Instruction: Generate impression based on findings.

Input: Diarrhea. History of Crohn's disease. Evaluate for active bowel inflammation. History of ileocecectomy in 2013. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postsurgical changes from an ileocecectomy. Overall there is a paucity of distal small bowel loops related to prior ileal resection.The residual small bowel is well-distended with oral contrast. There are segments of the jejunum which appear poorly distended but are otherwise unremarkable, likely secondary to peristalsis. The neoterminal ileum is clearly identified. The bowel is normal in caliber and wall thickness. There is no abnormal postcontrast enhancement or restricted diffusion. No significant fibrofatty proliferation or mesenteric lymphadenopathy. No fixed luminal narrowing or prestenotic/upstream dilatation. No sinus tract or fistula formation. No significant free fluid or loculated fluid collection.The distal colon is collapsed. There is mild circumferential wall thickening of the distal colon with restricted diffusion and mild hyperenhancement compatible with a non-specific colitis. Large hiatal hernia. BONES, SOFT TISSUES: Small pleural effusions. Patchy marrow signal intensity is not significantly changed. OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: See discussion above.BONES, SOFT TISSUES: Patchy marrow signal intensity is not significantly changed.OTHER: No significant abnormality noted.

Output: 1.Paucity of small bowel related to previous resection without evidence of active small bowel inflammation or flow limiting stricture. 2.Nonspecific rectosigmoid wall thickening, enhancement and restricted diffusion compatible with a nonspecific colitis which may be infectious/inflammatory or less likely ischemic in etiology.


Instruction: Generate impression based on findings.

Input: Shoulder pain ROTATOR CUFF: There is mildly increased signal intensity of the posterior fibers of the supraspinatus which may reflect mild interstitial or tearing (series 800 image 6/24). This is superimposed upon mild to moderate osteoarthritis and articular surface fraying which involves less than 50% of the tendon. When compared to the prior examination, the abnormal signal intensity is less conspicuous. There is no evidence of a full-thickness rotator cuff tear. The rotator cuff musculature is normal in caliber and signal.SUPRASPINATUS OUTLET: There is perhaps mild osteoarthritis of the acromioclavicular joint. There is no fluid within the subacromial subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is mild osteoarthritis of the glenohumeral joint with degenerative cystic changes noted along the glenoid. Evaluation of the labrum is limited given the lack of intra-articular contrast however there appears to be detachment of the posterior labrum (series 900 image 14/27) with probable degenerative tearing of the anterior labrum.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: 1. Mild interstitial tearing and articular surface fraying of the supraspinatus tendon posteriorly however this appears less extensive than the prior exam. There is no evidence of full-thickness rotator cuff tear.2. Mild osteoarthritis of the glenohumeral joint.3. Probable detachment of the posterior labrum with degenerative tearing of the superior labrum.


Instruction: Generate impression based on findings.

Input: 68-year-old female with memory complaints status post left subtemporal meningioma resection. Evaluate for interval change. Redemonstration of left middle cranial fossa post-operative changes including encephalomalacia of the inferior and middle temporal gyri without change since the prior exam. The left tentorial edge meningioma is unchanged compared to the prior exam.There is no evidence of intracranial hemorrhage, or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Stable left middle cranial fossa post operative changes and left tentorial meningioma. No new findings are seen to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Bilateral knee pain Right knee:MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: No significant abnormality noted. Note is made of a small bone island in the medial femoral condyleLIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Radial tear in the anterior horn of the left lateral meniscus and globular nonspecific changes in the posterior horn of the left medial meniscus. No additional acute or subacute MR abnormalities are observed.2. Multiple scattered bone islands observed bilaterally, raising the question of possible underlying osteopoikilosis


Instruction: Generate impression based on findings.

Input: 76 year old man with history of coronary artery disease complicated by myocardial infarction and treated with bypass surgery (LIMA to LAD, SVG to diagonal, SVG to OM). He presents with atypical chest pain and referred to rule out ischemia.MEDICATIONS: aspirin, atorvastatin, furosemide, metoprolol, nitroglycerin PRN. First Pass PerfusionDuring hyperemia, a borderline perfusion defect was noted in the basal anterior, basal septal, and mid septal walls. The overall ischemia score is 3 out of 32 and 9% of the myocardium is ischemic.Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable.Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 67%, the LV end diastolic volume index is 74 ml/m2 (normal range: 74+/-15), the LVEDV is 154 ml (normal range 142+/-34), the LV end systolic volume index is 24 ml/m2 (normal range 25+/-9), the LVESV is 50 ml (normal range 47+/-19), the LV mass index is 50 g/m2, and the LV mass is 105 g. There are no regional wall motion abnormalities present. Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 57%, the RV end diastolic volume index is 88 ml/m2 (normal range 82+/-16), the RVEDV is 184 ml (normal range 142+/-31), the RV end systolic volume index is 37 ml/m2 (normal range 31+/-9), and the RVESV is 78 ml (normal range 54+/-17).Right AtriumThe right atrium is moderately dilated.Aortic ValveThe aortic valve opens widely and there is mild aortic regurgitation. The aortic valve is trileaflet.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is mild pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is moderate 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 FindingsSternal wires are noted. A small hepatic cyst/ hemangioma is noted. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. During hyperemia, there is a borderline perfusion defect/ "ischemia" which involves the basal anterior, basal anteroseptal, and mid anteroseptal walls.2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and systolic function (LVEF 67%) without evidence of underlying myocardial fibrosis, inflammation, or infiltration.4. Normal RV size and systolic function (RVEF 57%).5. Moderate tricuspid regurgitation.6. Moderate right atrial dilation.


