Instruction: Generate impression based on findings.

Input: 27 year old female with history of PVC, now with mildly reduced LVEF, eval for PVC induced cardiomyopathy Left VentricleThe left ventricle is mildly dilated with normal global systolic function. The overall LV ejection fraction is 56%. The LVEDV is 164 ml (normal range 109+/-23), LV end diastolic volume index is 89 ml/m2 (normal range: 65+/-11), LVESV is 71 ml (normal range 31+/-10), and LV end systolic volume index is 39 ml/m2 (normal range 18+/-5). The LV mass is 103 g (normal range 114+/-24) and the LV mass index is 56 g/m2 (normal range 67+/-11). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. Native T1-mapping is not interpretable due to arrhythmia or gating error. Left AtriumThe left atrium is normal in size.Right VentricleThe right ventricle is mildly dilated with normal function. The overall RV ejection fraction is 64%, the RV end diastolic volume index is 104 ml/m2 (normal range 69+/-14), the RVEDV is 193 ml (normal range 110+/-24), the RV end systolic volume index is 38 ml/m2 (normal range 22+/-8), and the RVESV is 69 ml (normal range 35+/-13). No focal wall motion abnormality or aneurysm. Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve is trileaflet, opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Mild left ventricular dilation with normal systolic function (LVEF 56%) without evidence of underlying myocardial fibrosis, inflammation, or infiltration. 2. Mild right ventricular dilation with normal systolic function (RVEF 64%). No CMR evidence of arrhythmogenic right ventricular dysplasia. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Reason: ro medial meniscal/ligament injury History: medial knee pain and swelling MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: No significant abnormality noted.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Unremarkable appearance of the left knee.


Instruction: Generate impression based on findings.

Input: 27-year-old male patient with bilateral knee pain. Evaluate for etiology. Left knee: There is mild sharpening of the tibial spines but otherwise the knee appears normal.Right knee: There is mild sharpening of the tibial spines but otherwise the knee appears normal.

Output: Mild sharpening of the tibial spines but otherwise normal appearing knees.


Instruction: Generate impression based on findings.

Input: Inability to walk and poor rectal tone. Evaluate for cord or nerve impingement. There is approximately 60% height loss involving the T12 vertebral body symmetrically compatible with a compression fracture. This is associated with heterogeneously T1-hypointense, T2 hyperintense signal with no significant extension into the posterior elements and is associated with small posterior retropulsion which does touch the spinal cord and causes moderate spinal canal narrowing. However, there is no or very minimal intrinsic T2 hyperintensity within the conus medullaris. There is no soft tissue component in the paraspinal tissues.Multilevel degenerative changes, 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: There is mild diffuse disc bulge, ligamentum flavum thickening, and facet arthropathy resulting in mild spinal canal stenosis. There is also mild to moderate right greater than left neural foraminal stenosis.L5-S1: Diffuse disc bulge, ligamentum flavum thickening, and facet arthropathy moderate spinal canal stenosis. There is moderate right worse in left neural foraminal stenosis with possible impingement, particularly on the right of the L5 nerve roots.The urinary bladder is markedly distended. T1-hypointense, T2 hyperintense renal cortical lesions are probably cysts. There appears to be dilatation of the common bile duct, pancreatic duct, and mildly intrahepatic bile ducts which can be better evaluated with ultrasound. There is also dilatation of the infrarenal abdominal aorta measuring up to 4 cm in the transverse diameter with heterogeneous signal involving the right lateral aspect of the lumen.

Output: 1. T12 compression fracture with 60% loss of height with associated moderate spinal canal stenosis and mild impression on the thoracic cord at this level. There may be minimal T2 cord signal abnormality.2. Degenerative changes at the L4-L5 and L5-S1 level with up to moderate L5-S1 spinal canal stenosis and right worse in left L5-S1 neural foraminal stenosis. There may be impingement of the right L5 nerve root.3. Dilatation of the extrahepatic, pancreatic, and mildly the intrahepatic biliary ductal system which can be better evaluated with dedicated ultrasound. There is also aneurysmal dilatation of the infrarenal abdominal aorta which can also be further evaluated with dedicated imaging.4. Markedly distended urinary bladder.Dr. Monther Qandeel discussed the above findings with the neurosurgical team (Dr. Jason Choi) over the phone on August 8, 2015 at 1042 hours.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Eval GBM. Pt s/p RT/TMZ an 6 cycles of TMZ+TTF Perfusion images were not adequately obtained due to technical factors.Right frontal craniotomy related to resection of right frontal lobe mass is again demonstrated. Fluid within the surgical cavity along the medial right frontal lobe near the vertex is again demonstrated. Inferiorly, adjacent to the anterior horn of the right lateral ventricle is redemonstration of nodular enhancing soft tissue which appears more prominent when compared to prior examination (coronal postcontrast series1202, image 87). There is also increased enhancement extending inferiorly along the right lateral ventricle ependyma. A small amount of hemosiderin deposition in the surgical bed is again demonstrated. T2/FLAIR signal surrounding the surgical cavity appears similar to prior examination. There is no diffusion restriction to suggest acute ischemia. No significant midline shift is appreciated. No new intra-axial or extra-axial fluid collections are visualized.

Output: Nodular enhancing soft tissue inferior to the surgical cavity and adjacent to the anterior horn of the right lateral ventricle appears more prominent with increased inferior extension along the right lateral ventricle ependymal margin when compared to prior examination concerning for tumor progression.


Instruction: Generate impression based on findings.

Input: 19-year-old woman with history of syncope and collapse. EKG changes. Left Ventricle Normal qualitative left ventricular ejection fraction. There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is normal in size.. Right VentricleThe right ventricle is normal in size and functionRight AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsNo significant extracardiac findings. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. No evidence of infiltrative abnormality within the heart. 2. Qualitatively normal biventricular function without right ventricular aneurysm or areas of focal wall motion abnormality.3. No convincing evidence of focal fatty regions within the RV or LV myocardium.An addendum will be made to this report once quantitative measurements of the right ventricle and left ventricle are available.


Instruction: Generate impression based on findings.

Input: 85-year-old female with cirrhosis and pancreatic ductal dilatation. ABDOMEN:LIVER, BILIARY TRACT: Common bile duct is mildly dilated measuring up to 10 mm. Pancreatic duct is also dilated measuring up to 7 mm all the way to the ampulla. A benign ampullary stricture is likely present.There is focal fatty infiltration anterior to the main portal vein. No focal solid lesions are seen in the liver.SPLEEN: No significant abnormality noted.PANCREAS: No solid lesions in the pancreas. Pancreas is atrophic. Pancreatic duct is dilated throughout its course all the way to the ampulla.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Simple 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: 1.Focal fatty infiltration anterior to the main portal vein. Dilated common bile and pancreatic ductal limited to the ampulla suspicious for a stricture at the level of the ampulla likely benign.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 hip pain, evaluate known hip fracture. ACETABULAR LABRUM: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: There is a nondisplaced fracture of the right greater trochanter. There is surrounding soft tissue swelling and edema.SOFT TISSUES: No significant abnormality noted. ADDITIONAL

Output: Nondisplaced fracture of the right greater trochanter with soft tissue swelling.


Instruction: Generate impression based on findings.

Input: Reason: evaluate for crohns History: diarrhea, fam hx of crohns 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: No bowel wall thickening or dilatation. No abnormal enhancement. No strictures or fistulas are evident. No findings to suggest acute or chronic formation of the bowel. No fibrofatty proliferation.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Normal MR enterography without findings to suggest inflammatory bowel disease.


Instruction: Generate impression based on findings.

Input: 35 year-old female history of sarcoma There is no evidence of osseous or soft tissue mass in the pelvis. There are no areas of abnormal enhancement. The marrow signal is within normal limits. The pelvic musculature is within normal limits.No definite postsurgical changes are identified to suggest previous resection. There is no significant pelvic lymphadenopathy. Physiologic follicles are present in both ovaries. There is a small amount free fluid in the pelvis, likely physiologic.

Output: No evidence of abnormal mass lesion in the pelvis.


Instruction: Generate impression based on findings.

Input: 37-year-old female with nasal congestion and discharge. Recurrent sinusitis. Extensive postsurgical findings of a large bifrontal craniotomy with underlying encephalomalacia and gliosis of the anterior frontal lobes presumably postprocedural in etiology. Abnormal bone mineralization involving the anterior cranial fossa, cribriform plate, and extending into the sinus septae. Within the bilateral ethmoids and abutting the aforementioned abnormal bone, there is an extensive irregular enhancing soft tissue mass which measures approximately 58 x 40 mm (AP x TR, series 501 image 40) with the osseous abnormality measuring approximately 32 x 34 x 27 (AP x TR x CC, series 6 image 20, series 80434 image 28). This mass extends inferior into the nasal vault and appears contiguous with dural thickening along the left rectus gyri. Deformity and mass effect on the left medial orbital wall with lateral displacement of the left medial rectus, which abuts the left optic nerve, although the thinned medial orbital wall appears intact. These findings are suggestive of an ethesioneuroblastoma.There is complete opacification of the sphenoid sinuses likely due to obstruction from the mass. There is right maxillary sinus mucosal thickening and frothy debris compatible with acute sinusitis. No intracranial hemorrhage.Slight ex vacuo dilatation of the frontal horn of the left lateral ventricle. Otherwise, the CSF spaces are appropriate for the patient's stated age with no midline shift. 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 mastoid air cells are clear.

