Instruction: Generate impression based on findings.

Input: Female 44 years old Reason: Cervical cancer History: Cervical cancer PELVIS:UTERUS, ADNEXA: There is a peripherally enhancing, centrally necrotic mass arising from the cervix and extending to involve the left lower uterine segment. This measures approximately 4.0 x 5.4 x 3.8 cm. The mass extends posteriorly to invade the rectum. There is invasion of the bilateral vesicoureteric junction and the distal portions of the bilateral ureteric stent are noted within the bladder. The mass extends superiorly to invade the adjacent bowel, including small bowel and there is tethering of adjacent small bowel loops and mild small bowel dilatation. The mass extends into the left adnexal region however, there is no definite evidence of pelvic sidewall invasion. BLADDER: No significant abnormality noted.LYMPH NODES: There is no significant pelvic lymphadenopathy.BOWEL, MESENTERY: Please see above.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Pelvic mass consistent with provided history of cervical cancer with rectal and bladder invasion as described above. Additionally, there is invasion of adjacent bowel loops with small bowel dilatation and the possibility of partial small bowel obstruction is not excluded.


Instruction: Generate impression based on findings.

Input: The exam is limited by motion artifact and the lack of intravenous contrast. Within these limitations, there is no evidence of intracranial mass. The ventricles and sulci are normal in size. There is no or midline shift. The pituitary gland is unremarkable. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem, or cerebellar infarction. The major cerebral flow voids appear to be intact. There is mild mucosal thickening in the sphenoid sinuses. The skull, orbits, and scalp soft tissues are unremarkable.

Output: No discernible evidence of intracranial metastases, although the assessment is limited by the lack of intravenous contrast and patient motion artifact.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 35-year-old man with history of perforated sigmoid diverticulitis 6/2016 with diffuse small bowel inflammation. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in signal and morphology. The gallbladder is normal. There is no intra or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Simple right renal cysts noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Small fat-containing inguinal hernias.OTHER: No significant abnormality noted.

Output: No evidence of small bowel or colonic inflammation.


Instruction: Generate impression based on findings.

Input: Nausea with vomiting, unspecified [R11.2], Reason for Study: ^Reason: NSCLC mets to brain with bulky dz and hz of radiation (last in 12/2015), now with intractable nausea/vomiting History: nausea/vomiting There are significant interval decrease in size as well as the extent of surrounding edema of all previously seen intra axial enhancing lesions since prior scan including the right corpus callosum splenium lesion and multiple left cerebellar hemispheric lesions.Those lesions demonstrate susceptibility artifacts indicating the nature of those lesions contain internal hemorrhages. No evidence of acute ischemic or hemorrhagic lesion. There is no evidence of new enhancing lesion. The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The left frontal sinus shows fluid collections.Bilateral mastoid air cells demonstrate fluid collections.

Output: 1. Interval decrease in size and the extent of surrounding edema on previously seen intra axial metastatic lesions since prior scan indicating interval improvement.2. No new metastatic lesion is found.3. No evidence of acute ischemic or hemorrhagic lesion.


Instruction: Generate impression based on findings.

Input: Female, 39 years old, with neurofibromatosis type II, brainstem tumor, vestibular schwannoma, presenting with pain. Evaluate for schwannomas or other tumors. Cervical:Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. No evidence of pathologic marrow edema or enhancement is seen. The spinal cord shows normal signal intensity and is free of pathologic enhancement. Furthermore, no intraspinal or paraspinal enhancing lesions are seen. No foraminal remodeling is detected to suggest the presence of tumor. Minimal degenerative disc disease is seen without significant compromise of the spinal canal or foraminal. Scattered small lymph nodes are evident on both sides of the neck. The patient's known left vestibular schwannoma is partially visualized.Thoracic:Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. No evidence of pathologic marrow edema or enhancement is seen. The spinal cord shows normal signal intensity and is free of pathologic enhancement. No intraspinal or paraspinal enhancing lesions are seen. No foraminal remodeling is seen. The intervertebral discs are preserved with no evidence of spinal canal or foraminal compromise.Lumbar:Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. No evidence of pathologic marrow edema or enhancement is seen. The spinal cord, conus and nerve roots of the cauda equina show normal signal intensity and are free of pathologic enhancement. No intraspinal or paraspinal enhancing lesions are seen. Tarlov cysts are present in the sacral region which do cause widening of the foramina. The intervertebral discs are preserved. No significant spinal canal or foraminal stenosis is suspected. Mild facet arthropathy is seen at lower lumbar levels.

Output: No evidence of any intraspinal, foraminal or paraspinal tumors.


Instruction: Generate impression based on findings.

Input: 14 years Female (DOB:2/19/2002)Reason: Evaluate for demyelinating disease, leukodystrophy History: Developmental regressionPROVIDER/ATTENDING NAME: MICHAEL H KOHRMAN MICHAEL H KOHRMAN The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There is a mild degree of subcortical punctate hyperintense white matter lesions in the frontal lobes present identified on the FLAIR and T2 images.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus. There is a developmental venous anomaly present in the right frontal lobe.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.There are punctate subcortical white matter lesions in the frontal subcortical white matter which are nonspecific. They could be vascular related, related to demyelination, trauma, vasculitis, sarcoid. They are nonspecific. 2.There is a developmental venous anomaly present in the right frontal lobe.


Instruction: Generate impression based on findings.

Input: 34-year-old female with a history of left hip pain and sickle cell disease and radiograph suggestive of avascular necrosis. Note is made of heterogeneous bone marrow signal abnormality consistent with the patient's stated history of sickle cell disease. There is curvilinear signal abnormality within the superior femoral head consistent with avascular necrosis. No definite subchondral collapse is identified. There is a small amount of fluid within the joint without evidence of a large effusion. The imaged musculature of the left hip is normal in appearance. There is mild peritrochanteric inflammation which is not necessarily of any clinical significance. Note is made of multiple prominent lymph nodes in the left inguinal region.

Output: Avascular necrosis of the left femoral head.


Instruction: Generate impression based on findings.

Input: History of indeterminate colitis and primary sclerosing cholangitis. ABDOMEN:LIVER, BILIARY TRACT: Note is made of a segment 7 hemangioma.There is minimal focal intrahepatic biliary ductal dilatation in the left hepatic lobe without an associated mass. There is mild narrowing of the common hepatic duct, although this may be partly due to a traversing vessel. The appearance is overall similar to the prior study.No suspicious liver lesion. The vessels are patent.SPLEEN: No significant abnormality noted.PANCREAS: Findings of pancreas divisum. No specific stigmata of acute or chronic pancreatitis.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Limited evaluation of the bowel shows no specific evidence of active inflammation.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.Note is made of physiologic cysts in the left adnexa.

Output: Minimal focal intrahepatic biliary ductal dilatation in the left hepatic lobe and stable mild common hepatic duct narrowing versus extrinsic mass effect from a traversing vessel. No dominant stricture or focal lesion.Pancreas divisum.


Instruction: Generate impression based on findings.

Input: Right arm numbness. The craniovertebral junction appears within normal limits. The cervical spine alignment is maintained and the cervical vertebral body heights are intact. There is mild multilevel disc height loss. At C2-3 and C7-T1, there is no significant compromise to the spinal canal or neural foramina. At C3-4, there is a disc osteophyte complex and small right foraminal disc protrusion with facet hypertrophy, mild spinal canal stenosis and mild right neural foraminal narrowing. At C4-5, there is a disc osteophyte complex, facet hypertrophy and moderate right neural foraminal narrowing. There is no left neuroforaminal spinal canal stenosis at this level. At C5-6, there is a disc osteophyte complex and facet hypertrophy with moderate left neuroforaminal narrowing. There is no spinal canal stenosis at this level. At C6-7, there a disc osteophyte complex and facet hypertrophy with mild spinal canal stenosis and moderate to severe bilateral neural foraminal narrowing. The bone marrow signal is within normal limits. The cervical spinal cord has normal signal characteristics and overall morphology. The vertebral artery flow voids appear to be intact. The paraspinous soft tissue structures appear within normal limits.

Output: Multilevel degenerative cervical spondylosis of the cervical spine most prominently involving the bilateral C5-6 and C6-7 neural foramina, left worse than right, as well as at most mild spinal canal stenosis at the C3-4 and C6-7 levels.


Instruction: Generate impression based on findings.

Input: Reason: view for cav mal History: 12yr female with headaches and familial history of CCM The CSF spaces are appropriate for the patient's stated age with no midline shift. Artifact from the patient's dental procedure obscures the visualization on many of the pulse sequencesNo abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.There is no evidence for cerebral cavernous malformation on this exam to the extent of visualization possible on this exam. Please note that some metal artifact from the patient's dental work may obscure a very subtle and very small cavernoma.2.No abnormal mass lesions are appreciated intracranially.


Instruction: Generate impression based on findings.

Input: 10-year-old male with relapsed AML on chemotherapy with fevers, pain and new onset left eye ptosis. There is no evidence of intracranial hemorrhage or mass. The brain parenchyma appears grossly unremarkable on the sequences provided. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull and scalp soft tissues are unchanged.There is marked mucosal thickening and debris within the right maxillary sinus. The remaining imaged paranasal sinuses are unremarkable.