Instruction: Generate impression based on findings.

Input: 33 year old female with history of lupus, endstage renal disease on dialysis and pleuritic chest pain was referred for cardiac MRI without contrast to evaluate for pericardial disease. Left VentricleThe left ventricle is mildly dilated with normal systolic function. The overall LV ejection fraction is 67%, the LV end diastolic volume index is 96 ml/m2 (normal range: 65+/-11), the LVEDV is 213 ml (normal range 109+/-23), the LV end systolic volume index is 21 ml/m2 (normal range 18+/-5), the LVESV . There are no regional wall motion abnormalities present. Native T1 relaxation time is ~1010ms, which is within normal limits.Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal size with normal systolic function. The overall RV ejection fraction is 60%, the RV end diastolic volume index is 79 ml/m2 (normal range 69+/-14), the RVEDV is 176 ml (normal range 110+/-24), the RV end systolic volume index is 32 ml/m2 (normal range 22+/-8), and the RVESV is 71 ml (normal range 35+/-13). Right AtriumThe right atrium is mild-moderately dilated. Aortic ValveThe aortic valve opens widely and there is at least mild 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 at least mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThere is an SVC catheter. The SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is a trivial pericardial effusion. Pericardial thickness is ~4mm, which is within normal limits. There is no evidence of increased signal on T2-STIR imaging to suggest pericardial edema. Further characterization is not possible due to inability to administer contrast. Tagging sequences and real-time cine imaging are not suggestive of constrictive physiology.Extracardiac FindingsThere is a trivial right pleural effusion. Kidneys are small consistent with history of chronic kidney disease. Liver is relatively hypointense. Tiny cyst within the liver anteriorly. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Mildly dilated left ventricle with normal systolic function (EF 67%).2. Normal size right ventricle with normal systolic function (EF 60%).3. At least mild tricuspid regurgitation.4. At least mild aortic regurgitation.5. A trivial pericardial effusion is present without overt evidence of pericardial thickening, edema or constriction.


Instruction: Generate impression based on findings.

Input: Pain, tenderness, and lump in left anterior neck. There is no evidence of measurable mass lesions or significant cervical lymphadenopathy. The thyroid and major salivary glands are unremarkable. The major cervical flow voids are patent. The osseous structures are unremarkable. There is patchy T2 hyperintensity in the pons and a probable lacunar infarct in the right pons. There are bilateral lens implants. There is mild fluid within the right mastoid air cells.

Output: 1. No discernible measurable mass lesions or significant lymphadenopathy in the neck.2. Probable right pons chronic lacunar infarct and a background of chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: 59 year old female with new diagnosis of LV dysfunction. Referred for further evaluation. Left VentricleThe left ventricle is mildly dilated with mildly reduced systolic function. The overall LV ejection fraction is 46%, the LV end diastolic volume index is 90 ml/m2 (normal range: 65+/-11), the LVEDV is 173 ml (normal range 109+/-23), the LV end systolic volume index is 48 ml/m2 (normal range 18+/-5), the LVESV is 93 ml (normal range 31+/-10), the LV mass index is 37 g/m2 (normal range 67+/-11), and the LV mass is 71 g (normal range 114+/-24). There is septal dyssynergy consistent with conduction abnormality otherwise global hypokinesis. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. Pre-contrast, native T1 mapping = 1064 msLeft AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 62%, the RV end diastolic volume index is 73 ml/m2 (normal range 69+/-14), the RVEDV is 140 ml (normal range 110+/-24), the RV end systolic volume index is 28 ml/m2 (normal range 22+/-8), and the RVESV is 53 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size (sinus of Valsalva 29 mm).Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size (22.5 mm). Venous AnatomyThe SVC and IVC 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. The left ventricle is mildly dilated with mildly reduced systolic function (LVEF 46%). There is global hypokinesis. 2. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.3. The right ventricle is normal in size with normal systolic function (LVEF 62%).I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Reason: 74M with hx of biliary stricture History: biliary stricture. ABDOMEN:LIVER, BILIARY TRACT: Widening of the hepatic fissures and left hepatic lobe hypertrophy compatible with chronic liver disease, unchanged. Intrahepatic biliary ductal dilatation, left greater than right, is unchanged. Stricturing of the common bile duct from the junction of the right and left hepatic ducts extending to the mid duct is unchanged. Associated common bile duct wall thickening. Enhancement of the biliary ductal wall involving the right hepatic lobe. SPLEEN: Splenomegaly, unchanged. Extensive splenic varices, unchanged.PANCREAS: No significant abnormality noted. Pancreatic duct is normal in caliber.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Stable common bile duct stricture.2.Findings suggestive of chronic liver disease with associated portal hypertension, unchanged.