Output: 1.CT and MRI demonstrate extensive bifrontal postsurgical findings with extensive destructive soft tissue mass centered just below the region of the cribriform plate and ethmoids suggestive of residual esthesioneuroblastoma. Correlate with clinical history, imaging, and pathology from outside institutions. 2.Postobstructive sphenoid sinusitis. Acute right maxillary sinusitis.


Instruction: Generate impression based on findings.

Input: 44-year-old female with recent ruptured appendix, pathology showed low-grade appendiceal mucinous neoplasm. ABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy. Hepatic steatosis.SPLEEN: T2 hyperintense cyst in the spleen.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted. Left para-aortic nodule may be connected to the medial limb of the left adrenal gland.KIDNEYS, URETERS: Exophytic T2 hyperintense cyst in the superior pole of the right kidney. No hydronephrosis or perinephric inflammation.RETROPERITONEUM, LYMPH NODES: There is a left para-aortic nodule measuring 1.9 x 1.3 cm, nonspecific. There is no drop in signal on out-of-phase imaging.BOWEL, MESENTERY: Status post appendectomy.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Bilateral probable physiologic follicles. Nabothian cysts are present.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.Enlarged left para-aortic nodule is nonspecific and may represent a lymph node versus indeterminate adrenal nodule. 2.No peritoneal deposits are evident.


Instruction: Generate impression based on findings.

Input: 62 years old Male. Reason: h/o metastatic prostate CA, spinal pain History: as above. C7 is incompletely imaged. And there is a suggestion of loss of height of the C7 vertebral body. Suggest further evaluation with CT or MRI if clinically indicated.There is no evidence of acute fracture or dislocation in the C1-C6 vertebrae. Degenerative changes are seen in the cervical spine.

Output: Probable loss of height of C7 vertebral body which is incomplete imaged. Suggest further evaluation with CT or MRI if clinically indicated.


Instruction: Generate impression based on findings.

Input: 38-year-old female with surgery of bloody left nipple discharge for one month. A solid, hypoechoic lesion in the left breast was noted on previous ultrasound. There is a heterogeneous amount of fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.There is an enhancing lesion in the left posterior breast at the 4:00 position, which measures 10 x 6 x 11 mm (series 500, images 6-9), with morphology is most suggestive of a fibroadenoma. This lesion demonstrates mixed kinetics. Additionally, there is a smaller lesion in the left breast at the 3:00 position, slightly lateral to the aforementioned lesion which measures 8 x 4 x 3 mm (series 500, images 2-4). This lesion also demonstrates mixed kinetics. An enhancing lesion in the left posterior central breast has benign kinetics, measuring approximately 4 mm, the morphology of which may represent a fibroadenoma versus a benign intramammary lymph node. There is an additional small enhancing lesion immediately lateral to the lesion at the 4:00 position, measuring approximately 3 mm, which may also represent a fibroadenoma versus a benign intramammary lymph node.No abnormal axillary lymph nodes are identified in either axillary region.

Output: Enhancing lesions in the left breast, some of which have morphology suggestive of fibroadenomata. Biopsy of the two largest/most suspicious masses is recommended.Please note ultrasound-guided biopsies of the masses at the 3:00 and 4:00 positions were performed on the same date.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Stage 4 neuroblastoma post induction chemotherapy, resection, auto transplant, and radiation therapy (C7 to T12 and L2 to L3 spine in September, 2015) at outside hospitals and completion of antibody therapy: assess for disease. There are post-radiation effects throughout the thoracic spine, with diffuse fatty marrow replacement. There is enhancement and sclerosis surrounding the basivertebral vein in the T8 vertebral body. There is also heterogeneous enhancement and sclerosis of the C6 and C7 vertebrae. There is no residual tumor in the thoracolumbar junction region. The vertebral body heights and alignment are preserved. The spinal cord appears unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: Treatment effects in the spinal column with resolution of the tumor in the thoracolumbar junction region. Nonspecific enhancement and sclerosis in the C6, C7, and T8 vertebral bodies may be reactive bone marrow or treatment effect versus less likely neoplastic in the setting of a negative recent MIBG scan.


Instruction: Generate impression based on findings.

Input: Previous right tonsil cancer. Biopsy in July 2016 yielded fibrosis and chronic inflammation, negative for carcinoma. There are postoperative findings in the right tongue base region. There appears to be a somewhat ill-defined persistent area of enhancement in the right tonsillar sulcus and posterior tongue region, which measures up to 20 mm. There is a small retropharyngeal effusion. There is no significant cervical lymphadenopathy based on size criteria. The thyroid and major salivary glands are unremarkable. There is mild multilevel degenerative spondylosis. The imaged intracranial structures and orbits are unremarkable. There is a small amount of fluid in the right mastoid air cells.

Output: Postoperative findings with a persistent area of enhancement in the right tonsillar sulcus and posterior tongue region, which may represent recurrent tumor and/or treatment effects. Otherwise, no evidence of significant cervical lymphadenopathy based on size criteria.


Instruction: Generate impression based on findings.

Input: Disorder of brain, unspecified [G93.9], Reason for Study: ^Reason: pre-op for crani History: brain lesion Multiple fiducial markers attached to skull focal the stealth protocol MRI.There are multiple rim-enhancing intra-axial masses involving right thalamus, posterior aspect of basal ganglia as well as insular. Associated brain edema is seen and extends through the right cerebral peduncle reaching to the level of the right midbrain. There is minimal midline shift toward left side.The largest lesion was measured as 27.2 mm x 31.8 mm. Small daughter nodules are seen adjacent to the largest lesion involving the right thalamus and right frontal lobe (series 401, image 130).The ventricles, sulci and cisterns are 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.Mucosal thickenings on ethmoid sinus are seen.

Output: Right thalamic rim enhancing lesion associated with multiple small enhancing nodules and extensive surrounding brain edema involving right thalamus, right basal ganglia and right frontal lobe indicating malignant process. Differential diagnosis include high grade glioma or metastatic lesions more likely, less likely differential diagnosis include lymphoma or inflammatory/infectious process.


Instruction: Generate impression based on findings.

Input: Reason: L knee pain x3 weeks after skiing History: L knee pain x3 weeks MENISCI: The medial and lateral meniscus appear intact.ARTICULAR CARTILAGE AND BONE: There is degeneration of the articular cartilage of the patella including several focal full-thickness defects with cysts in the underlying bone as well as more diffuse superficial fraying of the articular cartilage. There is relative sparing of the medial and lateral compartment articular cartilage.LIGAMENTS: The ACL and PCL appear intact. There is mild edema along the superficial band of the MCL which may reflect a sprain in the correct clinical context. The LCL appears intact. EXTENSOR MECHANISM: The quadriceps tendon appears slightly thickened which may reflect chronic tendinosis, but we see no full-thickness tear. The patellar tendon appears intact.ADDITIONAL

Output: 1. Edema along the vastus lateralis and iliotibial band suggesting a strain injury. The ACL and menisci appear normal.2. Mild edema along the MCL may represent a mild sprain in the correct clinical context.3. Degeneration of the articular cartilage of the patella.4. Chronic quadriceps tendinosis.


Instruction: Generate impression based on findings.

Input: Female, 81 years old, with history of subacute cognitive decline and expressive predominant global aphasia, initial imaging suspicious for pneumatosis versus PRES, status post biopsy with findings of amyloid angiopathy and mild astrocytic proliferation but no clear evidence of inflammation. Since the prior examinations, marked T2 hyperintensity involving the left temporal and occipital lobes, and to a lesser degree the right temporal and occipital lobes, has significantly improved. There is no longer any evidence of edema or mass effect, and the areas of parenchymal signal abnormality which remain demonstrate a more chronic morphology. The previously seen areas of restricted diffusion have resolved and there is no pathologic enhancement.Single voxel spectroscopy performed over the affected left occipital parenchyma shows perhaps a slight reduction of the NAA peak, but otherwise a relatively normal metabolite profile. A broad negative peak at 1.55 ppm is likely artifactual.Sequelae of prior left temporal biopsy are redemonstrated. Numerous scattered foci of periventricular and subcortical ill-defined T2 hyperintensity are again seen without significant interval change. No mass effect is detected. No abnormal extra-axial fluid collections are observed. However, there are numerous scattered punctate foci of susceptibility throughout the cerebral hemispheres, similar to the prior examination.

Output: 1.Since the prior examination, areas of marked signal abnormality in the temporal and occipital lobes, left side more than right, have markedly improved. The previously seen edema, mass effect and restricted diffusion have resolved, and there is no pathologic enhancement. Spectroscopic assessment over one of the affected areas shows no evidence to support an aggressive neoplastic process.2.As on the prior examinations, there are numerous scattered foci of subcortical and periventricular ill-defined T2 hyperintensity. Also noted are numerous punctate foci of susceptibility which, given findings on pathology, likely correlate to amyloid angiopathy.3.The differential diagnosis would continue to include a vascular process such as vasculitis or PRES. A rare inflammatory response to amyloid angiopathy can also be considered. An aggressive neoplastic process such as gliomatosis is considered unlikely.


Instruction: Generate impression based on findings.

