarction or other forms of infiltration.No intracavitary thrombus was noted.No myocardial iron overload was noted.No malignant tumor was noted involving the heart.Left AtriumThe left atrium is normal in size (70ml). Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 50%, the RV end diastolic volume index is 48 ml/m2 (normal range 82+/-16), the RVEDV is 119 ml (normal range 142+/-31), the RV end systolic volume index is 24 ml/m2 (normal range 31+/-9), and the RVESV is 59 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 upper limits of normal size (37 x 37mm).Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumSignificant pericardial fat was noted with no effusion and without evidence of hemodynamic influence.Extracardiac FindingsA large left lung mass and mediastinal lymph nodes are noted. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with low-normal systolic function, the LVEF is 53%. There is dyskinesis of the mid to apical inferior and inferolateral walls.2. There is transmural late gadolinium enhancement at the mid to apical inferior and inferolateral walls. This findings is compatible with a transmural myocardial infarction and these segments are not likely to be viable. 3. No malignant tumor was noted involving the heart.4. The right ventricle is normal in size with normal systolic function, the RVEF is 50%. 5. See extra-cardiac findings. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Inflammation, check for osteomyelitis with left foot ulcer A moderate deep ulcer is noted under the ball of the foot as well as diffuse irregularities to the soft tissues of involving the more medial aspects and first digit. Severe degenerative and demineralization limits sensitivity creating mildly irregular cortical margins, specifically involving the base of the first proximal phalanx and head of the first metatarsal. No definite destruction and primary changes of osteomyelitis, however in light of the history and ulceration, concern remains. Follow-up serial imaging and/or possibly 3 phase bone scanning or MRI can be considered.The remainder of the second through fifth digits again demonstrate scattered more moderate degenerative changes more mild abnormalities in the midfoot and hindfoot. Mild to moderate arterial vascular disease. Diffuse additional soft tissue changes that may represent mild cellulitis.

Output: Marked limitations with nonspecific findings involving the first digit with an underlying moderately deep plantar ulceration. Close serial imaging and/or possibly 3 phase bone or scanning should be considered, if suspicion remains high and for confirmation.


Instruction: Generate impression based on findings.

Input: Examination is obtained without contrast. There is no evidence of acute infarct, hemorrhage, or other new findings when compared to prior. There is no gross change in the appearance of the diffuse bilateral hypothalamic-optic gliomas with lack of contrast and absence of dedicated orbital sequences limiting optimal comparison.Supracerebellar CSF intensity collection demonstrates no significant change in size since 11/13/2015 measuring approximately 16 mm in the craniocaudal dimension and 3 cm in the AP dimension in the midline. There is also no significant change in mass effect upon the underlying tectum, which remains thickened and demonstrates T2 signal at the level of the cerebral aqueduct and compatible with tectal glioma. No significant change in mild downward mass effect on the cerebellum. There is stable focal effacement of the cerebral aqueduct.Stable lateral and third ventricular dilatation as well as periventricular T2/FLAIR hyperintensity likely relating to chronic transependymal CSF flow. Surgical tracts related to prior ventriculostomy. There are stable foci of non-enhancing T2 hyperintensity in the anterior left frontal lobe and cerebellar white matter which are nonspecific, although the cerebellar findings likely represent FASI of NF-1. There is also no significant changes in the crowding at the foramen magnum with slightly pointed cerebellar tonsils. Cervicomedullary junction which is masslike also appears to be unchanged, with T2/STIR hyperintensity within this lesion better appreciated on prior spine studies. Mild retroflexion of the dens with platybasia also contribute to narrowing at the foramen magnum.

Output: 1. No acute findings. No appreciable change in the diffuse hypothalamic/optic gliomas although lack of contrast and dedicated orbital sequences limit optimal comparison.2. No significant change in ventricular dilatation and evidence transependymal flow. Supracerebellar cistern enlargement which demonstrates mass effect on the tectum is also not significantly changed.3. No significant change in tectal lesion which is compatible with a low-grade glioma. Masslike thickening at the cervicomedullary junction which is also suspected to be related to neoplasm is also not significantly changed. Crowding at the foramen magnum is also not significantly changed.


Instruction: Generate impression based on findings.