Instruction: Generate impression based on findings.

Input: T1N0 left tongue cancer s/p glossectomy (4 mm depth of invasion) with primary closure 7/2009 and and revision glossectomy and neck dissection in 8/2009. There are postoperative findings related to partial left glossectomy and neck dissection, with resection of the left submandibular gland. There is an unchanged small patchy area of high T2 signal in the posterior left oral tongue. Otherwise, there is no evidence of gross tumor in the upper aerodigestive tract. There is a persistent prominent left lateral retropharyngeal lymph node that measures up to 9 mm. Otherwise, there is no significant lymphadenopathy in the neck. The remaining salivary glands are unchanged. The mucosal thickening within the maxillary sinuses has nearly resolved, with minimal residual thickening along the right infundibulum. The thyroid gland appears unchanged. The orbits and imaged intracranial structures are grossly unremarkable. There is multilevel degenerative cervical spondylosis.

Output: 1. Postoperative findings related to partial left glossectomy and neck dissection, with an unchanged small patchy area of high T2 signal in the posterior left oral tongue. Otherwise, there is no evidence of gross tumor in the upper aerodigestive tract. 2. Nonspecific persistent prominent left lateral retropharyngeal lymph node that measures up to 9 mm. Otherwise, there is no significant lymphadenopathy in the neck.


Instruction: Generate impression based on findings.

Input: Please do a portable CT patient is intubated and ventilated. Patient with intracranial hemorrhage or 63 years old. The CSF spaces are appropriate for the patient's stated age. There is redemonstration of a large left basal ganglia hematoma currently measuring 38 x 43 millimeters which measures similar to the prior exam. It is associated with a satellite foci of hemorrhage in the left inferior frontal gyrus measuring about 10 mm x 9 mm also unchanged since prior exam . It is also Associated with a small amount of intraventricular blood in the lateral ventricles. There is mass effect present with shift of the septum pellucidum approximately 2 mm to the right of midline and the shift of the third ventricle approximately a 3 mm the right of midline. The suprasellar cistern appears intact. Since the previous exam the amount of the vasogenic edema associated with this and a focus of hemorrhage appears to be stable.There is a hyperdense focus present in the left temporal lobe anterior pole measuring 10 mm in diameter on the previous exam which is not visible on the current exam. there a hyperdense focus present in the the right precentral gyrus measures approximately 8 mm in diameter and previously measured 5 mm in diameter. A couple are present along the pars marginalis bilaterally each measuring about 4 or 5 mm and several are present along the left superior frontal gyrus which are all adjacent to each other. Overall these have been identified on the gradient echo MRI. It can also be identified on prior CT scan .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.Since the previous exam of there has not been a significant change. There is redemonstration of multiple hemorrhagic foci in both hemispheres. The left basal ganglia lesion is the largest as indicated above. A right precentral gyrus lesion appears slightly larger. A left anterior temporal pole lesion is not identified on the current exam probably due to use of portable CT technique.


Instruction: Generate impression based on findings.

Input: History of liver mass seen on CT. ABDOMEN:LIVER, BILIARY TRACT: The liver demonstrates normal morphology and background parenchymal signal intensityThere is a large, lobulated and sharply marginated, encapsulated mass centered in hepatic segment 4a also extending into segments 2 and 8 with reference measurements below. The mass demonstrates heterogeneous increased T2 signal, decreased T1 signal, restricted diffusion, and no evidence of intralesional fat. The lesion demonstrates heterogeneous enhancement with suggestion of filling in on more delayed images. No definite washout is seen. There is a subcentimeter T2 hyperintense nonenhancing lesion within the anterior inferior aspect of hepatic segment 2 compatible with a cyst. No additional focal hepatic lesions are identified.There is attenuation/obstruction of the hepatic vessels traversing the mass, including the middle hepatic vein. The main portal vein and proximal branches appear patent.The gallbladder is nondistended. 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: Several scattered subcentimeter cysts.RETROPERITONEUM, LYMPH NODES: There are 2 abnormally enlarged cardiophrenic lymph nodes, increased in size from prior with reference measurements belowBOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: There is a enhancing, spiculated mass within the right breast which is suspicious for malignancy with reference measurements as below.OTHER: No significant abnormality noted.INDEX LESION MEASUREMENTS (Current exam date/time: 9/14/2016 10:15:00)LEFT HEPATIC LESION : 9.2 x 8.1 cm (Image 12, Series 4); 8.1 cm (Image 15, Series 6); 6.2 x 6.0 cm on prior (5/17/2016) (Image 18, Series 80376).RIGHT BREAST LESION: 1.6 x 1.5 cm (Image 8, Series 9).CARDIOPHRENIC LYMPH NODE: 1.2 x 0.9 cm (Image 18, Series 9); 0.9 x 0.6 cm on prior (5/17/2016) (Image 12, Series 80376).