Input: Unspecified dementia without behavioral disturbance [F03.90], Reason for Study: ^Reason: memory loss, r/o vascular dementia History: memory loss. There is no evidence of acute ischemic or hemorrhagic lesion.Multifocal patchy scattered FLAIR high signal intensities on bilateral periventricular white matter and centrum semiovale indicate nonspecific small vessel ischemic disease.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. 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. Opacification on the left ethmoid sinus and frontal sinus are seen.

Output: 1. Nonspecific small vessel ischemic disease.2. No evidence of acute ischemic or hemorrhagic lesion.


Instruction: Generate impression based on findings.

Input: Brain stem acute ischemic stroke: left hemiparesis. There are multiple scattered foci of restricted diffusion and high T2 signal in the bilateral posterior cerebral hemispheres, including the right thalamus, left hippocampal tail, bilateral parietal and occipital lobe cortices, and splenium of the corpus callosum, as well as in the right pons and middle cerebellar peduncle, and left cerebellar hemisphere. There is a background of diffuse patchy cerebral and pontine white matter T2 hyperintensity without associated restricted diffusion, which may represent chronic small vessel ischemic disease. There is no evidence of intracranial hemorrhage or mass. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The orbits, skull, and scalp soft tissues are grossly unremarkable. There are secretions in a left ethmoid sinus and a small retention cyst in the right maxillary sinus.

Output: Multiple supratentorial and infratentorial small acute embolic infarcts in the posterior circulation distribution, but no evidence of acute hemorrhage or midline shift. Please refer to the recent head CTA regarding the status of the vasculature.


Instruction: Generate impression based on findings.

Input: Evaluate lesion in the pancreas. History of necrotizing pancreatitis with necrosectomy in 2012. Evaluate with secretin stimulation. EUS 11/11/2015: 1.2 cm ill-defined hypoechoic focus in pancreatic body with biopsy found to be atypical mucinous epithelial cells, neoplasm not excluded. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: The intrinsic T1 signal of the pancreas is decreased. There is mild beading and dilatation of the mid to distal pancreatic duct with multiple focal outpouchings, compatible with side branch ectasia, similar to prior CT December 9, 2012. No abnormal corresponding enhancement is identified. No peripancreatic fluid is identified. Post secretin administration, there is compromised compliance of the pancreatic duct. Fluid is seen at the level of the third perforation of the duodenum, confirming satisfactory exocrine function.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: There is a left midpole 1.4 cm simple cyst. No pancreatic mass identified. There is no hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The bowel loops are normal in appearance. There is no evidence of bowel obstruction. No ascites is identified.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Mid to distal pancreatic duct dilatation and side branch ectasia, with no enhancing lesion identified. Compromised compliance of the pancreatic duct post secretin administration. Constellation of findings compatible with history of chronic pancreatitis.


Instruction: Generate impression based on findings.

Input: Reason: Nodules (one on the L popliteal fossa and one on the L medial ankle inferior to maleolus) History: Nodules. There is a small amount of fluid within a popliteal cyst. No abnormal soft tissue mass to account for the patient's palpable abnormality.No abnormal soft tissue mass about the ankle to account for the patient's palpable abnormality.Osteoarthritis affects the knee.

Output: 1.Small popliteal cyst.2.No abnormal soft tissue mass.3.If clinical concern remains for soft tissue mass, then dedicated knee and/or ankle MRI's are recommended.


Instruction: Generate impression based on findings.

Input: 22-year-old male with history of sporadic abdominal pain with strong family history of Crohn's disease. 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: No evidence of bowel obstruction, abnormal mucosal enhancement, or bowel wall thickening.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No evidence of bowel obstruction, abnormal mucosal enhancement, or bowel wall thickening.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No MR findings of inflammatory bowel disease.


Instruction: Generate impression based on findings.

Input: 37-year-old female with nasal congestion and discharge. Recurrent sinusitis. Extensive postsurgical findings of a large bifrontal craniotomy with underlying encephalomalacia and gliosis of the anterior frontal lobes presumably postprocedural in etiology. Abnormal bone mineralization involving the anterior cranial fossa, cribriform plate, and extending into the sinus septae. Within the bilateral ethmoids and abutting the aforementioned abnormal bone, there is an extensive irregular enhancing soft tissue mass which measures approximately 58 x 40 mm (AP x TR, series 501 image 40) with the osseous abnormality measuring approximately 32 x 34 x 27 (AP x TR x CC, series 6 image 20, series 80434 image 28). This mass extends inferior into the nasal vault and appears contiguous with dural thickening along the left rectus gyri. Deformity and mass effect on the left medial orbital wall with lateral displacement of the left medial rectus, which abuts the left optic nerve, although the thinned medial orbital wall appears intact. These findings are suggestive of an ethesioneuroblastoma.There is complete opacification of the sphenoid sinuses likely due to obstruction from the mass. There is right maxillary sinus mucosal thickening and frothy debris compatible with acute sinusitis. No intracranial hemorrhage.Slight ex vacuo dilatation of the frontal horn of the left lateral ventricle. Otherwise, the CSF spaces are appropriate for the patient's stated age with no midline shift. 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 mastoid air cells are clear.

Output: 1.CT and MRI demonstrate extensive bifrontal postsurgical findings with extensive destructive soft tissue mass centered just below the region of the cribriform plate and ethmoids suggestive of residual esthesioneuroblastoma. Correlate with clinical history, imaging, and pathology from outside institutions. 2.Postobstructive sphenoid sinusitis. Acute right maxillary sinusitis.


Instruction: Generate impression based on findings.

Input: Ms. Brennan is a 66 year old female with BRCA2 mutation carrier and a strong family history of breast and ovarian cancer, including in her mother and three maternal cousins. Personal history of left breast benign MRI guided biopsy in 2011 There is scattered fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.Susceptibility artifact from biopsy marker clip is identified in the left breast, at site of prior benign breast biopsy. Scattered foci of enhancement are seen bilaterally, none of which appear more suspicious than the rest. No abnormal enhancement is seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: Diagnosis: Lumbago Acquired spondylolisthesisDiagnosis Edits: Clinical question: eval for spondylolysis or facet injurySigns and Symptoms: lbp for 1 1/2 years with extension 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 are pars interarticularis defects present bilaterally. This has not changed since the prior exam. There is minimal anterior subluxation of L5 on S1 which remains stable.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. There is mild loss of disc space height and mild disc desiccation at this level associated with some mild compression of the anterior aspect of the L4 superior endplate due to a large Schmorl's node.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.Spondylolysis at L5 is stable compared to the prior exam. There is minimal anterior subluxation of L5 on S1 which remains stable.2.There is mild degenerative disc disease present at L3-4 which is also stable.


Instruction: Generate impression based on findings.

Input: Reason: brainstem ischemia History: dysparthria The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. There are punctate T2 and flair hyperintense lesions present in the brainstem especially the left pons.On susceptibility imaging there is a hypointense focus present in the pons just to the right of midline. On T2 imaging and appears to have a central signal hyperintense focus.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 demonstrates a small maxillary sinuses and some scattered mucosal thickening. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin.

Output: 1.A 5mm hemorrhagic focus is present in the pons. It is possible this may represent a small cavernoma but could represent a small hemorrhage in the early chronic/late subacute stage. Examination when the patient is able to cooperate better with MRI may be useful in evaluating this further.2.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 3.No evidence for acute ischemic stroke or intracranial mass.4.Examination is somewhat compromised due to patient motion which may obscure more subtle abnormalities.


Instruction: Generate impression based on findings.

Input: 55 year old woman with history of PVCs. Evaluate for scar and sarcoidosis. Study moderately limited by cardiac arrythmia.Left VentricleQualitatively normal LV function. There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is mildly enlarged. Right VentricleQualitatively normal RV function. Right AtriumThe right atrium is nonenlarged.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveTrace mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsScattered pulmonary micronodules. 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: Study moderately limited by cardiac arrythmia.No late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Qualitatively normal biventricular function.Quantitative measures of LV and RV function and size will be reported as an addendum.


Instruction: Generate impression based on findings.

Input: There are few non-specific foci of T2/FLAIR signal hyperintensity in the left frontal lobe. Linear enhancement within the inferior left frontal lobe may represent a developmental venous anomaly. Otherwise, there is no abnormal enhancement in the brain, evidence of intracranial mass, mass effect, or midline shift. No diffusion weighted abnormalities are identified. There is no evidence for intracranial hemorrhage. No mass is identified in the cerebellopontine angles, and there is no obvious abnormal facial nerve enhancement. The ventricles and sulci are normal in size. There are no extraaxial fluid collections or subdural hematomas. The paranasal sinuses and mastoid air cells are clear. There is a 1 cm benign appearing lesion centered in the outer table of the right parietal bone which demonstrates increased T2 signal and enhancement on postcontrast imaging with mineralization evident on prior CT, which may represent an intraosseous meningioma or hemangioma.

Output: 1. MRI of the brain is essentially within normal limits for age. Specifically, no evidence of acute infarct or intracranial mass. A few foci of T2 hyperintensity in the left frontal lobe are nonspecific, but may relate to prior inflammation or can be seen with entities such as migraines.2. Enhancing lesion in the right parietal calvarium with mineralization evident on recent CT. Lesion is nonspecific but favored to represent a benign entity suggest as atypical hemangioma or intraosseous meningioma


Instruction: Generate impression based on findings.