Input: Chronic meningoencephalitis, neoplasm, vasculitis. Persistent bilateral lower extremity weakness and encephalopathy of unclear etiology. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are extensive areas of abnormal T2 hyperintensity within the periventricular and subcortical white matter, a few of which are increased in size or new, notably in the left temporal lobe and posterior limbs of the bilateral internal capsules. There are similar signal changes in bilateral basal ganglia and bilateral paramedian pons to a lesser degree. There is no abnormal parenchymal or leptomeningeal enhancement. There is an apparent prior right transfrontal surgical track with linear susceptibility effect. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. There is a nonspecific peripherally enhancing 6 mm nodule in the right temporal subcutaneous tissues, which is unchanged from 11/17/2014. There are multiple prominent occipital arachnoid granulations. There is right posterior frontal burr hole. There is a mucous retention cyst in the right maxillary sinus.

Output: 1. No evidence of acute intracranial hemorrhage, mass, brain abscess, or acute cerebral infarct.2. Extensive areas of abnormal signal in the cerebral white matter are non-specific, but may represent chronic small vessel ischemic disease. 3. Nonspecific subcentimeter nodule in the right temporal subcutaneous tissues, unchanged from 11/17/2014.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Numbness in feet Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position.Minimal degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: No significant disc disease. No spinal canal or neural foraminal stenosis.L4-L5: Mild disc desiccation, left dorsolateral annular fissure, and mild bulge. There is minimal left neural foraminal narrowing. No significant spinal canal or right neural foraminal narrowing. Mild facet arthropathy.L5-S1: No significant disc disease. No spinal canal or neural foraminal stenosis. Mild facet arthropathy.Paraspinous soft tissues are within normal limits.

Output: Minimal degenerative changes in the lumbar spine. There is very mild left L4-L5 neural foraminal stenosis. Otherwise no significant spinal canal or neural foraminal stenosis at any level in the lumbar spine.


Instruction: Generate impression based on findings.

Input: Solitary cavernoma with growth between 2011 and 2014: Headaches. MRI: There is a cavernous malformation in the right cingulate gyrus that measures up to 7 mm, previously also 7 mm in 2014. There may be a small associated developmental venous anomaly. There is no surrounding edema or midline shift. There are no other intracranial mass lesions. There is no evidence of acute cerebral infarction. The ventricles are stable in size and configuration. There is a T2 hyperintense focus in the left frontal skull that measures up to 11 mm, which likely represents a hemangioma. MRA: There is no evidence of significant steno-occlusive lesions or aneurysms.

Output: A cavernous malformation in the right cingulate gyrus measures up to 7 mm, which is unchanged since 2014.


Instruction: Generate impression based on findings.

Input: Reason: eval for chondral injury, patellar tendinitis History: chronic R knee pain MENISCI: The lateral meniscus appears intact. The medial meniscus appears intactARTICULAR CARTILAGE AND BONE: There is a cortically based focus of low signal intensity in the distal femoral metaphysis likely representing a nonossifying fibroma. Otherwise no bone marrow signal abnormality is identified. No full-thickness or near full-thickness articular cartilage defects are seen.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: Findings of borderline patella alta. Otherwise normal appearing right knee without findings to account for the patient's pain.


Instruction: Generate impression based on findings.

Input: 49-year-old female patient with history of small bowel resection for obstruction presents with abdominal pain and nausea. Surgical history includes closed loop obstruction with subsequent resection of 1.5 feet of small bowel with end-to-side anastomosis. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: End to side anastomosis with susceptibility artifact from surgical material is noted with small bowel and cecum, which is widely patent. There is no significant small bowel wall thickening or evidence of stenosis. No small bowel dilatation. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.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.Postsurgical changes from small bowel resection without evidence of obstruction or acute intra-abdominal pathology.


Instruction: Generate impression based on findings.

Input: Female, 12 years old, with history of astrocytoma status post chemotherapy. Off therapy evaluation. Redemonstrated are findings secondary to suboccipital approach surgery. An exophytic lesion projecting from the left anterolateral aspect of the medulla is stable in size and morphology. Internal to this tissue, there is a region of intrinsic T1 hyperintensity with minimal if any superimposed true enhancement.No new intracranial lesions or pathologic intracranial enhancement is seen. A small linear focus of T2 hyperintensity adjacent to the right frontal horn is stable. Prominence of the cerebellar fissures is compatible with volume loss. No abnormal fluid collections are seen. The ventricles are stable and normal in size.

Output: Stable exophytic tissue projecting from the left anterolateral aspect of the medulla.


Instruction: Generate impression based on findings.