Output: 1.No gross evidence of intracranial hemorrhage or mass, although the exam is limited by the lack of intravenous contrast and patient motion. 2.Mucosal thickening and secretions within the right maxillary sinus may represent acute sinusitis in the correct clinical setting.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Bladder distention and frequent incontinence. There are degenerative changes in the cervical spine with small disc osteophyte complexes at the C3-C4 C4-C5, C5-C6 levels which along with ligamentum flavum thickening contribute to mild to moderate spinal canal stenosis, relatively worse at the C5-C6 level. No higher grade spinal canal stenosis or evidence of acute cord compression is seen. No obvious cord signal abnormality within the limits of the study. Apparent high signal on the cervical spine STIR sequence may be artifactual.There is a chronic appearing compression fracture involving the T6 vertebral body with approximately 30-40% loss of height and not significantly changed since prior MRI from 7/16/2014. Minimal wedging and endplate irregularity involving the vertebral bodies more inferiorly is also not significantly changed. There is no significant spinal canal stenosis in the thoracic spine or obvious cord signal abnormality within the limits of the study. Mild multilevel thoracic degenerative changes are again seen. Multiple foci of T1 hyperintensity involving multiple vertebral bodies are compatible with hemangiomas or foci of fat. Degenerative changes are also evident in the lumbar spine better evaluated on prior dedicated lumbar spine MRI study from/26/2014. There is mild or mild to moderate stenosis at multiple levels in the mid to lower lumbar spine which can be better assessed on dedicated lumbar spine sequences. No findings to suggest acute cord compression or significant cauda equina compression.There is dextrocurvature involving the upper thoracic spine and thoracolumbar junction as well as levocurvature at the mid to lower thoracic level as seen on prior studies. There is edema involving the posterior subcutaneous soft tissues in the lumbar region which is probably related to dependency.

Output: Note this is a limited exam per cord compression protocol. Patient did not want to proceed with further dedicated sequences. There is no evidence of acute cord compression or high grade cauda equina compression. Please see additional details above. Further imaging can be considered as clinically indicated.


Instruction: Generate impression based on findings.

Input: Female 2 years old Reason: 23 month old girl with history of Diamond Black-fan Anemia and transfusion related iron overload History: iron overload Axial and coronal T2* sequences were performed to assess iron load of the liver. Recovery time was 5.4 ms on average on coronal sequences and 4.9 ms on axial sequences.

Output: 1. Moderate iron load of the liver.


Instruction: Generate impression based on findings.

Input: Hemorrhagic pituitary adenoma. Status post transsphenoidal surgery. Follow-up. There are stable postoperative findings related to transsphenoidal surgery. There is no evidence of intrasellar hemorrhage, new mass, or acute infarct or in the included part of brain. There is unchanged pituitary tissue in the right sella with deviation of the infundibulum to the right. There is no mass effect upon the optic apparatus or cavernous sinuses but the optic chiasm remains tethered inferiorly. There are small soft tissue nodules in the parotid glands, most of which are unchanged and probably represent incidental parotid lymph nodes.

Output: Stable postoperative findings related to transsphenoidal surgery without evidence of recurrent pituitary tumor.


Instruction: Generate impression based on findings.

Input: Clinical question: History of grade 2 oligodendroglioma status post resection and RT. Signs and symptoms: Surveillance scan. Pre-and post-enhanced brain MRI:Examination demonstrate interval complete resolution of previously noted blood/fluid level in the dependent/posterior aspect of left frontal surgical cavity.There is also slight interval decreased size of surgical cavity in the left frontal lobe with entirely CSF signal intensity and measuring approximately 26 x 24 mm in transaxial dimensions.There is decreased peri-surgical cavity flair hyperintensity representing post operative and edema and gliosis.The anatomic morphology and signal intensity of brain parenchyma is otherwise within normal on all MRI sequences and is stable since prior study.Post-enhanced images demonstrate interval increased linear and minimally nodular enhancement along the surgical cavity wall as well as adjacent falx since prior study. Findings likely representing post treatment/surgical change however further follow up is needed to exclude less likely possibility tumor recurrence. Stable expected postoperative changes of left frontal craniotomy and including adjacent dural thickening and enhancement which also appears a slightly more prominent compared to prior exam.

Output: 1.Interval improvement with evidence of resolution of blood products from left frontal surgical cavity, decreased surgical cavity size and decreased peri-surgical cavity flair hyperintensity since prior exam.2.Interval increased enhancement along the surgical cavity wall and adjacent falx which is suggestive of postoperative change however less likely possibility of tumor should also be considered and further follow-up is needed.3.Postoperative changes of left frontal craniotomy with evidence of interval increased epidural enhancement along the inner table of craniotomy flap is within expected postsurgical finding.


Instruction: Generate impression based on findings.

Input: Pinching/kinking of the cervical spinal cord and 1q42.1-44 interstitial deletion. There is persistent considerable narrowing of the upper cervical spinal canal associated with a narrow C1 arch in the anteroposterior dimension. The posterior arch of C1 indents the cervical spinal cord, but there is no evidence of associated signal abnormality within the spinal cord. The atlantoaxial articulation otherwise appears to be intact and the remainder of the cervical spine and imaged upper thoracic spine appears to be unremarkable. The paraspinal soft tissues are unremarkable.

Output: Persistent narrowing of the upper cervical spinal canal associated with a narrow C1 arch in the anteroposterior dimension with indentation of the cervical spinal cord likely represents a developmental anomaly. Please refer to the recent brain MRI report regarding intracranial findings.


Instruction: Generate impression based on findings.

Input: 12-year-old female with history of left hip pain. ACETABULAR LABRUM: The acetabular labrum appears intact.ARTICULAR CARTILAGE AND BONE: There is slight bony prominence along the anterolateral aspect of the femoral head/neck junction indicating a mild CAM deformity with an alpha angle of approximately 60 degrees. We see no frank acetabular overcoverage.The articular cartilage is unremarkable. Bone marrow signal intensity is within normal limits.SOFT TISSUES: Signal intensity of the musculature is within normal limits other than gadolinium and edema within the iliopsoas which is iatrogenic related to injection. The ligamentum teres appears intact.

Output: Mild CAM deformity of the proximal femur, however we see no labral tear.


Instruction: Generate impression based on findings.

Input: 24 year old with right bloody nipple discharge, with cytology showing atypia. Mild parenchymal enhancement is noted bilaterally. Heterogeneous fibroglandular tissue is present. There are multiple right breast masses. The largest is a branching retroareolar mass near the 10:00-12:00 positions measuring up to 2.6 x 1.9 cm. The next largest mass is located in the 7:00 retroareolar region and measures 1.3 x 0.8 cm. Located 1.6 cm posterior to the main mass is a smaller enhancing mass in the same ductal distribution that measures 0.8 x 0.7 cm. There are multiple bilateral foci and small enhancing masses of benign morphology in each breast which are non-uniquely enhancing and are present outside of the ductal system of the largest mass. No abnormal axillary lymph nodes are identified in either axillary region.

Output: Multiple right breast masses, including a complex branching retroareolar mass near 10:00-12:00, a 7:00 right retroareolar mass and a 12:00 mid to posterior depth mass. These may all represent papillomas. The largest mass was previously seen on ultrasound and is amenable to ultrasound guided biopsy if clinically desired. The smaller masses could be further evaluated with MRI directed ultrasound. Surgical consultation is recommended and the patient has been seen by Dr. Chhablani. BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Brachytherapy planning, cervical malignancy PELVIS:UTERUS, ADNEXA: Intrauterine linear structure related to therapy receipt. Interval improvement in size of heterogeneous cervical mass, measuring 2.8 x 1.6 cm, image 27 series 501, remeasured and previously measured 3.7 x 2.9 cm. Improvement in degree of extension into uterus and improved adjacent soft tissue stranding/parametrial invasion. Corresponding postcontrast arterial enhancement no longer delineated. Stable to minimal interval decrease in size of right adnexal lesion, may reflect patient's normal ovary but nonspecific, measuring 4 x 2.5 cm, image 44 series 501, previously measured 4.4 x 2.8 cm. Presumed left ovary on image 414 series 1204, stable in appearance. ABLADDER: No significant abnormality noted.LYMPH NODES: Reference left pelvic sidewall lymph node demonstrates interval decrease in size, measuring 0.8 x 0.6 cm, image 394 series 1204, previously measured 1.4 x 1 cm.BOWEL, MESENTERY: Mild circumferential rectosigmoid colon wall thickening.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Decreased size of heterogeneous cervical mass. Improvement in degree of extension into uterus and improved adjacent soft tissue stranding/parametrial invasion. Stable to minimal interval decrease in size of right adnexal lesion, may reflect patient's normal ovary but nonspecific, may be further assessed with dedicated pelvic sonography. 2. Decreased size of reference left pelvic side wall lymph node.


Instruction: Generate impression based on findings.