Output: 1.Hepatic mass highly suspicious for neoplasm, increased in size compared to 5/17/2016 CT. Differential considerations include cholangiocarcinoma, hepatocellular carcinoma, mixed tumor, or less likely solitary metastasis. Associated cardiophrenic lymphadenopathy.2.Enhancing right breast mass suspicious for neoplasm. Dedicated breast imaging and workup is recommended if not recently performed.


Instruction: Generate impression based on findings.

Input: T3N2b right BOT HPV+ SCC, non-smoker, on OPTIMA trial, s/p induction chemotherapy with carboplatin/abraxane followed by 5/5 cycles of TFHX completed on 11/11/16. The images are degraded by patient motion. There are post-treatment findings without evidence of measurable residual oropharyngeal tumor. The irregular right level 2A lymph node is no longer discernible and a right level 3 lymph node measures 8 x 9 mm, previously 9 x 14 mm. The left cervical lymph nodes are not particularly enlarged. The salivary glands are unremarkable. There is mild degenerative spondylosis at C4-5 and C5-6. There is a subcentimeter left maxillary sinus retention cyst. The orbits and imaged intracranial structures are grossly unremarkable.

Output: 1. Post-treatment findings without evidence of measurable residual oropharyngeal tumor, although the images are degraded by patient motion. 2. No evidence of significant residual cervical lymphadenopathy, although the images are degraded by patient motion.


Instruction: Generate impression based on findings.

Input: Abdominal pain. Assess Crohn's disease activity. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left renal subcentimeter simple cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is a severe circumferential wall thickening and surrounding inflammation of the terminal ileum and mild wall thickening of the cecum which is conical in configuration. Proximal to the very distal terminal ileum the bowel is focally dilated up to 3.0 cm (series 5 image 26). Proximal to this the bowel is mildly thickened and narrowed for a 3.8 cm length segment of distal ileum. The more proximal bowel is normal in caliber. There is marked postcontrast enhancement of the described thickened bowel and surrounding soft tissue with restricted diffusion of the bowel. No discrete fluid collection to suggest an abscess.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: See above discussion.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Active phlegmonous inflammation of the terminal ileum and cecum. Mild proximal short segment bowel dilatation of the terminal ileum. More proximal 3.8 cm focal stricture of the distal ileum without significant proximal dilatation.


Instruction: Generate impression based on findings.

Input: History of refractory epilepsy. There has been expected interval evolution of left medial temporal lobe laser ablation effects including development of an area of encephalomalacia measuring up to 28 mm in the previously enhancing treated region of the left temporal lobe. There appears to be a small area of encephalomalacia in the posterior external capsule region on the right. The ventricles are unchanged in size and configuration. There is no midline shift. There are small left maxillary and sphenoid sinus retention cysts and mild mucosal thickening in the right maxillary sinus.

Output: Expected interval evolution of left medial temporal lobe laser ablation effects.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Transphenoidal surgery for pituitary apoplexy: Left eye 3rd nerve palsy. There are interval postoperative findings related to transphenoidal surgery. There is a non-enhancing area in the left sella alongside the left cavernous sinus, which measures 10 mm in width, 8 mm in height, and 5 mm anteroposteriorly, which may represent residual hemostatic agent or necrotic pituitary tumor, but there is no mass effect upon the optic apparatus. The pituitary infundibulum is slightly deviated to the right. There is interval resolution of the diffuse dural thickening and enhancement. There is scattered cerebral white matter T2 hyperintensity, which may be related to chronic small vessel ischemic disease. There is a small amount of residual mucosal thickening in the sphenoid sinuses.

Output: 1. Interval postoperative findings related to transphenoidal surgery for resection of an infarcted pituitary adenoma with no residual massa effect upon the optic apparatus.2. Interval resolution of the diffuse dural thickening and enhancement.


Instruction: Generate impression based on findings.