Input: Chronic bilateral lower extremity pain, no weakness. Evaluate for cord or nerve root compression. Five lumbar type vertebral bodies are presumed to be present. There are postsurgical changes of laminectomy from L3-L4 to the L5-S1 levels. There is enhancement involving the posterior paraspinous soft tissues compatible with granulation tissue. Vertebral body heights are normal. There is grade 1 anterolisthesis of L4 on L5. Alignment of the lumbar spine is otherwise maintained. Bone marrow signal is benign. Conus is in normal position. There are multilevel degenerative changes, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: Minimal disc bulge. No spinal canal or neural foraminal stenosis.L3-L4: Disc desiccation and mild disc bulge with small dorsal annular fissure. Small extrathecal collection is noted along the left lateral aspect of the thecal sac without mass effect and compatible with postsurgical change. Prior laminectomy. No significant spinal canal stenosis. There is mild right and moderate left neural foraminal stenosis. There is facet arthropathy, relatively worse on the left. L4-L5: Disc desiccation and disc bulge. Grade 1 anterolisthesis. There is advanced bilateral facet arthropathy. Evidence of prior laminectomy without significant spinal canal stenosis. There is moderate bilateral neural foraminal stenosis.L5-S1: Minimal disc bulge including a small central protrusion. Prior laminectomy. There is no significant spinal canal stenosis. There is advanced bilateral facet arthropathy. No significant spinal canal stenosis. There is moderate left and mild to moderate right neural foraminal stenosis. No suspicious enhancing lesions are appreciated. There is enhancement associated with the facet arthropathy at the L3-L4, L4-L5, and L5-S1 levels which is likely on a degenerative basis.

Output: 1. Multilevel degenerative changes in the lumbar spine with evidence of prior laminectomies from L3-L4 to the L5-S1 levels. There is no significant spinal canal stenosis at any level. There are varying degrees of mild to moderate neural foraminal stenosis bilaterally at the L3-L4, L4-L5, and L5-S1 levels as described above.2. Advanced facet arthropathy at the L4-L5, L5-S1, and to a lesser degree at the L3-L4 levels.


Instruction: Generate impression based on findings.

Input: Male, 79 years old, with low back pain, radiculopathy, and lower leg weakness. A trace grade 1 anterolisthesis of L4 relative to L5 is not significantly changed. Sagittal alignment is otherwise unremarkable.Vertebral body height and morphology are within normal limits. Marrow signal characteristics are heterogeneous, but there are no areas of significant marrow edema or concerning marrow replacement.The visualized distal spinal cord, conus and nerve roots of the cauda equina are unremarkable except as discussed below. No epidural abnormalities are suspected.L1-2: No significant spinal canal stenosis or neuroforaminal narrowing. No interval changes. L2-3: Facet arthropathy and ligamentum flavum thickening, progressed from prior. No significant spinal canal stenosis. Mild bilateral foraminal narrowing, progressed from prior. L3-4: Facet arthropathy and ligamentum flavum thickening, progressed from prior. A previously seen synovial cyst projecting into the right lateral spinal canal has since resolved. Progressive loss of disc height and disc bulging is seen. A mild generalized spinal canal stenosis is detected along with moderate bilateral foraminal narrowing, progressed from prior. L4-5: Marked facet arthropathy and ligamentum flavum thickening, progressed from prior. There appears to be a new synovial cyst measuring up to 8 mm projecting into and effacing the left lateral recess (see image 8 series 501, and image 14 series 901). Disc bulging. Significant generalized spinal canal narrowing is seen with effacement of CSF and crowding of the cauda equina nerve roots. Both neural foramina are moderately narrowed. Findings have progressed from prior. L5-S1: Facet arthropathy and ligamentum flavum thickening. Mild disc bulging with a new small superimposed right paracentral protrusion. No significant generalized spinal canal stenosis. Moderate bilateral foraminal narrowing, unchanged.

Output: Progressive degenerative disease is seen at most levels in the lumbar spine. The most severely affected level is L4-5, where facet arthropathy and disc bulging result in a significant generalized spinal canal stenosis with crowding of the cauda equina. In addition, there appears to be a new synovial cyst projecting into the left L4-5 lateral recess. Both neural foramina are moderately narrowed.


Instruction: Generate impression based on findings.