Input: 77-year-old woman with history of outside CT demonstrating intrahepatic biliary duct dilatation. This examination is limited by respiratory motion as patient could not tolerate the respiratory gating belt. Additionally, there is no intravenous contrast to evaluate for enhancing solid organ lesion.ABDOMEN:LIVER, BILIARY TRACT: Increased parenchymal signal on the opposed phase images suggest iron deposition of the liver.There is extrahepatic biliary duct dilatation with no significant intrahepatic duct dilatation. The common bile duct is dilated up to 16 mm (series 13, image 104) and tapers smoothly in the intrapancreatic portion.SPLEEN: The spleen is low in signal suggesting deposition.PANCREAS: The pancreatic duct in the body and tail is dilated up to 8 mm (series 13, image 115). The pancreatic duct in the head appears relatively normal. No focal pancreatic masses identified.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Innumerable bilateral renal cysts are noted.RETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: The visualized small bowel and colon are normal.BONES, SOFT TISSUES: A large focus of susceptibility artifact centered in the right iliac wing is noted, likely postsurgical artifact.OTHER: No significant abnormality noted.

Output: 1.Limited examination due to patient body habitus, inability to tolerate respiratory gating, and lack of intravenous contrast.2.Common bile duct dilatation with smooth tapering of the intrapancreatic portion suggesting a distal stricture.3.Pancreatic duct dilatation in the body and tail suggesting pancreatic duct stricture.4.No definite obstructing lesion identified, however this is a very limited examination, and this can be further evaluated with EUS as clinically warranted.


Instruction: Generate impression based on findings.

Input: 37 year old status post cerebellar biopsy. A small focus of blood with surrounding edema is present in the left cerebellar hemisphere. The fourth ventricle is slightly displaced by related mass effect and the left quadrigeminal cistern is effaced. Accounting for differences in technique, the right frontal region of encephalomalacia appears unchanged from the MRI dated 4/22/2008. The anterior horn of the right lateral ventricle is mildly enlarged, likely reflecting adjacent volume loss. A surgical bony defect is present in the left aspect of the occipital bone. The patient is status post right frontoparietal craniotomy.The visualized paranasal sinuses and mastoid air cells are normally pneumatized.High attenuation structure noted near the roof of the left orbit may be related to previous ocular procedure -- correlate with history.

Output: 1. Postoperative findings of cerebellar biopsy with minimal mass effect.2. Unchanged right frontal encephalomalacia.3. Additional abnormalities as detailed above.


Instruction: Generate impression based on findings.

Input: Exam is limited by motion artifact and suboptimal field of view.Brain: No diffusion weighted abnormality. No evidence of intracranial hemorrhage. The gray-white matter differentiation is preserved. The signal intensity and morphology of the cerebral, cerebellum and pons are within normal limits. No evidence of mass, mass effect, or hydrocephalus. There is no abnormal intracranial enhancement. No extra-axial fluid collections. Tonsils are at the level of the foramen magnum, stable from prior study. Mucosal thickening of the left maxillary sinus, bilateral sphenoid sinuses, and opacification of left ethmoid air cells, new from prior study. Trace opacification of bilateral mastoid air cells. The orbits are unremarkable. Flow voids are present within the major vessels indicating patency. Pituitary: Exam is limited by motion artifact and suboptimal field of view. Pituitary gland is small, similar to the prior study, which can be normal for patient's age. The size and signal intensity of the pituitary stalk is well demarcated and enhanced. The optic chiasm and hypothalamus demonstrate normal signal intensity and morphology.

Output: 1.Exam is limited by motion artifact and suboptimal field of view. Within this limitation, there are no gross abnormalities of the brain or pituitary gland.2.Paranasal sinus opacification as above.


Instruction: Generate impression based on findings.

Input: 61 year-old female with headache. Prominent hypodensities at the bifrontal convexities may represent prominent subarachnoid space; however, chronic subdural collections may have a similar appearance. This finding can be compared to outside studies if available or a follow-up MRI may be considered if clinically needed. No acute findings identified. There is no evidence of acute intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Prominent hypodensities at bifrontal convexities may represent prominent subarachnoid space. However chronic subdural collections may have a similar appearance. Please correlate this finding with outside studies if available. An MRI evaluation may be considered if clinically indicated.


Instruction: Generate impression based on findings.

Input: Enlarged thyroid. Look for supraclavicular lymph node. RIGHT LOBE MEASUREMENTS: 4.8 x 1.0 x 1.7 cmLEFT LOBE MEASUREMENTS: 4.1 x 1.1 x 1.4 cmISTHMUS MEASUREMENTS: 0.1 cmRIGHT LOBE: 3 mm nonspecific noduleLEFT LOBE: No significant abnormality noted.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Numerous small lymph nodes are noted bilaterally. The largest lymph node in the right measures 1.4 x 0.4 x 1.0 cm and has a benign appearance. At the site of the palpable abnormality in the left supraclavicular area, there is an 8 mm nonspecific lymph node.OTHER: No significant abnormality noted.

Output: Small lymph nodes bilaterally in the neck of unclear etiology or significance. These could be better defined using CT or MRI if clinically indicated.


Instruction: Generate impression based on findings.

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

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


Instruction: Generate impression based on findings.

Input: Lennox-gastaut syndrome with intractable epilepsy: preoperative planning. There is no evidence of intracranial hemorrhage or mass. The brain appears unremarkable on the provided T1-wegithed sequence. 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, paranasal sinuses, and scalp soft tissues are grossly unremarkable. The calvarium is diffusely thickened, perhaps due to the long-term effects of anti-epileptic medication.

Output: Preoperative planning MRI does not demonstrate any gross potential seizure focus.


Instruction: Generate impression based on findings.

Input: Breast density study, exam for research purposes only. Research scanning of both breasts was performed with the research protocol. The images are stored for research analysis. Formal interpretation was not performed, existing data are not to be used for clinical purposes.

Output: This study was completed for research purposes only. Formal interpretation was not performed, existing data are not to be used for clinical purposes.


Instruction: Generate impression based on findings.

Input: 67-year-old male with history of metastatic bladder cancer presents with left arm weakness, shoulder pain, lower extremity weakness, and left hip pain. Left shoulder: There is a 2.5 cm ovoid lucent lesion within the proximal humeral diaphysis compatible with stated history of metastatic disease. We see no fracture. Mild osteoarthritis affects the glenohumeral and acromioclavicular joints. The humeral head is slightly high riding suggesting chronic rotator cuff tear or atrophy. There are surgical staples within the axilla.Left hip: There is osteolysis of the lesser trochanter indicating metastatic disease, but we see no fracture. Additional metastatic lesions are noted within the right ischium. Several additional metastatic lesions are identified within the proximal femur and bones of the pelvis, which are better seen on recent MRI examination. Mild osteoarthritis affects the hip.

Output: Metastatic disease as described above. We see no fracture on these studies.


Instruction: Generate impression based on findings.

Input: Evaluate left upper quadrant mass. ABDOMEN:LIVER, BILIARY TRACT: Diffuse hepatic steatosis. Otherwise, no significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.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: Fluid and omental fat containing small periumbilical hernia.OTHER: No significant abnormality noted.

Output: No left upper quadrant mass or other significant abnormality.


Instruction: Generate impression based on findings.

Input: Female, 58 years old, follow-up examination status post C5 anterior corpectomy for tumor resection, history of lung cancer. Cervical:Findings are redemonstrated compatible with anterior corpectomy of C5 with anterior instrumented fusion of C4-C6.Bulky residual tumor involving the C5 paraspinal and ventral epidural spaces is again seen. The largest component is in the right paraspinal region and measures 33 x 19 mm, previously 31 x 18 mm. The ventral epidural component has mildly thickened now resulting in constriction of the spinal canal to 8 mm AP, with a previous caliber of 10 mm AP.Tumor in the left paraspinal space at C5 is also slightly bulkier compared to prior. Paraspinal tumor encroaches upon the C4-5 and C5-6 neural foramina bilaterally. Paraspinal tumor also abuts the vertebral arteries bilaterally with partial encasement on the right.No new lesions are detected in the cervical spine. No other areas of significant spinal canal or foraminal narrowing are suspected.Thoracic:A severe compression deformity of the T5 vertebral body is again seen with complete tumor infiltration and retropulsion into the ventral epidural and right posterior lateral paraspinal spaces. The spinal canal is severely narrowed and the cord is compressed but with no evidence of spinal cord edema. The size of the tumor and the degree of spinal canal narrowing and cord impingement are unchanged from prior. The right T5-6 neural foramen is severely encroached by tumor.A moderate compression of the T8 vertebral body with tumor infiltration of the anterior aspect is again seen appearing similar to the prior examination. No epidural extension is seen and the spinal cord and canal are not compromised.No additional or new osseous lesions are detected. Elsewhere the spinal canal and neural foramina are not significantly narrowed. The spinal cord is free of pathologic signal change and enhancement.A mass is partially visualized in the left lung apex.

Output: 1.Demonstration of postoperative findings related to anterior C5 corpectomy as well as anterior instrumented fusion of C4-C6.2.Interval growth of tumor is seen in the C5 paraspinal and ventral epidural spaces. The spinal canal at C5 is further encroached by this growing epidural tumor.3.Stable metastatic involvement of the T5 vertebral body with a significant compression deformity and significant epidural and paraspinal tumor extension. The degree of spinal canal narrowing and cord impingement at T5 are unchanged.4.Stable metastatic involvement of the T8 vertebral body with no significant spinal canal compromise.5.No new metastatic lesions are seen in the cervical or thoracic spine.