Input: History of bladder cancer status post partial cystectomy. Evaluate for metastatic disease. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: Postsurgical changes of a partial cystectomy without evidence of recurrent or residual disease.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Previously seen right inguinal region fluid collection is no longer evident.OTHER: No significant abnormality noted.

Output: No evidence of recurrent, residual or metastatic disease.


Instruction: Generate impression based on findings.

Input: An intra-axial, predominately cystic lesion is present in the right frontal lobe measuring approximately 6.5 AP x 5.8 ML x 5.2 CC cm with surrounding confluent T2 signal abnormality. There is substantial mass effect on the right lateral ventricle with partial effacement, and 8mm midline shift to the left. There is mild left lateral ventricular dilatation compatible with entrapment. The lesion is dominated by two large cystic components. Anteromedial to them, there is an elongated ovoid region of near CSF signal intensity through which it appears that small vessels may pass and which may also be a part of the lesion. The walls of the cystic components enhance, as does the solid nodular portion which is located more laterally. The solid portions of the lesion demonstrate mildly increased diffusion signal and subtle susceptibility effect suggesting hemorrhage and/or mineralization. The solid nodular portions of this tumor are inseparable from the right frontal opercular gyri which are thickened and heterogeneous, further supporting that the mass is intra-axial, and possibly originating from the cortex. The internal cystic components show no restricted diffusion.

Output: Large intra-axial cystic and solid mass with enhancing nodular components in the right frontal region with extensive mass effect, and midline shift as described above. Although the point of origin of this lesion is not entirely clear, it may originate from the cortex of the right frontal operculum as described above. A primary brain tumor is the favored diagnosis. Certainly atypical or parasitic infectious processes can present similarly, but given the findings detailed above, this is considered much less likely.


Instruction: Generate impression based on findings.

Input: 17-year-old female with hip pain for months. Evaluate for labral tear. ACETABULAR LABRUM: There is linear increased signal abnormality traversing the anterior superior acetabular labrum.ARTICULAR CARTILAGE AND BONE: No bone marrow signal abnormalities identified.SOFT TISSUES: No significant abnormality noted. ADDITIONAL

Output: Findings consistent with an anterior superior acetabular labral tear.


Instruction: Generate impression based on findings.

Input: 68-year-old female with history of medullary thyroid cancer with metastatic disease to the liver. Patient is on clinical trial. Follow-up examination to evaluate liver disease. ABDOMEN:LIVER, BILIARY TRACT: Again noted are multiple hepatic metastatic lesions. Reference measurements are as follows:Right posterior segment peripheral lesion measures 6 mm (series 5, image 12), previously measures 6 mm.Anterior segment lesion measures 9 mm (series 5, image 12), previously measuring 10 mm.More inferior posterior segment lesion measures 8 mm (series 5, image 17), previously remeasured at 8 mm.Inferior posterior segment peripheral lesion measures 12 mm (series 5, image 21), previously measuring 12 mm.No definite new lesions are identified.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Superior pole simple cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Enhancing L2 vertebral body osseous lesion is unchanged.OTHER: No significant abnormality noted.

Output: Stable metastatic disease to the liver and lumbar spine.


Instruction: Generate impression based on findings.

Input: Ms. Bergiel is a 34 year old female with known multifocal right breast cancer. She presents for MRI evaluation after neoadjuvant chemotherapy. There is heterogeneous amount of fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.Susceptibility artifact from the two posterior-most biopsy marker clips are identified. There is no abnormal enhancement seen around these clips or elsewhere in the right breast. Previously seen enhancing masses along with associated non-mass enhancement is no longer present on today's exam.There is no abnormal enhancement seen in the left breast. No abnormal lymph nodes are identified in either axillary or internal mammary region.

Output: (1) Complete imaging response of malignancy in the right breast. If breast conservation therapy is desired, a single wire can be placed targeting the anterior-most clip (rod shaped) and then extend the surgical specimen posteriorly to the pectoralis muscle. (2) No MRI evidence for malignancy in the left breast. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: 60-year-old man status post nephrectomy in 2014 for chromophobe RCC, now with right flank pain, left thigh numbness, and periportal lymphadenopathy. ABDOMEN:LIVER, BILIARY TRACT: There is mild fatty infiltration of the right lobe of the liver. The gallbladder appears normal. There is no intra or extra hepatic biliary duct dilatation. SPLEEN: The spleen appears normal.PANCREAS: The pancreas appears normal.ADRENAL GLANDS: The adrenal glands are normal.KIDNEYS, URETERS: The patient is status post right nephrectomy and there is no evidence of local recurrence or abnormal enhancing mass. The left kidney appears normal.RETROPERITONEUM, LYMPH NODES: Subcentimeter portacaval lymph nodes are noted. Subcentimeter retroperitoneal lymph nodes are also noted.BOWEL, MESENTERY: The partially visualized small bowel and colon appear normal.BONES, SOFT TISSUES: There is a small fat-containing umbilical hernia. There is an L3 Schmorl's node, please see concurrent MR L-spine report for complete description.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: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Status post right nephrectomy without local recurrence or lymphadenopathy.2.Please see concurrent MR L-spine report for additional findings.