Input: T4 breast cancer with lethargy and wight loss. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are a few scattered nonspecific cerebral white matter T2 hyperintense foci. 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. There is a 15 mm long T1 hyperintense lesion that losses signal with fat suppression in the occipital bone, which likely represents a hemangioma. The orbits, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No evidence of intracranial metastases.


Instruction: Generate impression based on findings.

Input: Female 18 years old Reason: Lab Tear History: left hip pain ACETABULAR LABRUM: The acetabular labrum is intact.ARTICULAR CARTILAGE AND BONE: The articular cartilage is intact. There is no abnormal bone marrow signal. The alpha angle is 45 degrees, within normal limits.SOFT TISSUES: No significant abnormalities within the soft tissues. There is a small amount of gadolinium within the iliopsoas muscles secondary to iatrogenic injection.ADDITIONAL

Output: Intact acetabular labrum.


Instruction: Generate impression based on findings.

Input: Persistent low back pain despite all appropriate nonoperative measures. For the purposes of numbering, there are 5 lumbar vertebrae--with small ribs associated with L1, as numbered previously. The vertebral column alignment is within normal limits. There is mild anterior wedging of the L1 vertebral body as seen previously without marrow edema. Again seen is disc desiccation with height loss involving the L3-L4 disc, minimally worse since 11/2/2015. Disc desiccation is also evident at L4-L5 and to an even lesser degree at L5-S1 without height loss. Again seen are edematous endplate changes involving the superior endplate of L4 as well as inferior endplate of L3, which have slightly progressed since prior. No suspicious osseous lesions are evident.There is no significant spinal canal stenosis. The distal spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable. T12-L1: There is a tiny disc bulge but no significant compromise to the spinal canal or neural foramina.L1-L2: There is no significant compromise to the spinal canal or neural foramina.L2-L3: There is no significant compromise to the spinal canal or neural foramina.L3-L4: Again seen is disc bulge with left foraminal disc extrusion component which causes mild to moderate left neural foraminal stenosis and effacement of the left lateral recess. There is mild right neuroforaminal narrowing. There is mild facet arthropathy with distention of the facet joints similar to prior. There is minimal central spinal canal narrowing.L4-5: There is a mild disc bulge and mild facet arthropathy which causes mild left neural foraminal stenosis. There is no significant right neuroforaminal or central canal stenosis. L5-S1: There is no significant compromise to the spinal canal or neural foramina. Mild facet arthropathy.

Output: 1. Compared to 11/2/2015, there is slight progression of degenerative disc endplate changes at the L3-L4 level with mild increase in edema involving the adjacent endplates. There is mild to moderate left neural foraminal stenosis related to disc extrusion at this level similar to prior. There is also facet arthropathy at this level with mild distention of the facet joints. 2. Mild degenerative changes at additional levels as described above which are not significantly changed since prior. Mild anterior wedging of L1 vertebral body without edema again seen.3. Please note numbering scheme above with hypoplastic ribs associated with the L1 vertebral body, as numbered previously.


Instruction: Generate impression based on findings.

Input: There is an enhancing left cerebellar mass measuring 2.2 x 1.9 cm with surrounding edema extending into the left middle cerebellar peduncle as well as associated susceptibility effect representing hemorrhage. There is local mass effect with partial effacement of the fourth ventricle, but no hydrocephalus. Susceptibility with associated volume loss in the left occipital and right parietal lobes likely related to chronic hemorrhage. There is also smaller foci of susceptibility seen in the left frontal lobe and right cerebellum. No evidence of acute infarct. No extra-axial collections. No midline shift or uncal herniation. No destructive lesions within the calvarium are appreciated.

Output: 1.Hemorrhagic lesion in the left cerebellum with enhancement and surrounding edema suspected to represent hemorrhagic metastasis. There is associated partial effacement of the fourth ventricle, but no hydrocephalus is seen. 2.Susceptibility with associated volume loss in the left occipital and right parietal lobes likely representing chronic hemorrhage which may be related to prior treated hemorrhagic metastases versus chronic hemorrhagic infarcts. Similar but smaller chronic hemorrhagic lesions without enhancement are also seen in the left frontal lobe and right cerebellar hemisphere. There is no MRI available for comparison, although these lesions are not seen on 2013 PET/CT.


Instruction: Generate impression based on findings.

Input: Diagnosis: Kidney transplant status End stage renal disease Other symptoms and signs involving the musculoskeletal systemDiagnosis Edits: ||Clinical question: Leg weakness, neuro consult recommendations. No contrast as is s/p kidney transplantSigns and Symptoms: as above Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. There is multilevel disc desiccation present. There appears to be hypertrophy of the ligamentum flavum extending from C1 down to the C4-5 disc space level.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is a diffuse disc bulge present associated with hypertrophy of the ligamentum flavum. There is flattening of the spinal cord associated with T2 signal hyperintensity within the spinal cord at this level. Overall there is severe spinal stenosis at this level.At C4-5 there is a diffuse disc bulge present associated with some ligamentous hypertrophy. There is effacement of spinal fluid ventral and posterior the spinal cord and mild flattening of the spinal cord. Overall there is moderate spinal stenosis 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.Exam is compromised by patient motion.MRI thoracic spine:The thoracic vertebral bodies are appropriate in the overall alignment and height. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots. Exam is compromised by patient motion.

Output: 1.There are degenerative changes present in the cervical spine with severe spinal stenosis at C3-4 and moderate spinal stenosis at C4-5. There is associated cord signal change at C3-4 and flattening the spinal cord.2.Exam is compromised by patient motion. This may obscure more subtle abnormalities.


Instruction: Generate impression based on findings.

Input: Female, 55 years old, history of metastatic non-small cell lung cancer with confusion. Brain:Evidence of treated tumor is again seen within the far lateral left cerebellum and within the right cingulate gyrus. Both lesions show hemosiderin staining and neither lesion demonstrates any appreciable enhancement. Both are unchanged in size relative to the immediate prior examination, and much smaller when compared to earlier studies.A 4 mm enhancing focus within the inferior lateral left cerebellum and a 2 mm enhancing focus within the right inferior cerebellum are both unchanged. No new enhancing lesions are seen.No evidence of significant generalized mass effect is detected. No acute intracranial hemorrhage or any abnormal extra-axial fluid collections are observed. The ventricles are stable and normal in size. An incidental pineal region cyst is unchanged. Mucosal thickening is demonstrated in the paranasal sinuses and the mastoid air cells are partially opacified.C-spine:Sagittal alignment is anatomic. Vertebral body heights are preserved. No evidence of concerning marrow replacement, edema or pathologic enhancement is observed. The rectus capitis and obliquus capitis inferior muscles on the right are very slightly hyperenhancing. The visualized spinal cord demonstrates normal signal intensity throughout and is free of pathologic enhancement. No epidural abnormalities are suspected.C2-3: Unremarkable. C3-4: Unremarkable. C4-5: Right facet arthropathy. Minimal posterior disc-osteophyte complex formation. No spinal canal stenosis. Mild right foraminal narrowing. C5-6: Facet arthropathy. Posterior disc-osteophyte complex formation. Mild spinal canal narrowing. Moderate bilateral foraminal narrowing. C6-7: Unremarkable. C7-T1: Unremarkable.  A right pleural effusion is partially visualized.

Output: 1.No change in the size of treated tumors within the far left lateral cerebellum in the right fibula gyrus.2.Two additional enhancing lesions in the cerebellum also show no significant interval change.3.No evidence is seen to suggest metastatic disease to the cervical spine. Multilevel disc degeneration is evident most notably affecting C5-6 where there is spinal canal stenosis and significant bilateral foraminal narrowing.4.Mild hyperenhancement of the upper right posterior spinal paraspinal muscles may represent mild injury or inflammation.


Instruction: Generate impression based on findings.

Input: Brain MRI on 2/26/16 showed an incidental 4 mm wide T1 hyperintense nodule superior to the pituitary gland. There is redemonstration of a small T1 hyperintense focus posterior and superior to the pituitary gland, alongside the neurohypophysis. The pituitary infundibulum is intact. The anterior pituitary gland is unremarkable. The optic apparatus and cavernous sinuses are unremarkable.

Output: Redemonstration of a small T1 hyperintense focus posterior and superior to the pituitary gland may represent a prominent dorsum sella versus less likely a Rathke cleft cyst.


Instruction: Generate impression based on findings.

Input: Clinical question: History of lung cancer, compared to prior exam. Signs and symptoms: None. Nonenhanced brain MRI:No diffusion weighted abnormalities.Examination demonstrates interval improvement of postoperative changes of right frontal lobe tumor resection. There is interval decreased size of the small hematoma adjacent to the surgical cavity since prior study. Remaining hematoma on coronal T2 weighted images measures approximately 7.7 x 4-mm in size compared to prior study measurement of approximately 5.8 x 8-mm.there is also interval decreased size of surgical cavity demonstrating hemosiderin deposition along its wall since prior study. The surgical cavity measures approximately 6.7 x 8.7 mm in transaxial dimensions compared to prior study measurements of approximately 10 x 11 mm.Surrounding white matter T2 hyperintensity in the pattern of vasogenic edema all of without associated mass effect demonstrates subtle interval decrease extension.Extensive periventricular and pontine and to a lesser degree subcortical foci of flair hyperintensity suggestive of chronic nonhemorrhagic small vessel ischemic strokes are again noted. There are small foci of flair hyperintensity in the right inferior cerebellum consistent with chronic right cerebellar ischemic strokes without change. Ventricular system remain within normal size and it maintained midline.