Instruction: Generate impression based on findings.

Input: 60-year-old female status post seizure. Exam is limited secondary to motion artifact. No susceptibility artifact to indicate intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration.There is an area in the left posterior temporo-occipital white matter which demonstrates decreased signal on dADC and increased signal on eADC without corresponding changes on diffusion or FLAIR imaging. This likely represents artifact on the ADC maps.Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical, periventricular white matter, and right thalamus which are nonspecific, but compatible with chronic small vessel ischemic changes. Brain parenchyma is otherwise unremarkable for age.No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: 1. Mild chronic small vessel ischemic changes.2. Decreased signal on the ADC maps in the left posterior temporal occipital white matter without corresponding diffusion or FLAIR changes. These findings are likely artifactual, but could be confirmed with short-term follow-up MRI including coronal diffusion images. Please correlate with clinical symptoms.


Instruction: Generate impression based on findings.

Input: Female, 5 months old, with multiple focal seizures. Brain parenchymal morphology and signal characteristics are within normal limits. No evidence of edema, mass effect or any focal lesion is seen. The pattern of white matter myelination is appropriate for age.The pituitary structures are unremarkable. The corpus callosum is fully formed and normal. The brainstem, cerebellar vermis and cerebellar hemispheres are within normal limits.No evidence of intracranial hemorrhage or any abnormal extra-axial fluid collection is seen. The ventricles are normal in size and morphology.

Output: Unremarkable evaluation with no specific findings to account for the patient's seizures.


Instruction: Generate impression based on findings.

Input: History of rheumatoid arthritis, cervical cancer, now with new fecal incontinence and leg weakness. History of a cervical spine injury in 2015. Evaluate for metastasis, spinal cord compression, other etiology. MRI C-Spine:Redemonstration of cranial settling/basilar invagination with superior migration of the dens of up to 1 cm, which results in crowding at the foramen magnum and mild impression on the right medulla. Again seen is widening of the atlantodental interval up to 5 mm which appears less prominent compared to the previous exam due to patient positioning. There is subtle abnormal T2 signal suspected along the ventral aspect of the cervical cord but this also appears similar to the cervical spine MRI from 2008. The atlantooccipital joint is maintained. The cervical vertebral body heights are preserved. The bone marrow and end plates demonstrate a normal MR appearance without evidence of metastasis. The remainder of the cervical spine MRI demonstrates no significant spinal canal or neuroforaminal stenosis at any level. The paraspinal soft tissues are unremarkable. Heterogeneous appearance and fatty changes involving the bilateral parotid glands which may represent secondary Sjogren's. Right parotid gland cystic lesion is similar to prior.MRI L-Spine:Normal lordotic spinal alignment. There is edema involving the inferior aspect of the L5 vertebral body with subtle linear low T1 and T2 signal noted ventrally, findings which are suspected to represent an insufficiency fracture. No significant loss of height of the vertebral body is evident. There is no significant spinal canal or neuroforaminal stenosis at any level in the lumbar spine to suggest compression of the cauda equina. The conus medullaris terminates at the T12-L1 level. The paraspinal soft tissues are unremarkable.

Output: 1.Redemonstration of cranial settling/basilar invagination with superior migration of the dens resulting in crowding at the foramen magnum and mild impression on the right medulla. Subtle T2 hyperintensity is suspected in the ventral upper cervical cord. Remainder of the cervical spine MRI demonstrates no significant spinal canal or neural foraminal stenosis at any level.2.Edema involving the inferior aspect of the L5 vertebral body with subtle linear low T1 and T2 signal noted ventrally, findings which are suspected to represent an insufficiency fracture. No significant loss of height of the vertebral body is evident. There is no significant spinal canal or neural foraminal stenosis at any level in the lumbar spine to suggest compression of the cauda equina.3.Heterogeneous appearance and fatty changes involving the bilateral parotid glands which may represent secondary Sjogren's. Right parotid gland cystic lesion is similar to prior.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate intracranial hemorrhage. Signs and symptoms: Headache with seizure. CT of brain without infusion:No evidence of hemorrhage, edema, mass-effect, midline shift or hydrocephalus. Vertical sulci, ventricular system and all CSF cisterns remain within normal. There are subtle foci of low-attenuation in the subcortical white matter of both cerebral hemispheres. These findings are suspect that for small vessel disease of indeterminate age. These findings were noted on prior MRI examination from 3 -- 16 -- 2009. In comparison with prior CT examination from 11 -- 5 -- 2009 no definitive appreciable interval change is detected.Calvarium, limited view of paranasal sinuses and mastoid air cells are also unremarkable.

Output: 1.No evidence of hemorrhage as clinically is suspected.2.Findings consistent with small vessel disease of indeterminate age.


Instruction: Generate impression based on findings.

Input: Leg and knee pain There is no fracture or dislocation. The lateral tibial plateau fracture identified on prior MRI is not well seen on radiographs. There is no sizable effusion.Cortical irregularity and sclerosis of the right proximal tibia is seen medially which is incompletely characterized on a single view but may represent a fibrous lesion.

Output: 1. Normal radiographic appearance of the left knee.2. Right proximal tibia irregularity is incompletely evaluated on single view but may represent a healing nonossifying fibroma.


Instruction: Generate impression based on findings.

Input: Diagnosis: Cerebral infarction, unspecifiedClinical question: StrokeSigns and Symptoms: L hemibody numbness and arm/leg weakness, stuttering speech The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: MRI of the brain is within normal limits. There is no evidence for acute ischemic cerebral infarction.


Instruction: Generate impression based on findings.

Input: Meningioma resection: surveillance. There are postoperative findings related to right frontal meningioma resection. There is mild dural thickening and enhancement in the surgical bed region, measuring up to 6 mm in thickness. There is encephalomalacia and probable gliosis in a portion of the underlying anterior right frontal lobe. There is no evidence of acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable. There is left maxillary and sphenoid sinus mucosal thickening.

Output: Mild dural thickening and enhancement in the surgical bed region may represent a small amount of residual meningioma and/or treatment effects.


Instruction: Generate impression based on findings.

Input: Low back and leg pain. History of lumbar fusion greater than 2 years ago. Assess for stenosis and and degeneration above fusion. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is maintained. Postoperative changes of L4-L5 fusion again seen with interbody graft, pedicle screws, and paraspinous rods better assessed on same-day CT. Bone marrow signal is benign with with mild nonspecific heterogeneity. The conus medullaris is normal in position.There are multilevel degenerative changes with a left paracentral disc protrusion at the L3-L4 level, which is new since prior MRI from 3/20/2012. 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: There is disc desiccation and height loss with a left-sided disc protrusion which is new since prior. There is also ligamentum flavum thickening and facet arthropathy. There is effacement of the left lateral recess as well as mild to moderate central canal stenosis. There is minimal narrowing of the neural foramen on the left. No right neural foraminal stenosis.L4-L5: Postoperative changes of fusion as above. There is mild right-sided neural foraminal narrowing related to endplate osteophyte. There is no spinal canal or left neural foraminal narrowing.L5-S1: Disc desiccation with mild disc height loss and small central disc protrusion with calcification. Disc contacts the S1 nerve root without clear impingement. No significant central canal stenosis. No significant neural foraminal stenosis. Paraspinous soft tissues are within normal limits.

Output: Postoperative changes of L4-L5 fusion with hardware better seen on CT from same day. There is a left paracentral disc protrusion at the L3-L4 level, which is new since prior MRI from 3/20/2012, and results in effacement of the left lateral recess. There is also mild to moderate central canal stenosis at this level. No high-grade neural foraminal stenosis is evident at any level. Please see above for additional details.


Instruction: Generate impression based on findings.

Input: 55-year-old female with multiple myeloma. Evaluate for source of new jaw numbness. There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration.The osseous structures including the calvarium, occipital condyles, and C1 and C2 vertebral bodies show innumerable permeative lytic lesions consistent with the patient's history of multiple myeloma. There is no discrete soft tissue mass to suggest a plasmacytoma. However, an MRI has already been ordered and should help in the evaluation for a plasmacytoma or other cause for the patient's symptoms. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Innumerable diffuse lytic lesions to the osseous structures are consistent with the patient's history of multiple myeloma. An MRI of the head and neck has been ordered and this will help in evaluation for a plasmacytoma or other cause for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: 41-year-old female with history of pleuritic chest pain several weeks ago. The comparison chest radiograph performed on 5/4/2015 demonstrates no focal pulmonary opacities or pleural fluid. The ventilation images show a uniform distribution of activity on single-breath and wash-in images. There is no abnormal Xe-133 retention during the wash-out phase. Incidentally there is hepatic retention of contrast suggesting hepatomegaly and hepatic steatosis, which was also noted on prior abdominal MRI examination. The perfusion images show a physiologic distribution of pulmonary perfusion.