Instruction: Generate impression based on findings.

Input: headache with papilledema, known AML patient on ATRA. No evidence of acute ischemic or hemorrhagic lesion.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear. Right maxillary sinus shows mucosal thickening.3D MRV brain pre and post-gadolinium with maximum intensity projections of the superficial/deep intracranial venous drainage demonstrate normal flow enhancement in the superior sagittal sinus, transverse sinuses, sigmoid sinuses, internal cerebral veins, vein of Galen and straight sinus.

Output: No evidence of acute ischemic or hemorrhagic lesion.Normal brain MRV.


Instruction: Generate impression based on findings.

Input: Female, 79 years old, with left hemiplegia from stroke, reported aneurysms of the left ICA and right MCA. A 4 x 2 mm aneurysm is evident projecting inferiorly from the supraclinoid left ICA. A 1 to 2 mm superiorly directed outpouching is present at the right MCA bifurcation. No additional aneurysm is identified. The right ICA is of smaller caliber than the left, as are the right MCA branches which demonstrate discontiguous flow related signal compatible with prior ischemia in this distribution. No additional high-grade vascular compromise is suspected.Since the prior MRI, ex vacuo dilatation of the right lateral ventricle has developed. A presumed cavernous malformation is redemonstrated in the midbrain.

Output: 1.A 4 x 2 mm aneurysm is present along the left supraclinoid ICA.2.A 1 to 2 mm aneurysm is evident at the right MCA bifurcation.3.Vascular compromise is redemonstrated involving the right ICA and MCA branches compatible with known prior ischemia in this distribution.


Instruction: Generate impression based on findings.

Input: History of primary sclerosing cholangitis status post liver transplant 2013 evaluate for worsening strictures and hepatic vasculature. ABDOMEN:LIVER, BILIARY TRACT: Postsurgical changes from liver transplant and hepaticojejunostomy. Minimal irregular dilatation of the left intrahepatic biliary tree is not significantly changed from the prior study. The right intrahepatic and the extrahepatic biliary tree appear unremarkable. No new dominant stricture or focal lesion. The hepatic vasculature appears patent.SPLEEN: Mild splenomegaly measuring 13.3 cm in length, decreased from prior. Splenic collateral vessels. Probable old splenic infarct from interval embolization of previously seen splenic artery aneurysms.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right renal cysts are unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted. Esophageal varices.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Very mild dilatation and irregularity of the left intrahepatic biliary tree is unchanged without a new dominant stricture or focal mass.2.Postoperative changes related to orthotopic liver transplant and hepaticojejunostomy.3.Interval splenic artery aneurysm embolization with chronic splenic infarct.


Instruction: Generate impression based on findings.

Input: Clinical question: 73-year-old male with bilateral arm pain and numbness, evaluate for cord compression. Signs and symptoms: Burning pain in both arms, syncope. Nonenhanced total spine MRI:Examination is performed utilizing cord compression protocol which does not include axial images.Examination demonstrates diffuse patchy foci of marrow signal replacement consistent with extensive osseous metastatic lesions throughout the cervical, thoracic and lumbosacral spine.Metastatic lesions at C6 and to a lesser degree C5 levels demonstrate extraosseous spread of tumor into the epidural space and resultant mass effect on the cord however without central spinal stenosis and no convincing evidence of cord edema.Mild extraosseous cyst. Of tumor from T8 vertebral body into the spinal canal is also noted without mass effect on the cord or central spinal stenosis. Minimal ventral epidural spread of tumor at T12 is also noted without spinal stenosis or mass effect on the cord.There is no evidence of fracture or malalignment. There is no detectable cord signal abnormality.The findings on this exam can be further and more accurately assessed if clinically deemed pertinent with pre and post enhanced dedicated spine MRI study.

Output: 1.Extensive osseous metastatic lesions throughout the spine as detailed.2.Small regions of epidural spread of tumor into the spinal canal more noticeably at C6 however without resultant central spinal stenosis or detectable cord signal abnormality as detailed.3.Normal signal intensity and caliber of the cord and cauda equina.


Instruction: Generate impression based on findings.

Input: History of Chiari malformation, acute trauma 2 days prior, altered mental status, unclear cause. Evaluate for swelling, etc. Examination is motion degraded on multiple sequences. The brain parenchyma appears within normal limits. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. Mild tonsillar ectopia is again seen without significant crowding at the foramen magnum. There is a partially empty sella as seen on the prior MRI. There is no abnormal intracranial enhancement. There is a mildly calcified ovoid lesion in the left parietal scalp with low T1 and T2 signal which may represent a benign scalp lesion such as a sebaceous cyst and can be correlated with clinical findings.