Output: 1.Interval improvement of postoperative changes of right frontal surgery and hemorrhage as detailed/measured above.2.No evidence of any new foci of edema or mass effect.3.Findings suggestive of chronic small vessel ischemic strokes grossly similar to prior study.4.Right cerebellar chronic ischemic strokes without change since prior exam. Diffusion-weighted images remain negative.


Instruction: Generate impression based on findings.

Input: 88-year-old female with cellulitis about the dorsum of the foot extending to the mid shin. There is mild soft tissue infiltration visualized about the dorsum of the forefoot that is continuous with mild soft tissue infiltration within the anterior ankle/distal tibia-fibula. This edema extends circumferentially and involves the posterior aspects of the ankle. No fluid collections to suggest abscess.TENDONS: The tendons of the ankle appear intact.LIGAMENTS: No significant abnormality noted.ARTICULAR SURFACES AND BONE: Mild osteoarthritis affects the midfoot, though this findings is essentially normal for age. ADDITIONAL

Output: Findings compatible with cellulitis of the ankle and dorsum of the forefoot, however no evidence suggest osteomyelitis.


Instruction: Generate impression based on findings.

Input: Seizure. There are large areas of restricted diffusion and high T2 signal in the bilateral frontal lobes, bilateral cingulate gyri, and left temporal, parietal, and occipital lobes. There are high T1 and T2 signal subdural fluid collections along the bilateral occipital convexities that measures up to 2 mm in thickness. In addition, there is diffuse restricted diffusion in the corpus callosum and along the posterior limbs of the bilateral internal capsules, with extension into the midbrain on the left. There is otherwise a background of normal myelination. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and paranasal sinuses are grossly unremarkable. However, there is an apical subgaleal fluid collection that measures up to 9 mm in thickness.

Output: 1. Recent infarcts involving the bilateral cerebral hemispheres, left more than right.2. Early subacute subdural hemorrhage along the bilateral occipital convexities that measures up to 2 mm in thickness. Discussed with nurse practitioner Sherri Sadler at 1:45 PM on 7/20/15.


Instruction: Generate impression based on findings.

Input: Male, 59 years old. Reason: history of thyroid nodules RIGHT LOBE MEASUREMENTS: 6.3 x 2.3 x 3.0 cmLEFT LOBE MEASUREMENTS: 6.8 x 3.4 x 3.3 cmISTHMUS MEASUREMENTS: 0.4 cmRIGHT LOBE: Heterogeneous echotexture. A right lower pole nodule measures 1.6 x 0.7 x 0 .6 cm, hypoechoic, with internal vascularity. An additional 1.0 x 1.2 x 0.8 cm echogenic nodule in the lower pole with internal calcifications suggested.LEFT LOBE: Heterogeneous echotexture. A left lower pole nodule measures 3.3 x 3.2 x 2.7 cm, heterogeneous, mixed cystic and solid, predominantly hypoechoic, with internal vascularity.ISTHMUS: Heterogeneous echotexture.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. A 3 cm mixed cystic and solid left lower pole nodule can be biopsied for further evaluation. 2. Additional smaller indeterminate nodules are identified on the right as detailed above.


Instruction: Generate impression based on findings.

Input: 65 year old female rule out CVA. Weakness, fall, headache and dizziness No evidence of hemorrhage, edema, mass-effect, midline shift or hydrocephalus is detected. Cortical sulci, ventricular system and all CSF cisterns remain within normal. Further evaluation with an MRI is recommended.Calvarium, paranasal sinuses and mastoid air cells are also within normal range.

Output: Normal CT of brain without infusion.


Instruction: Generate impression based on findings.

Input: Recurrent papillary thyroid carcinoma status post multiple recent biopsies. There are postoperative findings related to thyroidectomy and neck dissection. There is a persistent ill-defined soft tissues in the right tracheoesophageal groove region, albeit less conspicuous than previously. The mass infiltrates the party wall and mildly narrows the tracheal lumen. There is otherwise no evidence of other mass lesions of cervical lymphadenopathy. The salivary glands appear unchanged. There are scattered patchy cerebral white matter T2 hyperintense lesions, which may represent chronic small vessel ischemic disease. The osseous structures are unchanged. There is fluid in the bilateral maxillary sinuses and left sphenoid sinus. There are bilateral lens implants.

Output: 1. Postoperative findings related to thyroidectomy, with persistent ill-defined soft tissues in the right tracheoesophageal groove region, albeit less conspicuous than previously, likely related to residual tumor and treatment effects.2. Findings suggestive of acute sinusitis.


Instruction: Generate impression based on findings.

Input: This exam is mildly degraded by susceptibility artifact, including the thin section post-contrast images through the IACs. The internal auditory canals are symmetrical and normal in size. The inner ears are normal. There is no evidence for mass, abnormal enhancement, or vascular anomaly. There is a right maxillary sinus retention cyst and mucosal thickening within the right sphenoid sinus.

Output: Normal internal auditory canal MRI.


Instruction: Generate impression based on findings.

Input: NSCLC treated with CyberKnife, altered mental status since hospitalization for esophagitis and esophageal stent placement, known meningioma, new right more than left upper extremity tremor, right lower extremity tremor, and flat affect. There is no evidence of intracranial hemorrhage or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is a subcentimeter extra-axial enhancing lesion overlying the inferior left temporal convexity. There is no abnormal intraparenchymal 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: 1. No evidence of intracranial hemorrhage or acute infarct. 2. Unchanged subcentimeter presumed meningioma overlying the inferior left temporal convexity, but otherwise no evidence of intracranial metastases.


Instruction: Generate impression based on findings.

Input: Left parotid Warthin tumor status post surgery in 2008. There are postoperative findings related to left parotid tumor resection. There is scar tissue along the surgical approach, but no discernible tumor, aside from what appear to be subcentimeter intraparotid lymph nodes bilaterally. The other salivary glands are unremarkable. There is no evidence of cervical lymphadenopathy. There is degenerative cervical spondylosis with a small posterior disc-osteophyte at C6-7. The imaged portions of the orbits are unremarkable. There appears to be a punctate focus of enhancement in the pons, which may represent a telangiectasia.

Output: Postoperative findings related to left parotid tumor resection without convincing evidence of recurrent Warthin tumor.


Instruction: Generate impression based on findings.

Input: Reason: Please evaluate for possible obstruction, h/o of FAP s/p proctocolectomy with IPAA 1996 History: recurrent bowel obstructions with abdominal pain, distension and vomiting and hospitalized twice since January. Usually minor episodes that resolve on own every 4-6 weeks. The scout film showed a nonspecific bowel gas pattern a focally dilated loop of small bowel in the left upper quadrant. Multiple gallstones and a right ureteropelvic junction calculus are noted. Additional small nephrolithiasis suggested in the lower pole of the right kidney.There is long segmental relative narrowing of the proximal aspect of the J-pouch, as seen on the prior MRI from 6/10/2016, and measuring approximately 13.5 cm in length. This area is widely patent with lumen measuring up to 3 cm. Overall there is diffuse dilatation of small bowel. All of these findings are consistent with a normal postoperative appearance, with chronic changes reflective of patient's prior total colectomy with formation of J-pouch.Fluoroscopy Time: 2 minutes 27 secondsDose area product: 3480 uGy*m2Entrance dose: 97 mGy

Output: 1. No evidence of bowel obstruction. 2. Long segmental mild relative narrowing of the proximal aspect of the J-pouch, as seen on the prior MRI from 6/10/2016, and measuring approximately 13.5 cm in length. Luminal dilatation much improved compared to earlier MRI and site is widely patent with lumen measuring up to 3 cm. Overall there is diffuse dilatation of small bowel. All of these findings are consistent with a normal postoperative appearance, with chronic changes reflective of patient's prior total colectomy with formation of J-pouch.


Instruction: Generate impression based on findings.

Input: Reason: Right posterior buttocks SQ mass, probably lipoma, evaluate etiology No definite right posterior subcutaneous mass is identified. No abnormal enhancing lesion is present. Normal osseous alignment of bilateral femurs with mild joint space narrowing. No evidence of acute fracture. Mild degenerative change of the lower lumbar spine.

Output: No definite evidence of right posterior subcutaneous mass.


Instruction: Generate impression based on findings.

Input: 21-year-old male patient with history of Hb-SS presents with hepatomegaly, jaundice, increased indirect bilirubin. ABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy. There is biliary duct narrowing at Klatskin's point (series 901 image 73) without proximal intrahepatic biliary ductal dilatation. No extrahepatic biliary ductal dilatation. Hepatomegaly, measuring up to 22 cm in craniocaudal dimension. Extensive deposition noted in the liver parenchyma. Hepatic vasculature is patent. Enlarged porta hepatic lymph nodes noted.SPLEEN: Presumed splenectomy.PANCREAS: No pancreatic ductal dilatation or suspicious lesion.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Mildly dilated calices in the right kidney may be seen in the setting of papillary necrosis.RETROPERITONEUM, LYMPH NODES: Scattered retroperitoneal lymph nodes. Note that evaluation of the patient's known mesenteric mass is suboptimally evaluated due to the lack of intravenous contrast.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Hepatomegaly with extensive iron deposition.2.Narrowing at Klatskin's point without proximal intrahepatic biliary ductal dilatation.3.Dilated calices in the right kidney may be seen in the setting of papillary necrosis.