Input: Benign neoplasm of pituitary gland [D35.2] / Benign neoplasm of craniopharyngeal duct [D35.3] / Benign neoplasm of pituitary gland [D35.2], Reason for Study: ^Reason: Benign neoplasm of pituitary gland and craniopharyngeal duct (pouch), yearly follow up Pituitary MRIRedemonstration of convoluted shaped recurrent pituitary mass which is encasing right cavernous sinus ICA and extends toward left side suprasellar cistern, unchanged. The mass is measured about 23.6mm (AP measured on contrast enhanced sagittal scan) x 30.9mm (RL measured on T2 coronal scan) x 21.4mm CC measured on T2 coronal scan) which is unchanged since prior scan. The size, configuration and MR signal intensities appear to be stable, unchanged.The orbits and contents are unremarkable.  Brain MRIThere is no evidence of acute ischemic or hemorrhagic lesion. The sellar mass with suprasellar and right cavernous sinus extension is again seen, appears to be stable since prior scan.Scattered FLAIR/T2 high signal intensity lesions on bilateral periventricular white matter are seen, indicating non specific small vessel ischemic disease, unchanged since prior scan.The ventricles, sulci and cisterns are symmetric and unremarkable. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Recurrent pituitary mass with suprasellar as well as right cavernous sinus extension, stable in terms of size, configuration and MR characteristics.2. No evidence of acute ischemic or hemorrhagic lesion. No other abnormal enhancement.3. Unchanged non specific FLAIR/T2 high signal intensity lesions on bilateral periventricular white matter.


Instruction: Generate impression based on findings.

Input: Reason: 54 yo M hx of IPMN, last viewed on EUS in July 2015. 1 year follow up MRI/MRCP. Also eval pancreatic parenchyma and PD as there has been atrophy in past on imaging History: ipmn ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter hepatic cysts are unchanged.SPLEEN: No significant abnormality noted.PANCREAS: T2 hyperintense lesion within the pancreatic body which communicates with the main pancreatic duct measures 6 mm, similar in size and appearance to the exam from 12/17/2014. No abnormal enhancement.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable right renal 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: Cystic lesion in the pancreatic body is stable and likely represents a side branch IPMN.


Instruction: Generate impression based on findings.

Input: 77-year-old male with abnormal prior MRI, preoperative planning for biopsy. Redemonstrated are postoperative findings in the left occipital scalp including craniectomy. The previously demonstrated associated fluid collection is much smaller. There remains diffuse patchy enhancement within the adjacent parenchyma along the margins of the defect and discrete subcentimeter nodules inferior to the defect. There remains diffusely enhancing tissue between the scalp flap and underlying dura, especially posteriorly. Previously demonstrated patchy bone marrow enhancement along the margins of the craniotomy and the underlying dura is more difficult to assess given the lack of fat saturation with Stealth technique. Enhancement of the left cerebellar hemisphere, with scattered areas of high T2 signal and restricted diffusion are again noted. The degree of mass effect and fourth ventricular effacement has decreased. Cystic appearing components within both the left occipital and left cerebellar enhancement have decreased over the interim. There are also areas of encephalomalacia in the right corona radiata, right basal ganglia, and left thalamus, unchanged. There remains a background of patchy cerebral white matter T2 hyperintensity. The lateral and third ventricles are normal in size, unchanged. There is no midline shift. There is mucosal thickening and retention cyst formation in the left maxillary sinus as well as left mastoid fluid, unchanged.

Output: There remains diffuse patchy enhancement within left occipital parenchyma with discrete subcentimeter nodules inferior to the craniectomy. There remains diffusely enhancing tissue between the scalp flap and underlying dura, especially posteriorly. Enhancement of the left cerebellar hemisphere, with scattered areas of high T2 signal and restricted diffusion are again noted. The degree of mass effect and fourth ventricular effacement has decreased. Cystic appearing components within both the left occipital and left cerebellar enhancement have decreased over the interim.


Instruction: Generate impression based on findings.

Input: Multiple myeloma with a large lesion on PET impinging on T6/T7: No pain or neurologic deficits. There is an infiltrative, enhancing left posterior chest wall mass with left neural foraminal and epidural extension at theT6-7 level with mild narrowing of the thecal sac, but no spinal cord compression. The vertebral column alignment is within normal limits. There are multilevel small intravertebral disc herniations. The vertebral body heights are otherwise preserved. There is a small focus of left ligamentum flavum calcification that projects into the spinal canal at T10-11, without spinal cord impingement. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable. There is a small right renal cyst.