Output: 1. Mild cerebellar tonsillar ectopia is again seen without significant crowding at the foramen magnum. Brain parenchyma appears otherwise within normal limits. Specifically, no evidence of traumatic injury.2. Left parietal scalp lesion which may represent a benign scalp lesion such as a sebaceous cyst and can be correlated with examination.


Instruction: Generate impression based on findings.

Input: 79-year-old female with pain and swelling. Evaluate for osteomyelitis. Severe osteoarthritis affects the first MTP joint and mild osteoarthritis affects the interphalangeal joints.There is edema type signal seen within the middle phalanx of the third toe on T2 fat suppressed images, although the marrow maintains a normal fatty signal on T1 weighted images. The constellation of findings suggests reactive osteitis, with acute osteomyelitis considered less likely. There is mild edema along the dorsum of the foot as well as atrophy of the foot musculature. We see no discrete fluid collections.

Output: 1.Edema-type signal within the middle phalanx of the third toe is thought to represent reactive osteitis as opposed to osteomyelitis. This can be followed with dedicated toe radiographs if clinically warranted.2.Osteoarthritis and other findings as above.


Instruction: Generate impression based on findings.

Input: Female, 65 years old, history of small cell lung cancer with brain metastases status post radiation treatment. Most of the innumerable large enhancing lesions seen on the pretreatment examination remain significantly reduced in size or even undetectable with minimal if any enhancement above and beyond intrinsic T1 hyperintensity. Most of these prior lesions are hemosiderin stained. A formerly large extra-axial lesion along the right frontal lobe with a hemorrhagic component has been reduced to a small hemosiderin stained cystic space which has further decreased in size since the prior examination.However, a few enhancing lesions are now evident which were not seen on the prior examination or on the pretreatment exam. For example, there is a 4 mm lesion along the right superior frontal gyrus, a 6 mm lesion along the orbital gyrus of the right inferior frontal lobe, a 4 mm lesion within the left frontal operculum and a 5 mm lesion along the left precuneus. None of these lesions is associated with significant parenchymal edema or mass effect.Further interval progression of periventricular T2 hyperintensity is seen, particularly adjacent to the right frontal horn. The ventricles are stable in size relative to the prior examination but remain slightly larger than that seen on the pretreatment exam.

Output: 1.Numerous formerly large enhancing lesions seen on the pretreatment examination remain under excellent control showing stable or reduced size and minimal if any enhancement, mass effect and edema.2.Since the prior examination, however, at least 4 subcentimeter enhancing lesions have developed which were not evident on the immediate prior or on the pretreatment examinations. These are concerning for progressive metastatic disease.


Instruction: Generate impression based on findings.

Input: Reason: pt with newly diagnosed endometrial cancer, endocervical mass noted History: vaginal discharge PELVIS:UTERUS, ADNEXA: There is a T2 intermediate signal lesion distending the endometrial cavity, the proximal to the internal os measuring 1.6 x 1.5 cm in transverse dimension (901/21) and 2.5 cm in longitudinal dimension (701/21). There is 6 mm myometrial invasion into the posterior uterine musculature (less than 50%) as well as minimal anterior invasion (701/22). The lesion abuts the internal os, with a small amount extending into a region of extensive nabothian cysts.Multiple peripheral follicles bilaterally.BLADDER: No significant abnormality noted.LYMPH NODES: Small bilateral subcentimeter external iliac nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Lesion within the endometrial cavity with myometrial invasion (less than 50%) likely corresponds to patient's known endometrial cancer. The lesion abuts the internal os with a small amount extending into a region of extensive nabothian cysts, likely representing cervical invasion.2.Small subcentimeter pelvic lymph nodes are nonspecific.3.Multiple bilateral peripheral follicles are suggestive of polycystic ovaries. Correlate for history of polycystic ovarian syndrome.


Instruction: Generate impression based on findings.

Input: Clinical question: 51-year-old male with AML, Ommaya reservoir, history of peri ommaya hemorrhage. Now here with altered mental status. Please evaluate for intracranial hemorrhage or other intracranial process. Signs and symptoms: Altered mental status Right-sided ventricular catheter enters from high convexity right frontal bone and through the right frontal lobe with the tip at the right foramina of Monro. Slight prominence of the supratentorial ventricular system. Generalized uniform lower than normal density of white matter is noted. Please correlate with history. There are no old films available for comparison. This finding may be technique related. If clinical symptoms persist an MRI is recommended. Cortical sulci are within normal range for patient's stated age.No evidence of hemorrhage, mass-effect or midline shift. Calvarium, paranasal sinuses and mastoid air cells are unremarkable. A punctate air density within the temporal horn on the right.