Instruction: Generate impression based on findings.

Input: Clinical question: MS, new left hand tingling and stiffness. Signs and symptoms: Left hand tingling and stiffness, compared to previous exams. Pre and post enhanced brain MRI:No diffusion-weighted abnormalities. Examination demonstrates no detectable abnormal parenchymal, meningeal, calvarial or retro-orbital enhancement.Examination demonstrates no evidence of any new lesions since prior exam. Previously noted enhancing plaques are again identified however without detectable enhancement on current study. A single lesion in the left middle cerebellar peduncle is again identified without enhancement however with subtle decreased size since prior exam.Unremarkable cerebral cortex, cortical sulci, ventricular system and CSF spaces otherwise.Unremarkable calvarium, soft tissues of the scalp, orbits, paranasal sinuses and mastoid air cells.Pre- and post enhanced cervical MRI:There are no prior cervical MRI exams for comparison.Examination demonstrate no convincing evidence of abnormal signal intensity, cord caliber or abnormal enhancement of the cervical and upper most visualized thoracic cord.There is no evidence of a spinal stenosis at any level.Very mild degenerative changes of cervical spine are noted however without detectable neural foraminal compromise at any level.

Output: 1.Pre- and post enhanced brain MRI demonstrate no evidence of new lesions or any detectable abnormal enhancement. Mild chronic changes of demyelinating disease is again noted with interval complete resolution of previously seen enhancement.2.Pre and post enhanced MRI of cervical spine demonstrate no convincing evidence of demyelinating disease or abnormal enhancement. No spinal stenosis or neural foraminal compromise.


Instruction: Generate impression based on findings.

Input: Clinical question: Rule out enhancing lesion or new lesion compared to prior study. Signs and symptoms: Spastic parapresis Pre-and post-enhanced brain MRI:Near diffusion weighted series. Examination redemonstrate multiple small foci of hyperintensity (demyelinating plaques) in the periventricular and subcortical white matter of bilateral cerebral hemispheres, small lesion in the right anterior pons and left middle cerebellar peduncle which appear similar in size and number to prior exam. There is no convincing evidence of any new demyelinating plaque. There is no detectable abnormal enhancement of any of the lesions and post-enhanced images are essentially negative.Cortical sulci, ventricular system and CSF spaces are within normal patient stated each and stable since prior exam.Unremarkable images through the orbits and including axial fat sat post enhanced series.Pre-and post enhanced cervical MRI:Examination demonstrated multiple small foci of T2 hyperintensity throughout the cervical the spinal cord. There is questionable subtle further increased T2 signal intensity of the cervical cord at C2 adjacent to previously seen lesions at this level. This finding however can be entirely technique related and there is no detectable abnormal enhancement. This finding is only suspected on sagittal T2 stir series 1701 on image 7 and cannot be confirmed with certainty on any other MRI sequence. There is no detectable abnormal enhancement of the cord or the leptomeninges on post enhanced series.Degenerative changes of the cervical spine are again noted without significant change since prior exam. Prominent disk protrusion and C4 -- C5 demonstrate interval decreased size and better visualization of the ventral subarachnoid space. Disk osteophyte complex at C3 -- C4 with subtle mass-effect and posterior displacement of the cord also demonstrate no appreciable interval change.No significant central spinal stenosis at any level.The uppermost visualized thoracic cord and thoracic spine to T4 level is unremarkable

Output: 1.Mild findings of chronic multiple sclerosis both in the supra-and infratentorial brain parenchyma and without convincing evidence of interval change since prior study or any enhancing plaques.2.Extensive findings of multiple sclerosis of the cervical cord without convincing evidence of interval change and without detectable abnormal enhancement. Please see above comments.


Instruction: Generate impression based on findings.

Input: T4aN2b base of tongue squamous cell carcinoma status post treatment. There is no measurable tumor in the right tongue region. Likewise, there is no evidence of residual significant lymphadenopathy in the neck. The thyroid and salivary glands are unchanged. The larynx appears to be intact. There is multilevel degenerative cervical spondylosis with mild spinal canal narrowing at C3-4 and C4-5. There is rightward nasal septal deviation. The orbits and imaged intracranial structures are unremarkable.

Output: No evidence of measurable tumor in the right tongue base and no evidence of significant lymphadenopathy in the neck.


Instruction: Generate impression based on findings.

Input: Male, 63 years old, history of renal cell carcinoma with solitary metastasis to the brain, status post surgery and postoperative SRS. Although dedicated pituitary sequences were not acquired on this exam, there has been a slight interval decrease in the size of the mildly enhancing sellar and suprasellar mass. The lesion demonstrates T2 hypointensity which may again represent hemosiderin staining or mineralization. Sequelae of prior transsphenoidal sellar surgery are again noted.Elsewhere intracranially, no pathologic enhancement is seen. No areas of edema or mass effect are detected. No acute intracranial hemorrhage or any abnormal extra-axial fluid collection is seen. The ventricles are normal in size and morphology.An enhancing left masseter muscle lesion is partially visualized on only on the 3-D T1 post-contrast images. For further details, please refer to the CT of the neck tissues report from the same date.

Output: 1.Slight interval decrease in size of the sellar/suprasellar tumor. 2.No additional intracranial lesions are seen.


Instruction: Generate impression based on findings.

Input: 62 years Male (DOB:7/30/1953)Reason: Hx of head and neck cancer with AMS r/o mets / infarct History: altered mental statusPROVIDER/ATTENDING NAME: ANUBHA GANJOO KWANG JIN CHOI The exam is degraded by patient motion.The flow void of the left internal carotid artery is absent along the petrous and cavernous segments.There are punctate foci of T2 and FLAIR signal hyperintensity in the watershed zone in the periventricular white matter of the left hemisphere.There are punctate foci of T2 and FLAIR signal hyperintensity in the left pons and left midbrain associated volume loss. There are foci of T2 hyperintensity in the basal ganglia which are low signal on FLAIR MRI are present in enlarged perivascular spaces possibly related to prior vascular insults. A small focus of encephalomalacia is present along the inferior aspect of the right cerebellar hemisphere.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 demonstrate some mucosal thickening. The visualized portions of the mastoid air cells demonstrate opacities. The visualized portions of the orbits are intact.

Output: 1.There is occlusion of the left internal carotid artery associated with old watershed spinal foci of infarction in the left periventricular white matter and centrum semiovale.2.Punctate lesions involving the left brainstem and basal ganglia are suspected to be vascular related possibly to old lacunar infarcts.3.Small focus of encephalomalacia is present in the right cerebellar hemisphere. This is probably vascular related.4.Exam is degraded by patient motion. This may obscure smaller lesions. To the extent of visualization there is no evidence for brain metastases on the current exam.


Instruction: Generate impression based on findings.

Input: Female 39 years old Reason: uterine fibroids, s/p UFE History: uterine fibroids PELVIS:UTERUS, ADNEXA: The uterus is enlarged and heterogeneous measuring 7.8 x 6.9 x 9.7 cm. The dominant uterine fibroid measures 5.2 x 3.8 cm (previously 5.9 x 3.8 cm). This fibroid as well as multiple others does not demonstrate significant enhancement postcontrast consistent with treatment response. Normal-appearing ovaries are identified.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: Moderate pelvic free fluid, likely physiologic.

Output: 1.Multiple nonenhancing fibroids as described above, consistent with treatment response.


Instruction: Generate impression based on findings.

Input: 42-year-old female with left and right knee pain. Evaluate for osteoarthritis Weightbearing radiographs of the right knee reveal medial joint space narrowing as well as osteophyte formation along the lateral and medial femoral condyle and superior portion of the patella. Weightbearing radiographs of the left knee reveal lateral joint space narrowing as well as osteophyte formation along the lateral and medial femoral condyle and along the superior portion of the patella.Overall findings appear similar to prior study.

Output: Moderate osteoarthritis with no significant interval change from prior study.


Instruction: Generate impression based on findings.

Input: Anaplastic oligodendroglioma, WHO grade III status post treatment: surveillance. There are postoperative findings related to subtotal right frontal tumor resection, with a 5 mm wide extra-axial residual fluid collection anteriorly. There is interval increase in size of heterogeneously enhancing tumor with punctate foci of susceptibility effect along the resection cavity margins, which measures up to approximately 35 mm in thickness. There is also increased extensive surrounding non-enhancing confluent T2 hyperintensity with up to approximately 10 mm of midline shift to the left, as well as subfalcine herniation and partial effacement of the right lateral ventricle. There is no acute territorial infarct. The major cerebral flow voids are intact. The orbits are grossly unremarkable.

Output: Postoperative findings related to subtotal right frontal tumor resection with interval increase in size of tumor along the surgical margins, as well as the extensive surrounding edema and/or non-enhancing tumor infiltration with approximately 10 mm of midline shift.


Instruction: Generate impression based on findings.