Output: Left posterior chest wall multiple myeloma extends into left neural foramen and epidural space at theT6-7 level with mild narrowing of the thecal sac, but no spinal cord compression.


Instruction: Generate impression based on findings.

Input: 64-year-old male with rising PSA. Evaluate prostate gland. PELVIS:PROSTATE:Prostate Size: 3.4 x 4.7 x 3.0 cmPeripheral Zone: At the junction of the right peripheral and transitional zone, there is an ill-defined T2 hypointense lesion measuring approximately 3.4 x 1.5 cm (series 401, image 13) in the mid gland to apex; this is only well-visualized in the coronal plane without corresponding ADC abnormality or contrast enhancement.Central Gland: Nodular appearance of the central gland most compatible with benign prostatic hypertrophy.Seminal Vesicles: Seminal vesicles are unremarkable bilaterally.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: At the junction of the right peripheral and transitional zone in lower mid gland, there is an ill-defined lesion which is only well seen in the coronal plane, without corresponding ADC or postcontrast enhancement. Although, this lesion does not show classic imaging characteristics, carcinoma is not excluded. No other suspicious lesion delineated.


Instruction: Generate impression based on findings.

Input: h/o cervical myelopathy with lower back pain and lumbar radicular sx. The vertebral bodies are normally aligned. The vertebral body heights and intervertebral disc spaces are grossly maintained. No worrisome focal marrow signal is identified. The conus terminates at L1. The spinal cord and cauda equina demonstrate normal signal and morphology.T10-11: There is mild facet arthropathy and a mild diffuse disc bulge resulting in mild bilateral neuroforaminal narrowing.T11-12: There is a small left paracentral disc protrusion without significant neuroforaminal or spinal stenosis.T12-L1: There is a minimal diffuse disc bulge without significant spinal or neuroforaminal stenosis.L1-2: No significant disc herniation, neuroforaminal stenosis, or spinal stenosis is noted.L2-3: There is a mild diffuse disc bulge causing mild bilateral neuroforaminal narrowing without central spinal stenosis.L3-4: There is a diffuse disc bulge and hypertrophic degenerative changes of the facets/ligamentum flavum resulting in mild central spinal stenosis with moderate left and mild right neuroforaminal stenosis. In addition, there appears to be mass effect upon the far lateral exiting left L3 nerve root.L4-5: There is a mild diffuse disc bulge resulting in mild bilateral neural foraminal narrowing. There are mild hypertrophic degenerative changes of the facets.L5-S1: There is a large left lateral osteophyte impinging upon the exiting L5 nerve root (series 801, image 8).

Output: Multilevel degenerative changes of the lumbar spine as described above. Although there is no evidence of significant spinal canal stenosis, a laterally projecting osteophyte at L5-S1 does appear to impinge on the exiting left L5 nerve root.


Instruction: Generate impression based on findings.

Input: 34-year-old female with lower abdominal pain for two weeks and elevated white blood cell count. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: There is a small, subcentimeter hypodense lesion in the body of the pancreas (series 3 image 43/162). Recommend follow up with MRI to further characterize this lesion.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Hypodense, well circumscribed lesion in the lower pole of the left kidney, likely a simple cyst and without clinical significance.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: There are two cystic lesions in the left adnexa with surrounding inflammation compatible with pelvic inflammatory disease. There may be a left sided tubo-ovarian abscess and it is recommended to follow-up with pelvic ultrasound to further characterize this lesion.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: There is fluid in the left paracolic gutter. BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: 1. There are two cystic lesions in the left adnexa with surrounding inflammatory changes consistent with pelvic inflammatory disease. There is also some concern for possible tubo-ovarian abscess and it is recommended to follow up with pelvic ultrasound to further characterize the left adnexa. 2. There is a small subcentimeter hypodense lesion in the body of the pancreas which should be followed up with MRI to further characterize its nature.


Instruction: Generate impression based on findings.

Input: Untreated small brain metastases. There are several, at least 10, enhancing lesions, which are either new or have increased in size. For example, there is a new lesion in the right basal ganglia that measures up to 6 mm and a right occipital lobe lesion now measures up to 5 mm, previously 3 mm. There is no evidence of acute intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is fluid signal within the left mastoid air cells. The skull, paranasal sinuses, and scalp soft tissues are unremarkable.

Output: Interval appearance or increase in size of multiple intracranial metastases.