Output: Normal ventilation and perfusion images. No evidence of pulmonary embolism.


Instruction: Generate impression based on findings.

Input: 61 years Female (DOB: 10/18/1954)Reason: Assess for progression of stenosis/cord impingement History: Neck painPROVIDER/ATTENDING NAME: DALIA H ELMOFTY DALIA H ELMOFTY The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is multilevel disc desiccation present. There is partial anterior fusion at T1-T2.At C2-3 there is no significant compromise to the spinal canal or neural foramina. There is mild hypertrophy of the ligamentum flavum at this level with mild narrowing of the spinal canal. Overall the patient's cervical spinal canal is small congenital basis.At C3-4 there is no significant compromise to the spinal canal or neural foramina. There is a disc bulge present at this level. There are some endplate reactive changes present which were also present to some degree on the previous exam. There is mild narrowing of the spinal canal at this level with partial effacement of spinal fluid ventral but not posterior to the spinal cord.At C4-5 there is no significant compromise to the spinal canal or neural foramina. There is mild loss of disc space height and disc desiccation at this level associated with a minor disc bulge. Since the prior exam a central disc protrusion at this level has regressedAt C5-6 there is no significant compromise to the spinal canal or neural foramina. There is redemonstration of a right paramedian disc extrusion at this level which partially effaces spinal fluid ventral to the right hemicord and minimally displaces the spinal cord. It is stable and compared to the previous exam. Disc material does extend into the right neural foramen at this level and mildly encroaches on the right-sided exiting nerve roots. There is some mild hypertrophy of the ligamentum flavumAt 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.

Output: 1.There is some mild degenerative changes present in the cervical spine with mild degrees of the encroachment of right-sided exiting nerve roots at C5-6 which are stable since the prior exam and a mild degree of spinal stenosis at C3-4 which is also stable since prior exam. 2.There are some subacute endplate reactive changes at C3-43.Since the prior exam a small disc protrusion at C4-5 has regressed.


Instruction: Generate impression based on findings.

Input: Pain and decreased range of motion. Assess rotator cuff status post fall on outstretched hand. ROTATOR CUFF: There are complete tears of the supraspinatus and infraspinatus tendons with up to 2 cm of retraction. A small stump of tendon remains attached to the posterior aspect of the greater tuberosity. Thickening and increased signal intensity of the retracted supraspinatus and interspinous tendons suggest underlying tendinosis. There is mild fatty infiltration of the supraspinatus and infraspinatus muscles. The teres minor muscle and tendon appear intact. Mild increased signal intensity within the distal fibers of the subscapularis tendon suggests mild tendinosis and possibly undersurface fraying, but I see no full-thickness tear of the subscapularis tendon, and the muscle is within normal limits.SUPRASPINATUS OUTLET: There is an os acromiale. Mild osteoarthritis affects the acromioclavicular joint. There is a small amount of fluid in the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is a small to moderate-sized glenohumeral joint effusion. A small amount of fluid separates the anterior superior labrum from the underlying glenoid, but this may represent a normal variant, and I see no definite labral tear.BICEPS TENDON: There is thickening and increased signal intensity of the intra-articular portion of the tendon of long head of the biceps indicating moderate tendinosis. ADDITIONAL

Output: Complete tears of the supraspinatus and infraspinatus tendons and other findings as described above.


Instruction: Generate impression based on findings.

Input: Left modified radical mastectomy in April 20, 2013 for IDC grade 2, ER/PR positive HER-2 negative, ypT3. Status post neoadjuvant chemotherapy status post XRT. Started Arimidex therapy since August 2013. There is extreme amount of fibroglandular tissue in the right breast.Mild parenchymal enhancement is noted in the right breast.Status post left mastectomy. No abnormal enhancement is seen in right breast or left mastectomy bed. No abnormal lymph nodes are identified in either axillary region. Seroma cavity in the left axillary region is smaller from prior examinations.

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


Instruction: Generate impression based on findings.

Input: Male, 11 years old, with behavioral outburst spells. Evaluate for site of worsening focal seizure. A left frontal approach ventricular shunt catheter is demonstrated with its tip in stable position in the vicinity of the foramen of Monro. The left lateral ventricle is decompressed. The right lateral ventricle remains somewhat patent but with a wavy irregular contour and areas of periventricular T2 hyperintensity suggesting gliosis. The third ventricle is decompressed, and the fourth ventricle is normal. There has been no significant interval change in size or configuration of the ventricular system.Volume loss, particularly of the white matter, and dysmorphism of the right cerebral hemisphere are unchanged from prior. The corpus callosum remains thinned uniformly. No new parenchymal lesions are seen. No evidence of parenchymal edema or mass effect is detected. No abnormal extra-axial collections are detected.

Output: 1.Stable size and configuration of the shunted ventricular system.2.Stable generalized dysmorphism of the right cerebral hemisphere. No new parenchymal lesions are detected.


Instruction: Generate impression based on findings.

Input: Clinical question: Patient with bilateral upper extremity weakness and recent fall. Rule out hemorrhage/other acute processes. Signs and symptoms: Bilateral upper extremity weakness. Nonenhanced head CT:No detectable acute intracranial process. CT however is insensitive for the attention of acute nonhemorrhagic ischemic strokes.Cerebral cortex, cortical sulci and the ventricular system are within normal for patient stated age.The gray -- white matter differentiation is preserved.Calvarium and soft tissues of the scalp are unremarkable.Visualized paranasal sinuses, mastoid air cells and middle ear cavities are pneumatized and unremarkable. Very small retention cyst in the left maxillary sinus however is present.Nonenhanced cervical CT:There is no detectable bony fracture of the cervical spine.There is very significant degenerative changes of cervical spine with resultant near complete fusion of C3 and C4 , significant loss of intervertebral disk at C4 -- C5 and advanced degenerative changes at C5 -- C6 and C6 -- C7 levels. There is reversal of cervical lordosis centered at C3 there C4. There is highly suspected central spinal stenosis at C3, C4 and C5 levels.There are also bilateral multi-level neural foraminal compromise at C3 there C4, C4 -- C5 and to a lesser degree at C5 -- C6 and C6 -- C7 levels.No detectable paraspinal soft tissue abnormalities.Heavy vascular calcification of the right carotid bifurcation is noted.Enlargement of thyroid lobes with inhomogeneous pattern is concerning for goiter. There is no deviation or compromise of the trachea.

Output: 1.Negative nonenhanced head CT.No evidence of acute posttraumatic findings of cervical spine. Very advanced degenerative changes of cervical spine with resultant reversal of cervical lordosis and multilevel neural foraminal compromise and suspected central spinal stenosis.


Instruction: Generate impression based on findings.

Input: Chiari decompression with thoracic syrinx: surveillance. There are postoperative findings related to Chiari decompression. The inferior cerebellar hemispheres extend to the level of the tip of the dens. There is intact cerebrospinal fluid flow across the anterior neo-foramen magnum, but flow posteriorly appears to be blunted. There also appear to be fine low signal linear strands that extend from the mildly deformed posteroinferior cerebellar hemispheres to the overlying dura. There is interval decrease in caliber of the thoracic syrinx, which now measures up to 2 mm in width. There is mild retroflexion of the dens. The vertebral column alignment is otherwise within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. There is no evidence of pseudomeningocele.

Output: 1. Postoperative findings related to Chiari decompression with suggestion of adhesion formation between the cerebellum and overlying dura and mild retroflexion the dens.2. Substantial interval decrease in size of the thoracic syrinx.


Instruction: Generate impression based on findings.

Input: 57-year-old female with left hip pain. Evaluate for hip fracture versus metastases. BONE MARROW: There are multiple foci of bone marrow signal abnormality consistent with osseous metastatic disease involving the intertrochanteric region of the right femur, right iliac bone, left iliac bone, left superior acetabulum, and right sacrum. There is associated enhancement on postcontrast sequences. Note is made of decreased linear signal abnormality within the left iliac crest traversing the aforementioned metastatic lesion consistent with a pathologic fracture with minimal lateral displacement of the superior fracture fragment.SOFT TISSUES: Increased signal abnormality within the gluteal musculature on the left and left iliac musculature adjacent to the aforementioned metastatic lesion. There is an associated soft tissue component extending beyond the cortex of the left iliac bone adjacent to the aforementioned metastatic lesion. JOINTS: There is an osseous metastatic lesion involving the superior aspect of the left acetabulum. The left femoroacetabular joint alignment is anatomic. There is no evidence of a left femoral fracture.ADDITIONAL

Output: Multiple foci of osseous metastatic disease involving the imaged bones of the pelvis as described above. There is an associated pathologic fracture through the left iliac crest with associated slight lateral displacement of the superior fracture fragment. Other findings as described above.


Instruction: Generate impression based on findings.