Input: Large syrinx with Chiari, annual surveillance. Again seen is crowding at the foramen magnum with caudal displacement of peglike cerebellar tonsils, which measure up to 9 mm below the foramen of magnum similar to prior. The right-sided cerebellar tonsil is lower than the left. CSF flow sequence is technically degraded (related to patient motion due to claustrophobia and body habitus), however, there is significantly diminished biphasic flow dorsally at the foramen magnum. CSF spaces and flow are mildly diminished ventrally at the foramen magnum.Again seen is a spinal cord syrinx beginning at the C2 level and continuing caudally to approximately the T4 level. The syrinx cavity reaches its maximum caliber at C5-C6 where it measures 8 x 3 mm in the transverse and AP dimensions, previously 8 x 5 mm at this level. The thoracic component of the syrinx is suboptimally evaluated however there appears to be slight decrease in the thoracic component, as well, for example measuring up to 4 x 2 mm in the transverse and AP dimensions, previously 5 x 2 mm.The syrinx cavity is largely positioned in the center of the cord, though at the C2 level, there is a linear slitlike component which completely traverses the right hemicord and similar to prior.The remainder of the spinal cord is grossly unremarkable. Spinal alignment is anatomic. Vertebral body height, morphology and signal characteristics are all within normal limits. No significant spinal canal or neural foraminal stenosis is appreciated.

Output: 1. Findings consistent with known Chiari I malformation including crowding at the foramen magnum and peglike cerebellar tonsils extending approximately 9 mm below the foramen magnum. There is associated diminished CSF flow at the foramen magnum, particularly posteriorly.2. Compared to 8/22/2015, there are areas of minimal interval decrease in caliber of the cervicothoracic syrinx (axial plane) but otherwise not significantly changed in the craniocaudal extent from C2 to approximately the T4 level. 3. Note patient had difficulty tolerating the study, and the thoracic sequences are significantly motion degraded.


Instruction: Generate impression based on findings.

Input: Male, 8 years old, with frequent headaches, ataxia and tendon contractures. Evaluate for Chiari malformation, syrinx, tethered cord. A very slight levoscoliosis of the spine is seen which may be due to positioning. The sagittal alignment of the spine is otherwise unremarkable.A normal complement of normally formed vertebral bodies is seen. No segmentation anomalies are detected. Marrow signal characteristics are within normal limits.The cerebellar tonsils terminate at or above the level of the foramen magnum. The CSF space at the level of the foramen magnum is widely patent and there is robust biphasic CSF flow through this region both anteriorly and posteriorly.The visualized spinal cord demonstrates normal intensity and morphology. The conus tip terminates at the upper L2 level which is within normal limits. No evidence of any intraspinal mass or fatty infiltration of the filum terminale is seen.The intervertebral discs are well preserved throughout. No significant spinal canal or neuroforaminal stenosis is seen.

Output: Unremarkable evaluation with no evidence of Chiari malformation, spinal cord syrinx, tethered cord, or other specific findings to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Colloid cyst, questionable history of aneurysm. Again seen is an approximately 10 x 6 x 8 mm (AP by craniocaudal by transverse) nonenhancing lesion centered along the leftward aspect of the foramen of Monroe. The lesion is isointense on T1 with mixed intensity on T2 and high density on prior CT. Ventricular sizes remain normal without evidence of obstructive hydrocephalus at this time.There are scattered punctate foci of T2 hyperintensity primarily within subcortical white matter without associated mass effect, restricted diffusion, susceptibility abnormality, or enhancement. There are no additional masses or evidence of mass effect. No evidence of acute infarct or hemorrhage. Flow voids are present within the major vessels indicating patency. There is no abnormal enhancement within the brain. The paranasal sinuses and mastoid air cells are clear.

Output: 1. A 10 mm likely colloid cyst centered in the left foramen of Monro appears unchanged in size since prior examination from 9/30/2016. 2. Mild chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: MRI on 1/24/2008 with diagnosis of the C4/5 disk. Patient with neck pain with pain in right arm and hand/numbness tingling. Please note, CT examination is very the limited in the evaluation of disk herniation. Within this limitation, the following observations are made.The bony density and alignment of the cervical spine is normal. Degenerative disk disease affects the cervical spine, most severe at the C5/C6 and C6/C7 vertebral levels. Findings by specific intervertebral level are as follows:C2/C3: Unremarkable.C3/C4: Degenerative changes. No evidence of neural foraminal narrowing or central spinal canal stenosis.C4-C5: Degenerative bulge of disk material. The neural foramina are narrowed bilaterally, right greater than left, which appear similar to the prior examination.C5-C6: Advanced degenerative disk disease with near complete loss of disk height. A large epidural hypertrophic spur is seen on the right and there is questionable right neural foramina narrowing. I cannot evaluate for disk herniation on this noncontrast CT examination. In review of the prior MRI, no definite herniation of disk material is seen. Findings on prior MRI appear to represent calcific hypertrophic changes secondary to degenerative disease rather than disk herniation.C6/C7: Advanced degenerative disk disease and mild bilateral neural foraminal narrowing.C7/T1: Unremarkable.T1/T2: Unremarkable.

Output: Advanced degenerative disk disease, most severe at the lower cervical spine levels. Please note, I cannot evaluate for disk herniation on this noncontrast CT examination. However, in correlation with today's examination, no definite disk herniation is identified on the prior MRI examination dated 1/24/2008 and the previously seen findings are believed to be represent calcific hypertrophic changes of degenerative disease.


Instruction: Generate impression based on findings.

Input: Lipomatous neoplasm, evaluate for interval change There is redemonstration of a large predominantly fat-containing mass within the posterior compartment of the calf which is situated between the gastrocnemius and soleus muscles with the cranial extent of the mass noted at the level of the knee joint. When compared to the prior exam, the mass appears slightly increased in size now measuring 15.9 x 8.3 x 9.6 cm in the greatest craniocaudal, AP, and transverse dimensions as compared to 13.8 x 6.6 x 8.2 cm previously. There is an additional component extending anteriorly between the tibia and fibula along the lateral aspect of the posterior tibialis muscle. The mass displaces the popliteal neurovascular bundle and its branches anteriorly. The signal intensity is again predominantly fat signal intensity on all pulse sequences although it also contains scattered areas of poorly defined nonadipose elements. There are thin minimally enhancing septa and/or vessels within the mass but again, no dominant nodular component is identified. There is nonenhancing reticulation of the subcutaneous fat of the lower leg suggestive of edema. There is a small joint effusion, mild synovitis, and moderate osteoarthritis of the knee. Slight focal nonenhancing heterogeneity of the bone marrow of the proximal tibial diaphysis may represent an island of residual red marrow as this appears unchanged from the prior exam.

Output: Redemonstration of known adipose tumor within the popliteal fossa and calf which appears slightly increased in size from the prior exam and may represent an enlarging lipoma or atypical lipomatous tumor. Additional findings are described above.


Instruction: Generate impression based on findings.

Input: Female, 27 years old, 35 weeks 2 days gestational age, with multiple fetal anomalies identified on ultrasound including fetal hydrocephalus. The posterior fossa is distended by a large cystic structure which communicates freely with the 4th ventricle. A vestigial upturned vermis is seen with hypoplasia of the remaining cerebellum. The torcular is elevated as well.The lateral ventricles are dilated measuring up to 22 mm in diameter at the level of the atria. The septum pellucidum is absent, but the corpus callosum is present and appears to be fully formed.Brain morphology and the pattern of gyral development are otherwise within expected limits for gestational age. No significant intracranial hemorrhage is suspected.Although imaging was tailored for assessment of intracranial structures, numerous thoraco-abdominal anomalies are visualized incidentally. This includes a defect in the abdominal wall which contains nearly the entire liver and gallbladder, as well as the stomach, and part of the bowel. The thorax is small and appears to contain only a small amount of lung tissue on each side. The pharyngeal airway is patent and communicates with a patent trachea. A scoliotic curvature of the spine is seen which may in part be due to fetal lie.

Output: 1.Findings compatible with classic Dandy-Walker malformation.2.Ventriculomegaly which is a known association with Dandy-Walker malformation.3.Absence of the septum pellucidum, but with an intact corpus callosum.4.Multiple thoraco-abdominal anomalies including omphalocele containing liver, stomach and bowel, and suspected pulmonary hypoplasia.


Instruction: Generate impression based on findings.

Input: Female 54 years old Reason: pancreatitis, hypertriglyceridemia, gastric outlet obstruction secondary to duodenal stenosis, s/p gastrojejunostomy History: abdominal pain, nausea, vomiting ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. No suspicious hepatic lesions. Hepatic and portal veins are patent. Status post cholecystectomy. Common bile duct measures 10 mm. There is narrowing of the common bile but within the head of the pancreas for a 2 cm length.SPLEEN: Spleen is enlarged. There are multiple large varices in the splenic hilum and the back wall of the stomach.PANCREAS: Creating inflammation has resolved. The pseudocyst in the pancreatic head has resolved. The cystic area in the pancreatic tail measures 2.9 x 2.5 cm. And is unchanged from prior CT. Pancreatic duct is normal in caliber although it is slightly irregular through the body suggesting early stricture formation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small right renal cyst. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: Small upper abdominal retroperitoneal lymph nodes.BOWEL, MESENTERY: There is a stent between the stomach and the proximal jejunum. Stomach is not distended. The duodenum is normal in caliber.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No ascites.INDEX LESION MEASUREMENTS (Current exam date/time: 11/29/2016 10:00:00)PANCREATIC TAIL LESION: 2.9 x 2.5 cm (Image 24, Series 601); 2.8 x 3.1 cm on prior (10/10/2016) (Image 41, Series 201).