Instruction: Generate impression based on findings.

Input: The vertebral column alignment is within normal limits. There are mild chronic compression deformities involving the T10, T11, and L1 vertebral bodies with small Schmorl's nodes at the superior endplates. Appearance is unchanged since 9/14/2007. The vertebral bone marrow signal is unremarkable. The spinal cord displays normal signal and morphology with the conus terminating at L1-L2. There are subcentimeter left renal cysts. The paravertebral soft tissues are unremarkable.Individual levels as below:L1-L2: There is mild facet arthropathy and ligamentum flavum thickening without significant spinal canal or neural foraminal narrowing.L2-L3: There is mild facet arthropathy and ligamentum flavum thickening as well as minimal disc bulge without significant spinal canal or neural foraminal narrowing.L3-L4: There is moderate facet arthropathy and ligamentum flavum thickening as well as mild edema within the facet joints. There is also a mild disc bulge asymmetric to the left. These findings result in mild bilateral neural foramen stenosis and mild to moderate spinal canal stenosis.L4-L5: There is a mild to moderate disc bulge, slightly asymmetric to the right, as well as moderate facet arthropathy and ligamentum flavum thickening. These findings result in mild spinal canal stenosis and mild right neural foramen stenosis.L5-S1: There is mild facet arthropathy as well as a minimal disc bulge. These findings result in minimal right neural foramen stenosis without significant spinal canal stenosis.

Output: 1. Degenerative changes in the lumbar spine as detailed above, relatively worst at the L3-L4 level where there is mild to moderate spinal canal stenosis and mild bilateral neural foraminal stenosis.2. Mild chronic compression fractures involving the T10, T11, and L1 vertebral bodies which are unchanged since 9/14/2007. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Complex partial epilepsy, neuropathic pain, and new prolonged confusion state. There has been interval resolution of the subcentimeter lesion with high T2 signal and restricted diffusion in the midline of the splenium of the corpus callosum. The rest of the brain parenchyma also appears unremarkable. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Interval resolution of the lesion in the splenium of the corpus callosum. No evidence of intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: History of alcoholic cirrhosis. Segment 8 peripheral arterially enhancing lesion seen on the recent CT. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic nodular liver morphology with T2 hyperintense fibrotic changes with atrophy and capsular retraction. Recanalized periumbilical vein and mesenteric collateral vessels.Approximately 1.2 x 1.1 cm (series 9/61) peripheral segment 8 lesion near the right hepatic dome demonstrates arterial enhancement without washout, capsular formation, T2-weighted hyperintensity, intracellular fat or restricted diffusion.Additional subcentimeter segment 8 arterial enhancing lesion is too small to characterize (series 9/57).Attenuated right portal vein and its branches with small collaterals.Cholelithiasis without cholecystitis.SPLEEN: Borderline splenomegaly measuring 14 cm in length.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Simple appearing cysts and too small to characterize subcentimeter T2-weighted hyperintensities.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.Cirrhotic liver with extensive fibrosis and scarring.2.The right hepatic dome segment 8 lesion demonstrates arterial enhancement without washout. Although the lesion does not meet imaging criteria for HCC it remains worrisome and short interval follow-up is recommended.3.Portal hypertension. Chronic right portal vein thrombosis. Cholelithiasis without cholecystitis.


Instruction: Generate impression based on findings.

Input: Male 28 years old Reason: Pancreatic Neuroendocrine followup, hx of angiomyolipoma of kidneys, s/p distal pancreatectomy splenectomy, left nephrectomy, history tuberous sclerosis. Evaluate for interval change or development of met disease History: PNET and angiolipoma of kidneys ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. There are scattered well marginated T1 hyperintense lesions that suppress on fat suppressed imaging and are compatible with small fat containing lesions. The largest is in the left hepatic lobe measuring 1.3 x 1.3 cm.SPLEEN: Status post splenectomy. Small enhancing nodule in the splenic bed likely represent small residual splenic tissue.PANCREAS: Status post distal pancreatectomy. No fluid collections or focal mass identified in the surgical resection margin.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: There are multiple right renal lesions with fat intensity compatible with angiomyolipomas. Solid lesions such as the lesion in the upper pole of the right kidney as seen on image 53 of series 19 has only a few foci of fat and are likely lipid poor angiomyolipoma.Dominant fatty right kidney mass measures 4.8 x 3.7 cm with nodular enhancement. Postsurgical changes in the lower pole of the left kidney. There are multiple fat-containing lesions in the left kidney.Subcentimeter T2 hyperintense foci in the kidneys likely represent small cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: A fatty mass near the apex of the heart is present. PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Multiple liver lesions which are fat-containing.2.Multiple renal lesions most of which have fat compatible with angiomyolipomata. Dominant lesion is in the right kidney. 3.Status post distal pancreatectomy and splenectomy without definite recurrent disease.