Input: 62-year-old female with chronic lateral plantar heel callus. Evaluate lateral plantar heel callus for foreign body. A vitamin E capsule overlies plantar soft tissues underlying the calcaneus presumably representing the site of the patient's palpable abnormality. There is skin thickening in the area underlying the aforementioned marker. There is irregularity of the pad fat of the heel which extends to the superficial fascial plane. There is also a punctate focus of decreased signal abnormality within the skin surface about the superior aspect of the aforementioned marker. These findings are equivocal for a small foreign body. No large foreign body is identified. If further evaluation is clinically warranted, ultrasound examination could be considered. There is no focal fluid collection to suggest abscess formation. There is no susceptibility artifact to suggest a metallic foreign body. There are no inflammatory changed identified in the surrounding area. The flexor and extensor tendons appear intact. The peroneal tendons appear intact. The Achilles tendon is normal in appearance. The lateral collateral ligament complex appears intact. The distal tibiofibular syndesmotic complex appears intact. The imaged portions of the deltoid ligament appear intact. There is increased signal abnormality fourth tarsometatarsal joint, likely degenerative in etiology. There is associated subchondral cyst formation. There is a small amount of fluid within the tibiotalar joint without evidence of a large effusion. There is mild increased signal abnormality within the medial aspect of the talar dome, likely degenerative in etiology. No osteochondral defect is identified. There is a trace amount of fluid within the retrocalcaneal bursa.

Output: Equivocal tiny foreign body within the superficial soft tissues of the heel as described above. If there is strong clinical concern for a retained foreign body, further evaluation with a dedicated ultrasound examination could be considered.


Instruction: Generate impression based on findings.

Input: Clinical question: Status post ETV. Signs and symptoms: Status post ETV. Nonenhanced head CT:There is evidence of a small right recumbent AP paramedian frontal burr hole since prior study. Small punctate focus of air density immediately under the burr hole is present. Linear low attenuation traversing the right frontal lobe and terminating into the right lateral ventricle likely result of recent instrumentation. Punctate focus of air within the right frontal horn is also present.There is no radiopaque catheter in place.No convincing evidence of any change in size of ventricular system.Periventricular low attenuation of white matter is similar to prior exam corresponding to regions of small muscle ischemic strokes on prior MRI study. Possibility of underlying periventricular exudate of CSF should also be considered.

Output: 1.No convincing evidence of interval change in the size of the supratentorial enlarged ventricular system.2.Evidence of interval right frontal burr hole, minimal intracranial air, small linear low-attenuation across the frontal lobe likely along the track of instrumentation.3.No radiopaque ventricular catheter / shunt is present.


Instruction: Generate impression based on findings.

Input: Evaluation of suspected right frontal lobe cyst on OSH MRI. There is a cluster of cystic spaces in the subcortical white matter of the anterior right frontal lobe that collectively measure up to 20 mm. There is no evidence of intracranial hemorrhage or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: A cluster of cystic spaces in the subcortical white matter of the anterior right frontal lobe that collectively measure up to 20 mm are compatible with focally enlarged perivascular spaces.


Instruction: Generate impression based on findings.

Input: Female, 66 years old, with arm pain. Surgical instrumentation is again seen compatible with an anterior fusion spanning from C4 through C6. Spinal alignment is straightened, similar to prior. Vertebral body heights are preserved and, where not obscured by metal artifact, the marrow signal is within normal limits.T2 hyperintensity and thinning of the cord at the C4 level appears similar to the prior examination and is compatible with myelomalacia. Elsewhere, spinal cord signal and morphology are within normal limits.C2-3: Minimal disc osteophyte formation. No significant spinal canal or foraminal stenosis. No interval changes.C3-4: Posterior disc-osteophyte complex formation resulting in a moderate generalized spinal canal stenosis, unchanged from prior. No significant foraminal narrowing. C4-5: Postoperative findings. No significant spinal canal or foraminal stenosis. No interval changes. C5-6: Postoperative findings. No significant spinal canal or foraminal stenosis. No interval changes. C6-7: Minimal posterior disc-osteophyte complex formation. No significant spinal canal or foraminal stenosis. No interval changes. C7-T1: Unremarkable.

Output: 1.Redemonstration of findings related to anterior instrumented cervical fusion from C4 through C6.2.Moderate spinal canal stenosis at C3-4 is unchanged.3.Evidence of myelomalacia at C4 is unchanged.4.No significant interval changes and no additional areas of significant spinal canal or foraminal stenosis.


Instruction: Generate impression based on findings.

Input: Diplopia, structural lesion, brain stem?. Per medical record, patient has history of multiple myeloma. There is lobulated mass involving the sella measuring up to 3.8 x 3.9 x 3.5 cm in the maximal AP, transverse, and craniocaudal dimensions. Pituitary gland and infundibulum are anteriorly displaced. Mild suprasellar extension without significant mass effect on the optic chiasm is appreciated. There is inferior extension into the clivus involving the basisphenoid bone and the sphenoid sinus on the right. Laterally, there is extension into the bilateral cavernous sinuses without evidence of circumferential encasement of the cavernous carotid arteries. Bilateral optic nerves and chiasm are normal in signal. There is mild global parenchymal volume loss including the bilateral cerebellar hemispheres.There is volume loss and surrounding gliosis involving the left parietal lobe likely related to prior cortical infarct. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. The ventricles are within normal limits in size and configuration. Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with chronic small vessel ischemic changes. No mass effect on the brainstem is appreciated. Major flow-voids are preservedRight maxillary mucous retention cyst. There are numerous small enhancing lesions throughout the calvarium consistent with history of multiple myeloma. No associated intracranial mass effect.

Output: 1. Lobulated enhancing mass measuring 3.8 x 3.9 x 3.5 cm involving the sella with smooth expansile erosion involving the upper aspect of the clivus and sphenoid sinus. Pituitary gland and infundibulum appear anteriorly displaced. Lesion is favored to be related to multiple myeloma and less likely pituitary adenoma. Laterally there is some extension into the bilateral cavernous sinuses. 2. Multiple small enhancing lesions throughout the calvarium consistent with known multiple myeloma.3. Small chronic left parietal infarct.4. No lesions within the brainstem or mass effect on the brainstem.


Instruction: Generate impression based on findings.

Input: Clinical question: pituitary adenoma, please assess for changes. Signs and Symptoms: pituitary adenoma Pre and post enhanced pituitary MRI:Examination demonstrate a pituitary hypoenhancing microadenoma measuring at 6.5 x 4.2 mm coronal post enhanced images far laterally on the right. There is no appreciable change in size or morphology of this finding since prior exam from 6-20 8-14. There is no evidence of mass effect pituitary stalk remains in midline and with normal pattern of enhancement. The signal intensity and pattern of enhancement of the pituitary gland is otherwise within normal and measuring at approximately 7 mm heights in midline. The basal cistern and the suprasellar visual complex are unremarkable. Bilateral cavernous sinuses are unremarkable. Sphenoid sinus and images through the skull base are unremarkable.

Output: Stable pituitary microadenoma at 6.5 x 4.2 mm (coronal post enhanced series) far laterally on the right inferior aspect of sella.


Instruction: Generate impression based on findings.

Input: Evaluate for Chiari malformation and CSF flow: headache, N/V. Brain: There cerebellar tonsils extend up to 5 mm inferior to the foramen magnum, but display rounded morphology. There is intact CSF flow across the anterior foramen magnum, but perhaps somewhat blunted flow posteriorly. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift . The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Cervical Spine: The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: 1. Unchanged low-lying cerebellar tonsils. 2. No evidence of cervical spinal cord syrinx.


Instruction: Generate impression based on findings.

Input: Bilateral lower extremity pain. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The imaged portion of the distal spinal cord displays normal signal and morphology. The conus medullaris terminates at L2. The paravertebral soft tissues are unremarkable. There are small anterior disc osteophytes at multiple level of the lower thoracic and lumbar spine. There are mild disc bulges at L3-L4, L4-L5 ,and L5-S1. Facet degenerative changes are also present throughout the lumbar spine, most pronounced at L2-3 through L4-5 with associated joint effusions and at most mild neural foraminal narrowing, but no significant spinal canal stenosis.

Output: Multilevel degenerative spondylosis, including mild disc bulges at L3-L4, L4-L5 ,and L5-S1 and facet degenerative changes, particularly at L2-3 through L4-5 with at most mild neural foraminal narrowing, but no significant spinal canal stenosis.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Patient with two days history of headaches with frontal neurologic signs, vertigo, sensory deficit, bilateral hand tingling, right cranial nerves 6 palsy, vertical nystagmus. CT of brain without and with infusion:No evidence of hemorrhage, edema, mass effect, midline shift or hydrocephalus.Subtle foci of low-attenuation in the periventricular white matter of bilateral hemispheres are not specific and non-enhancing. The findings considering patient's age are concerning for demyelinating disease. Possibility of stroke cannot be entirely ruled out. Follow up with a dedicated MRI of brain is recommended. There is no evidence of parenchyma volume loss. Cortical sulci and ventricular system remain within normal. No evidence of any abnormality of cortex is detected.On post infusion images no abnormal enhancement of brain parenchyma or leptomeninges is detected.Calvarium is intact. Mastoid air cells and limited view of paranasal sinuses are unremarkable.100 cc of Omnipaque 350 was utilized for the above study.

Output: 1.Periventricular foci of low attenuation without enhancement is concerning for demyelinating disease considering patient's age. Ischemic stroke or other etiologies cannot be entirely ruled out and further follow-up with an MRI is recommended.2.There is no abnormal enhancement on post infusion images.3.Calvarium, paranasal sinuses and mastoid air cells are unremarkable.