Output: 1.Resolution of the pseudocyst in the head of the pancreas. Persistent narrowing of the common bile duct in the head of the pancreas with mild biliary duct dilatation.2.No significant size change in the pancreatic tail cystic lesion representing a pseudocyst.


Instruction: Generate impression based on findings.

Input: 65 year old female rule out CVA. Weakness, fall, headache and dizziness No evidence of hemorrhage, edema, mass-effect, midline shift or hydrocephalus is detected. Cortical sulci, ventricular system and all CSF cisterns remain within normal. Further evaluation with an MRI is recommended.Calvarium, paranasal sinuses and mastoid air cells are also within normal range.

Output: Normal CT of brain without infusion.


Instruction: Generate impression based on findings.

Input: 33-year-old male with a history of synovial cell sarcoma with pain. The bone marrow signal intensity is normal. The left hip appears normal. We see no effusion. There is a small amount of fluid within the joint with minimal synovial enhancement. Please note that this examination was not protocoled for detailed evaluation of the acetabular labrum, however, no abnormalities of the labrum are identified. The musculature of the left hip appears normal. On the large field-of-view images, the right hip appears normal as do the sacroiliac joints. Degenerative disc disease affects the level of L5/S1. The remaining visualized soft tissue structures appear normal.

Output: Minimal synovial enhancement of the left hip which is not necessarily of any clinical significance. Degenerative disc disease at L5/S1. We otherwise see no findings to account for the patient's pain.


Instruction: Generate impression based on findings.

Input: 61 years Female Reason: Evaluate IACs History: Right Asymmetrical SNHL Provider Name: EMMANUEL J VILLEGAS EMMANUEL J VILLEGAS No abnormal foci of enhancement are appreciated within the internal auditory canals. The cochlea and semicircular canals appear intact. The cochlear nerve can be followed bilaterally tracking into the cochlea. The modiolus is well formed bilaterally.No abnormal enhancing lesions are appreciated at the cerebellopontine angle cisterns nor the internal auditory canals.There is right periorbital soft tissue swelling present adjacent to the right side, along the lateral (temporal) aspect of the right orbital rim which can also be identified on the prior exam from 4/25/2013. At that time it appeared to measure approximately 7 x 11 mm axial dimensions on the current exam it measures 24 x 13 mm axial dimensions. This appears to extend to the skin surface. It appears to extend into the right extraconal space. The extraconal involvement is not completely included on the current exam.

Output: 1.No abnormal lesions are identified in the internal auditory canals or inner ear structures to explain the patient's asymmetric sensorineural hearing loss. 2.There is redemonstration of a right periorbital soft tissue lesion which appears slightly larger on the current exam when compared to the prior exam from 2013. The lesion is not entirely included on this exam and as a result cannot be adequately assessed. A biopsy from 7/2/2013 indicates that this represents xanthogranulomatous inflammatory change.


Instruction: Generate impression based on findings.

Input: There is no abnormal enhancement in the cervical spine. The cervical spine is in normal alignment, with a normal cervical lordosis. The vertebral body heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal which was better assessed on recent noncontrast study from 11/23/2015.. Mild degenerative changes are seen with small disc osteophyte complexes at C3-C4, C4-C5, and C5-C6 as well as ligamentum flavum thickening. There is no significant spinal canal stenosis at any level. There is mild to moderate right and mild left C4-C5 neural foraminal stenosis as well as mild right and minimal left C5-6 neural foraminal stenosis. No high-grade neural foraminal stenosis seen at any level. These findings are better assessed on recent noncontrast sequences.THORACIC SPINE

Output: No abnormal enhancement involving the cervical or thoracic spine. Please refer to report from 11/23/2015 with findings on the noncontrast sequences.


Instruction: Generate impression based on findings.

Input: left frontal meningioma postop follow up No evidence of acute ischemic or hemorrhagic lesion.There are two burr holes one on each frontal bone and evidence of craniotomy on the left frontal bone.Underlying dura shows homogenous linear enhancement especially on the left frontal hemisphere and anterior aspect of falx which likely represent postoperative changes. There is no evidence of nodular or mass like enhancement.There is no evidence of brain parenchymal enhancement on this scan.The left frontal lobe shows encephalomalacia with gliotic changes indicate postoperative no unusual finding.The ventricles, sulci and cisterns are symmetric and unremarkable.There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Post left frontal meningioma resection status, no unusual finding on today's scan.2. Non nodular enhancement of anterior falx and left frontal hemispheric meninges likely represent postoperative changes.3. No abnormal enhancement. No acute ischemic or hemorrhagic lesion.


Instruction: Generate impression based on findings.

Input: MRI BRAIN: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is minimal periventricular white matter T2 hyperintensity. The brain parenchyma otherwise appears unremarkable. There is no abnormal intracranial enhancement. The ventricles and sulci are borderline prominent. There is no midline shift or herniation. The major cerebral flow voids are intact. There are retention cysts in the sphenoid sinuses. The skull and scalp soft tissues are unremarkable. There is a partially-imaged cystic lesion in the right maxillary alveolus.MRA HEAD: There is no evidence of significant steno-occlusive lesions or aneurysms, within the limits of MRA.MRV HEAD: The left transverse and sigmoid sinuses and internal jugular vein are hypoplastic. However, there is no evidence of venous thrombosis.

Output: 1. No evidence of intracranial mass or acute infarction.2. No evidence of flow-limiting stenosis or aneurysm.3. No evidence of venous sinus thrombosis.4. Partially-imaged cystic lesion in the right maxillary alveolus may represent a radicular cyst or globulomaxillary cyst, for example. Dedicated maxillofacial imaging may be useful for further evaluation, if clinically warranted.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Reason: painful swelling ulnar side of wrist History: pain There is thickening and increased signal intensity of the extensor carpi ulnaris tendon as it courses through the distal ulnar groove and along the ulnar aspect of the wrist. This appears to have progressed when compared to the prior study. There is increased signal intensity within the tendon which extends to the surface indicating partial thickness tearing, but the tendon can be followed to its insertion on the base of the fifth metacarpal. Although there is little, if any, fluid surrounding the tendon, there is enhancement indicating a tenosynovitis with peritendinous inflammation of the adjacent soft tissues. There is a small amount of fluid within the abductor pollicis longus tendon sheath and perhaps mild enhancement which may represent a mild De Quervain's tenosynovitis. The remaining tendons are within normal limits. While this study was not protocoled for detailed evaluation of the intrinsic ligaments of the wrist or the triangular fibrocartilage complex, there is mild increased signal intensity within the triangular fibrocartilage complex at its ulnar styloid attachment likely representing degeneration or a mild synovitis, but we see no fluid-filled tear. We see no findings to suggest a tear of the scapholunate or lunotriquetral ligaments. There is a cluster of small round foci of fluid signal intensity volar to the radial styloid perhaps representing ganglion formation at the attachment of the long radiolunate ligament. There is mild enhancement of the distal radial ulnar joint suggesting a mild synovitis. Mild osteoarthritis affects the basilar joint.

Output: Severe extensor carpi ulnaris tendinopathy and other findings as described above.


Instruction: Generate impression based on findings.

Input: 7-year-old with breast cancer and confusion with hallucinations rule out brain metastases Noncontrast CT scan brain demonstrates no evidence of hemorrhage, mass or edema.There is evidence of periventricular hypodensities which given the patient's age most likely represent small vessel ischemic disease.Please note the lack of intravenous contrast limits the sensitivity in evaluating for metastatic disease. If this is of clinical concern repeat study with contrast or preferably MRI with contrast is recommended as a more sensitive means of islet for metastatic disease.

Output: No evidence of acute intracranial process sensitivity for metastatic disease is limited by the lack of intravenous contrast material


Instruction: Generate impression based on findings.

Input: 37-year-old with recent left bloody nipple discharge. Personal history of right mastectomy for breast cancer in 08/2014. Status post right mastectomy.There is extreme amount of fibroglandular tissue in the left breast.Mild parenchymal enhancement is noted in the left breast.On the non-contrast T1 weighted images, there is high signal fluid within a single ducts at 6:00 position at retroareolar region, and extending posteriorly into multiple branches. These images suggest a presence of proteinaceous fluid, likely correlating to the patient's clinical history of bloody nipple discharge. There is no abnormal enhancement in the left breast including the area of dilated ducts.No abnormal enhancement is seen in right mastectomy bed. No abnormal lymph nodes are identified in either axillary region.

Output: Proteinaceous fluid within the left breast ducts, likely correlating to the patient's clinical history of bloody nipple discharge.No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: C - Clinical Correlation Needed.


Instruction: Generate impression based on findings.

Input: Redemonstrated are innumerable supratentorial and infratentorial foci of susceptibility effect with heterogeneous associated T1 and T2 signal consistent with cavernous malformations. These are essentially unchanged in size, number, and appearance compared with the prior exam. There is no interval perilesional edema. For example, the largest lesion is located within the right basal ganglia, is unchanged in size, and measures up to 1.7 cm. Somewhat large lesions within the right hemi-midbrain as well as the bilateral pons are also unchanged. There is no evidence of acute intracranial hemorrhage 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 skull and scalp soft tissues are unremarkable. Previously demonstrated minimal mucosal thickening within the maxillary sinuses and mild fluid within the mastoid air cells has improved.

Output: Innumerable cavernous malformations are essentially unchanged in size, number, and appearance. There is no interval perilesional edema.