Instruction: Generate impression based on findings.

Input: Reason: 33 yo F with hx of HELLP syndrome s/p liver transplant 2/2016 here with acute hepatocellular injury, no evidence of rejection on biopsy, eval for stricture, eval vasculature patency of graft History: s/p OLT now with transaminitis of unclear etiology ABDOMEN:LIVER, BILIARY TRACT: Right hepatic hypodensity, likely a cyst. Status post liver transplant. No intrahepatic or extrahepatic biliary ductal dilatation. The anastomosis is patent. (801/53). There is a small cystic lesion measuring 7 x 6 mm adjacent to the cystic duct remnant (801/58) which may represent an adjacent hepatic cyst or be associated with the remnant. There is a nonenhancing T1 hyperintense lesion in the left hepatic lobe measuring 1.4 x 1.5 cm (1 101/161), likely a small focus of hemorrhage from recent biopsy.The hepatic vasculature is patent.SPLEEN: Small splenules.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: Midline incision with surrounding inflammatory changes. Inflammatory changes within the right anterior subcutaneous tissues are partially visualized.OTHER: No significant abnormality noted.

Output: 1.Postsurgical changes of liver transplant with patent biliary system and vasculature.2.Small focus of hemorrhage in the left hepatic lobe, presumably from recent biopsy.


Instruction: Generate impression based on findings.

Input: 55-year-old female with ischial and sacral wounds concern for osteoarthritis. There is ulceration of the soft tissue posterior to the lower sacrum and coccyx with an overlying bandage. Low signal intensity within the defect upon all sequences presumably reflects air trapped beneath the bandage. This presumed gas density extends to within 4 mm of the coccyx with signal abnormality interposed between the ulcer and bone likely representing inflamed tissue. The gas-filled ulcer extends into the subcutaneous fat distal to the coccyx, terminating into a small rim-enhancing fluid collection. There is edema and enhancement of the adjacent soft tissues reflecting inflammation.The marrow signal intensity of the sacrum is normal without evidence of osteomyelitis. There is mild increased signal intensity of the marrow of the coccyx on the fat suppressed T2 weighted images. The signal intensity of the majority of the coccyx on T1 weighted images is preserved, suggesting reactive osteitis rather than osteomyelitis. The very tip of the coccyx, however, is slightly indistinct and we cannot exclude the possibility of early osteomyelitis at this location. The signal intensity of the ischia is normal without evidence of osteomyelitis. We see no specific findings of osteomyelitis affecting the remainder of the pelvis. There is a small amount of fluid in both sacroiliac joints with mild enhancement of the right sacroiliac joint. These findings may reflect mild sacroiliitis, but we see no adjacent abscess or sinus tract to suggest a septic arthritis. Mild osteoarthritis affects both hips. There is diffuse atrophy of the musculature of the pelvis and upper thighs. There is a Foley catheter in the bladder.

Output: 1.Soft tissue decubitus ulceration as described above. 2.We see no findings to suggest osteomyelitis of the sacrum or ischia. There is abnormal signal intensity within the majority of the coccyx on T2 weighted images with preservation of signal on T1 weighted images, suggesting reactive osteitis rather than osteomyelitis. The distal tip of the coccyx is indistinct, and while this could conceivably reflect early osteomyelitis, this is equivocal. 3.Other findings as above.


Instruction: Generate impression based on findings.

Input: Unspecified convulsions [R56.9], Reason for Study: ^Reason: possible epilepsy History: as above There are multifocal bihemispheric supra and infra tentorial asymmetric, mainly subcortical white matter and corpus callosum FLAIR high signal intensity lesions. Most of them are not enhancing on post Gad images but the right superior parietal lobule lesion. There is no evidence of surrounding edema.There is no evidence of acute ischemic or hemorrhagic lesion.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.C Spine MRIThe cervical spine appears to be straightened.The cranial-cervical junction is normal. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The cord signal is normal. The epidural space, thecal sac, and spinal cord are preserved with no evidence of spinal canal/neural foraminal stenosis, cord compression or myelopathy.