Instruction: Generate impression based on findings.

Input: Female, 38 years old, with history of cerebral cavernous malformation. A focus of susceptibility is again seen along the posterior left cingulate gyrus measuring up to 5 mm on venBOLD imaging which is unchanged in size compared to the prior exam. No evidence of any significant associated edema is seen. There is the suggestion of wispy associated enhancement, similar to prior, which may represent the presence of a small adjacent developmental venous anomaly.Also unchanged is a punctate focus of susceptibility within the left aspect of the pons which is associated with no convincing T1 signal abnormality and no pathologic enhancement. No new intracranial lesions are seen. A few scattered foci of non-specific subcortical T2 hyperintensity are unchanged in the frontal lobes. No evidence of significant edema or mass effect is seen. No abnormal extra-axial collections are detected. The ventricular system is patent and normal in size.

Output: 1. Stable susceptibility inducing lesion within the posterior left cingulate gyrus compatible with a cavernous malformation. Wispy associated enhancement is also unchanged and suggestive of an adjacent developmental venous anomaly.2. A nonspecific punctate focus of susceptibility within the left aspect of the pons is also unchanged, with no convincing associated T1 signal abnormality or enhancement.


Instruction: Generate impression based on findings.

Input: Type 2 diabetes mellitus with diabetic chronic kidney disease [E11.22] / Chronic kidney disease, unspecified [N18.9], Reason for Study: ^Reason: R/O CVA/Cause of AMS History: AMS Motion artifact degraded image quality.However, there is no evidence of acute ischemic or hemorrhagic lesion on the scan.Scattered high signal intensities on periventricular white matter and centrum semiovale on FLAIR imaging indicate nonspecific small vessel ischemic disease, no change since prior scan.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.There are air-fluid levels in the sphenoid sinus indicating sinusitis.

Output: 1. Significant motion artifact degraded exam quality.2. No evidence of acute ischemic or hemorrhagic lesion. 3. Minimal to mild nonspecific small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: 69 year old BRCA2 positive female with a personal history of left breast lumpectomy for breast cancer in 2002 and left breast benign biopsy in 1967. She is status post chemotherapy and radiation. Family history of breast cancer in her sister and maternal aunt There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. Post operative volume loss and scarring of the left breast is stable. No abnormal 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: Redemonstrated is a small collection of T2 hyperintense foci within the left frontal white matter (best seen FLAIR technique series 801 image 8/25). This is not associated with susceptibility abnormality or enhancement. It correlates with an adjacent collection of perivascular spaces (best seen series 70 on image 15/30) both laterally in a subcortical location as well as in a perivascular/periventricular location. The larger more anterior focus of this collection is associated with a demonstrable parallel vessel as demonstrated by susceptibility weighted imaging (series 90 on image 36/120).The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. Scattered, sporadic, minimal foci of mucosal thickening can be found of the paranasal sinuses. A small focus of inflammatory change is noted in the medial left mastoid air cells. The right mastoid air cells are clear. There is no abnormal enhancement within the brain.

Output: 1.Redemonstrated is a small collection of T2 hyperintense foci within the left frontal white matter (best seen FLAIR technique). This is not associated with susceptibility abnormality or enhancement. It correlates with an adjacent collection of perivascular spaces both laterally in a subcortical location as well as in a perivascular/periventricular location. The larger more anterior focus of this collection is associated with a demonstrable parallel vessel as demonstrated by susceptibility weighted imaging. The constellation of these MRI imaging features is most suggestive of parenchymal T2 hyperintensity associated with perivascular spaces, which has been described in the literature. Other etiologies remain in the differential diagnosis, given this atypical perivascular appearance, however are considered to be less likely. Recommendations are made to perform repeat MRI imaging with contrast in one year at 3 Tesla to assess for stability (or consider sooner if patient symptomatology worsens). 3 Tesla imaging could also help to better define the associated anatomy.2.Scattered, sporadic, minimal foci of mucosal thickening can be found of the paranasal sinuses. A small focus of inflammatory change is noted in the medial left mastoid air cells.


Instruction: Generate impression based on findings.

Input: 7 years, Female, with right ear pain and bleeding. Evaluate for vascular malformation. There is enlargement and deformity of the right auricle which measures 4.5 x 1.5 x 5.9 cm and is diffusely contrast-enhancing; there are associated prominent flow voids suggestive of a vascular malformation (series 401, image 16) . The vasculature (ECA/retromandibular vein) within the right parotid gland is also more prominent when compared to the left parotid gland. Minimal prominent vascular enhancement is also seen involving the subcutaneous tissues overlying the right mastoid air cells. Remainder of the visualized scalp and deeper temporal bone structures appear within normal limits. There is mild hypoplasia involving the inferior cerebellar vermis can be normal variant. Limited evaluation of the visualized brain parenchyma appears otherwise unremarkable. Bone marrow signal is within normal limits.

Output: Enlargement of the right auricle with extensive enhancement and prominent flow-voids. Findings are suspicious for arteriovenous malformation. MRA covering the ear or conventional angiogram may be considered for further evaluation.


Instruction: Generate impression based on findings.

Input: 55 year old female with a history of benign right breast biopsy in 05/2015 and a strong family history of breast and other cancers. The patient also has a history of bilateral breast reduction in 2011. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.A small enhancing mass, which is a biopsy proven benign lesion, in the right nipple is again seen. It measures 4 x 6 x 3 mm (previously 9 x 8 x 7 mm). Posterior to this mass in the right retroareolar region, again seen is a tortuous ectatically dilated duct with increased T1 signal, consistent with proteinaceous fluid.There are no suspicious enhancing lesions in the right breast. No abnormal enhancement is seen in left breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: 50 serial female with spinal fusion L4/L5 9/05. Continued low back pain.IMAGE ACQUISITIONS: Thoracic/lumbar spine CT without contrast Thoracic spine alignment is normal. No evidence of central canal or neuroforaminal stenosis.Lumber spine alignment is normal. There is fusion of L4 and L5 with bilateral intrapedicular screws.L1-2: No central canal or neuroforaminal narrowing.L2-3: Minimal right facet joint hypertrophy. No central canal or neuroforaminal stenosis.L3-4: Posterior disk bulge cause centrally and left laterally. Mild left neuroforaminal impingement and mild central canal narrowing.L4-5: L4 Intrapedicular screws and right laminectomy. There is effacement right lateral and anterior to the thecal sac which raises the question of epidural fibrosis. MRI with contrast can be used to further evaluate.L5-S1: L5 interpedicular screws. There is narrowing of the right neural foramen.

Output: Postsurgical and degenerative changes as described above. There is question of right-sided epidural fibrosis at L4-5 for which MRI can be used to further evaluate.


Instruction: Generate impression based on findings.

Input: PEA arrest, CPR, and left renal mass invading the IVC. There are areas of cortical T2 hyperintensity and restricted diffusion involving the posterior occipital and frontoparietal cortices bilaterally. There is also a punctate focus of restricted diffusion in the left cerebellar hemisphere. There are scattered foci of T2 hyperintensity in the cerebral white matter. There is perhaps trace extra-axial fluid hemorrhage along the right aspect of the posterior falx cerebri. There is mild diffuse cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. There is mild scattered paranasal sinus mucosal thickening. The orbits, skull, and scalp soft tissues are grossly unremarkable. However, there is fluid signal in the bilateral mastoid air cells, which may be related to intubation.

Output: 1. Scattered areas of restricted diffusion primarily involving the posterior occipital and frontoparietal cortices bilaterally may represent acute infarcts related to hypoxia or less likely microemboli versus perhaps a form of posterior reversible encephalopathy syndrome.2. Scattered foci of T2 hyperintensity in the cerebral white matter are nonspecific, but may represent chronic effects of small vessel ischemic disease.3. Possible trace extra-axial fluid hemorrhage along the right aspect of the posterior falx cerebri.


Instruction: Generate impression based on findings.

Input: Male, 72 years old, with garbled speech. Evaluate for ischemic infarct. No restricted diffusion is seen. Extensive patchy periventricular white matter T2 hyperintensity is seen. No edema or mass effect is detected. No acute intracranial hemorrhage or any abnormal extra-axial fluid collections are seen. The ventricles are normal in size and morphology.

Output: 1.No evidence of acute ischemia.2.Sequelae of moderately extensive chronic microvascular ischemic disease.


Instruction: Generate impression based on findings.

Input: 24-year-old female with inflammatory back pain, please for sacroiliitis. The sacroiliac joints appear normal without fluid or enhancement. Bone marrow signal intensity is within normal limits. The soft tissues are unremarkable.There is a small amount of physiologic free fluid within the pelvis.

Output: No evidence of sacroiliitis or other specific findings to account for patient's pain.


Instruction: Generate impression based on findings.