Output: 1. Multifocal mainly subcortical white matter FLAIR high signal intensity lesions as described above. Differential diagnosis include ADEM, other post viral infection encephalitis, or other demyelinating disease such as multiple sclerosis which is less likely.2. Normal cervical spine MRI


Instruction: Generate impression based on findings.

Input: 71-year-old male with prostate cancer on active surveillance. PELVIS:PROSTATE:Prostate Size: 3.9 x 6 x 5.4 cm.Peripheral Zone: Small amount of T1 hyperintense hemorrhage is seen bilaterally. There is a 7 mm focus of low T2 signal with restricted diffusion in the right posteromedial mid gland, suspicious for prostate cancer (series 704/264). At the same level anterolaterally on the right, there is an area of low T2 signal with restricted diffusion measuring up to 8 mm, which is also suspicious for prostate cancer (series 901/14).Central Gland: Heterogeneous.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: None.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Findings suspicious for multifocal right mid gland prostate cancer without evidence of extracapsular extension.


Instruction: Generate impression based on findings.

Input: Male 40 years old Reason: eval stability of spine. History: right bicep weakness/atrophy, right arm pain Mild degenerative disk disease at C4-5 and C5-6. The alignment is within normal limits and we see no instability between flexion and extension views.

Output: Mild degenerative disk disease.


Instruction: Generate impression based on findings.

Input: Male, 59 years old, with history of CNS lymphoma status post autologous stem cell transplant. Restaging exam. Residual T2 signal abnormality and susceptibility are again seen within the right lateral cerebellum and left anterior cingulate gyrus compatible with sites of prior treated disease. No associated enhancement is seen.Patchy foci of T2 hyperintensity are also redemonstrated in the periventricular white matter, right more than left, which are unchanged. No new lesion or pathologic enhancement is detected.No acute intracranial hemorrhage or any abnormal extra-axial fluid collection is seen. The ventricular system is stable in size and morphology.

Output: Stable posttreatment findings with no evidence of residual or new active CNS lymphoma.


Instruction: Generate impression based on findings.

Input: Intractable epilepsy, convulsions. Many of the images are degraded by patient motion. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears grossly unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No evidence of potential seizure foci, within the limitations of patient motion artifact.


Instruction: Generate impression based on findings.

Input: Reason: diffusion imaging, r/o infection History: lower back pain, sepsis. Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. There is diffuse marrow replacement present.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There are endplate reactive changes at this level, loss of disk space height and a diffuse disk bulge the disk signal is hyperintense on T1 imaging.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is loss of disk space height T2 signal hyperintensity within the disk and diffuse disk bulge at this level associated with mild to moderate bilateral facet and ligamentum flavum hypertrophy. There is mild narrowing of the neural foramina bilaterally with partial effacement of the fat within the neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is loss of disk space height mild disk desiccation and a minor disk bulge at this level.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.Within the right psoas muscle there is signal change associated with a small fluid collection measuring approximately 7 by 11 mm in axial dimensions.There are multiple cysts present in both kidneys.The examination is degraded due to low signal to noise quantum mottle.

Output: 1.There degenerative changes present in the lower lumbar spine which have not changed since the prior exam and are without significant compromise of spinal canal or exiting nerve roots. There signal changes within the L4-5 disk space associated with some endplate reactive changes which are somewhat nonspecific. This could very well be related to degenerative change. There is an associated small cystic lesion in the right psoas muscle at the L5-S1 disk space level which could represent a small abscess. The possibility of diskitis and paraspinous abscess cannot be excluded. Since a contrast-enhanced MRI is higher risk for NSF based on renal function then a CT of the lumbar spine may be of further benefit to further delineate the psoas lesion - if the patient is on dialysis and if clinically appropriate. Given the possibility of two disk space level involvement, the possibility of TB cannot be excluded. Another explanation can be discitis related to hemodialysis related amyloid arthropathy or a combination of the above.2.There is diffuse marrow replacement present throughout the visualized spine. This could represent secondary hyperparathyroidism .3.Multiple renal cysts in both kidneys. The kidneys are relatively small.4.Findings were discussed with Mia Weiss at 8:40 am on 3/3/15.


Instruction: Generate impression based on findings.

Input: Migraine with auditory and olfactory aura. The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

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