Input: BRAIN: There is a punctate focus of restricted diffusion with FLAIR hyperintensity in the left thalamus, and a small second focus in the right subinsular/external capsule region. Compared to the prior MRI, there is volume loss in the left caudate/basal ganglia with resulting ex vacuo dilatation of the left frontal horn. There is resolved enhancement in the left caudate and lentiform nucleus. However, intrinsic T1 high signal in these structures persists. These findings were present to represent nonketotic hyperglycemia related changes. There is a nonenhancing small T2 hyperintensity within the left cerebellar white matter which is new and nonspecific. There is also a new nonspecific focus of FLAIR hyperintensity in the right corona radiata. There is new hyperintense T2 signal abnormality in the left cerebral peduncle at the level of the midbrain and pons, and redemonstration of abnormal signal in the right cerebral peduncle; findings suggest Wallerian degeneration, new on the left and persistent on the right. There is no significant mass effect or midline shift. The ventricles and sulci are more prominent consistent with increased volume loss. There is an incidental cavum septum pellucidum et vergae. ORBITS: Evaluation of the orbits is limited due to motion artifact. The optic nerves and optic sheaths are symmetric and show normal signal intensity. The globes are within normal limits. The extraocular muscles show normal caliber and signal intensity. There is no suspicious enhancement in the orbit. The cavernous sinuses enhance symmetrically. The pituitary gland is not enlarged. The pituitary stalk is midline. The optic chiasm is within normal limits.

Output: 1.Two punctate small acute infarcts in the left thalamus and the right subinsular/external capsule region without significant mass effect.2.No orbital mass or abnormal enhancement, although examination is limited by motion artifact.3.Evolution of previously seen findings present to be related to nonketotic hyperglycemia. Interval focal volume loss in the left caudate and basal ganglia with no residual enhancement, although persistent intrinsic T1 hyperintensity noted in the left lentiform nucleus.4.New nonenhancing small left cerebellar white matter and right corona radiata T2 hyperintensity which are nonspecific.5.Progressive T2 signal abnormality in the left cerebral peduncle which may represent Wallerian degeneration. Persistent right cerebral peduncle T2 hyperintensity without significant change, representing previously seen Wallerian degeneration.Findings were communicated to Dr. Christopher Boyle at 10:20 AM today over the telephone.


Instruction: Generate impression based on findings.

Input: Follow-up adrenal lesion. ABDOMEN:LIVER, BILIARY TRACT: No suspicious liver lesion biliary ductal dilatation or vascular abnormality. Normally distended gallbladder.SPLEEN: Stable peripheral splenic T2-weighted mildly hyperintense nonenhancing focus, likely a cyst.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Left adrenal nodule measures 2.5 x 2.2 cm, unchanged (series 701/368).The additional left adrenal body nodule measures 1.3 cm, unchanged (series 701/353). Both are homogeneous and demonstrate signal dropout on out of phase imaging.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Stable left adrenal nodules with imaging characteristics compatible with lipid rich adrenal adenomas.


Instruction: Generate impression based on findings.

Input: Female, 35 years old, with decreased sensation and pain on the left side of the body. The cerebral and cerebellar hemispheres and brainstem show normal signal intensity and morphology. No restricted diffusion is seen. No pathologic enhancement is detected.No evidence of parenchymal edema, mass, or mass effect is seen. There is no evidence of intracranial hemorrhage or abnormal extra-axial fluid. The ventricular system is normal in caliber and morphology. Signal intensity of the bone marrow is unremarkable. No significant abnormalities of the paranasal sinuses are detected.

Output: Unremarkable evaluation with no specific findings to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: 69 year old man who underwent heart and kidney transplant in 2005 now returning for surveillance for allograft vasculopathy with CMR stress perfusion imaging. MEDICATIONS: carvedilol, cellcept, lasix, hydralazine, lantus, omega 3 fatty acid, prednisone, tacrolimus, simvastatin, synthroid First Pass PerfusionDuring hyperemia, perfusion defects were present in the basal anteroseptum and inferoseptum, mid anterolateral, inferolateral, inferior, and inferoseptal walls. This pattern is similar to the observed perfusion defects from the previous study of 2014.Viability/ Myocardial ScarThere are foci of mild atypical heterogenous signal in the myocardium which are not consistent with ischemia. This could represent a subtle fibrotic, inflammatory or infiltrative process. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 60%, the LV end diastolic volume index is 89 ml/m2 (normal range: 74+/-15), the LVEDV is 178 ml (normal range 142+/-34), the LV end systolic volume index is 36 ml/m2 (normal range 25+/-9), the LVESV is 71 ml (normal range 47+/-19), the LV mass index is 93 g/m2, and the LV mass is 185 g. There are no regional wall motion abnormalities present. Left AtriumThe left atrium is consistent with prior transplant. Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 46%, the RV end diastolic volume index is 89 ml/m2 (normal range 82+/-16), the RVEDV is 178 ml (normal range 142+/-31), the RV end systolic volume index is 39 ml/m2 (normal range 31+/-9), and the RVESV is 77 ml (normal range 54+/-17).Right AtriumThe right atrium is consistent with prior transplant.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.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC 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. Perfusion defects seen in a similar distribution to the previous study of 2014. This may represent microvascular disease given the clinical history of no obstructive disease by angiography. 2. There is a mild atypical pattern of heterogenous signal seen on the delayed enhancement images which is not consistent with ischemia. 3. Normal LV size and systolic function (LVEF 60%), stable from the previous study.4. Normal RV size with reduced systolic function (RVEF 46%), stable from the previous study.


Instruction: Generate impression based on findings.

Input: Reason: Evaluate for prostate lesion for biopsy History: Elevated PSA for years and multiple negative prostate biopsy x 2. History of RCC. PELVIS:PROSTATE:Prostate Size: 5.5 x 3.6 x 3.9 cmPeripheral Zone: Lesion in the left apex measuring 1.0 x 0.5 cm (6 1/14) with low ADC/T2 and questionable early enhancement is suspicious for prostatic adenocarcinoma. Lesion within the midline peripheral zone at the base with low ADC/T2 does not demonstrate enhancement (601/23) and is of low suspicion.Central Gland: BPH nodules.Seminal Vesicles: No seminal vesicle invasion.Extracapsular Extension: No evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: Subcentimeter right external iliac node.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Left apex lesion is suspicious for prostatic adenocarcinoma.2.No pelvic lymphadenopathy


Instruction: Generate impression based on findings.

Input: Female 16 years old Reason: knee dislocation, eval MPFL History: knee dislocation. MENISCI: The medial meniscus appears slightly small but we see no tear. The lateral meniscus is normal in morphology and signal intensity.ARTICULAR CARTILAGE AND BONE: There is edema within the medial aspect of the patella as well as the lateral aspect of the lateral femoral condyle indicating prior transient patellar dislocation. The articular cartilage appears intact.LIGAMENTS: The medial collateral ligament, lateral collateral ligament, anterior and posterior cruciate ligaments are unremarkable. The medial patellofemoral ligament appears intact and we see no secondary findings such as significant edema, fluid or ligamentous thickening to suggest injury. EXTENSOR MECHANISM: The quadriceps and patellar tendons are intact.ADDITIONAL

Output: Findings indicating prior transient patellar dislocation. Despite the dislocation, the medial patellofemoral ligament appears intact.


Instruction: Generate impression based on findings.

Input: 40 year-old female with history of sinus congestion. Sinusitis, head pain. The paranasal sinuses are well pneumatized and demonstrate no evidence of acute or chronic inflammatory sinus disease. The OMUs of the maxillary sinuses are patent bilaterally. The bony density of area of exam is unremarkable. There is prominence of subarachnoid space in the bifrontal region (left greater than right). This is more than is expected for patient's stated age of 39. This examination utilizes bone algorithm for study of the sinuses and is not proper test for evaluation of soft tissues of intracranial content. The above findings are concerning for possible parenchymal volume loss or small chronic subdurals, dedicated CT of brain or an MRI is recommended.These findings were relayed to Anne Forsythe number 8158. The findings are also left on an answering machine at the level number 24851 at the time of interpretation.

Output: 1.No evidence of acute or chronic sinus disease.2.Prominence of the subarachnoid space in bifrontal region left greater than right as detailed. 3.4.


Instruction: Generate impression based on findings.

Input: 36-year-old male with left shoulder squeaking. Rule out loose suture anchors status post shoulder stabilization. ROTATOR CUFF: The supraspinatus muscle and tendon appear intact. There is increased signal abnormality within the supraspinatus indicating mild tendinosis. The infraspinatus muscle and tendon appear intact. The subscapularis and teres minor muscle and tendon appear intact. SUPRASPINATUS OUTLET: There is a trace amount of fluid within the subacromial subdeltoid bursa which is not necessarily of any clinical significance. The acromioclavicular joint is normal in appearance.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is anatomic. There is deformity, heterogeneity and increased signal abnormality within the anterior inferior glenoid which presumably represents prior tearing and postsurgical change, within the limitations of this non arthrogram study. No fluid-filled defects are identified to confirm a re-tear. BICEPS TENDON: The tendon of the long head of the biceps appears intact. ADDITIONAL

Output: Postoperative changes of prior Remplissage procedure and osseous Bankart repair. There is increased fluid signal abnormality surrounding the inferior suture anchor within the glenoid, which raises the question of loosening.