Output: No evidence of hemorrhage. Three see above comments.


Instruction: Generate impression based on findings.

Input: Alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign. The cervical and upper thoracic cord are normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.C2/3: UnremarkableC3/4: UnremarkableC4/5: UnremarkableC5/6: Mild disc bulge without cord abutment or resulting stenosis.C6/7: Mild disc bulge without cord abutment or resulting stenosis.C7/T1: UnremarkableT1/2: Tiny left paramedian disc protrusion without significant resulting mass effect or stenosis.

Output: 1.C5/6: Mild disc bulge without cord abutment or resulting stenosis.2.C6/7: Mild disc bulge without cord abutment or resulting stenosis.3.T1/2: Tiny left paramedian disc protrusion without significant resulting mass effect or stenosis.


Instruction: Generate impression based on findings.

Input: 78-year-old man with history of HCC status post Y90 radio embolization 9/6/2016. ABDOMEN:LIVER, BILIARY TRACT: The liver parenchyma demonstrates diffusely decreased T2 signal with reticular increased T2 signal.Multiple areas of T1 hypointensity and mild T2 hyperintensity are seen throughout the right lobe of the liver. A small focus of T1 hyperintensity along segment 5 (5/85) is favored to represent small amount of hemorrhage. There are no remaining hyperenhancing foci seen within the liver.The portal vein is patent.SPLEEN: No significant abnormality noted.PANCREAS: No pancreatic ductal dilatation. No focal parenchymal lesion.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Simple renal cysts are 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: Post treatment effects in the liver without evidence of hyperenhancing tumor.


Instruction: Generate impression based on findings.

Input: Female, 38 years old, with headache, status post Chiari decompression, six-week follow-up exam with CSF study. Postoperative findings are seen compatible with interval Chiari decompression including suboccipital craniectomy and resection of the posterior arch of C1. Edema and a small amount of fluid in the suboccipital extracranial soft tissues are within acceptable limits.With the postoperative changes, the caliber of the CSF space at the level of the posterior foramen magnum has been expanded. The cerebellar tonsils demonstrate a relatively round morphology. CSF flow imaging shows little if any biphasic biphasic signal alteration which may be technical in nature.Spinal alignment is anatomic. Vertebral body morphology and signal characteristics are within normal limits. The visualized spinal cord demonstrates normal signal intensity and morphology. No significant degenerative disc disease is seen. No spinal canal or neuroforaminal stenosis is detected.Incidental note is made of a partially cystic pineal gland which is, however, under 1 cm in diameter.

Output: Expected findings status post Chiari decompressive surgery. The caliber of the CSF space along the posterior foramen magnum is expanded relative to the preoperative study. CSF flow imaging is felt to be technically unreliable.


Instruction: Generate impression based on findings.

Input: C-Spine MRI:The cervical spine is in normal alignment, with a normal cervical lordosis. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal. There is no pathological enhancement. There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the cervical spine. T-Spine MRI: The thoracic spine is in normal alignment, with a normal thoracic kyphosis. The vertebral body and disk heights are well maintained. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber. There is trace prominence of the central canal, which is of doubtful clinical significance, and without evidence of a discrete syrinx. There is no pathological enhancement. There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the thoracic spine.L-Spine MRI: The lumbar spine is in normal alignment, with a normal lumbar lordosis. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. There is no pathological enhancement. The distal spinal cord and conus are within normal limits with the conus terminating at the L1 level. There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the lumbar spine.

Output: MRI of the complete spine appears within normal limits.


Instruction: Generate impression based on findings.

Input: History of prostate cancer. Status post brachytherapy, complicated by prostatitis. Pelvic/penile/rectal pain and spasms. Assess for sacral or pudendal nerve damage. LUMBAR SPINE: The examination is mildly limited by patient motion. There are 5 lumbar-type vertebrae. There is a broad-based levoconvex curvature, apex at L3. There is minimal anterior subluxation of L3 relative to L4 and L4 relative to L5. Sagittal alignment otherwise is notable for straightening which may reflect patient position. Left L5 spondylolysis is better appreciated on CT.There is multilevel degenerative disc disease manifested by desiccation and height loss, more pronounced at the lower 3 levels where it is severe and associated with endplate irregularity and osteophytes as well as facet arthropathy. In addition, there is subjacent marrow edema (degenerative change type I), most pronounced at L5-S1. The marrow is otherwise heterogeneous but there is no suspicious focal marrow lesion in the lumbar spine. The below described multilevel focal degenerative stenosis of the spinal canal is superimposed on mild congenital/developmental narrowing. The the conus medullaris is at the lower L1 level. The conus medullaris has normal shape and signal.T10-T11 (only on sagittal imaging): There is a disc indenting the ventral aspect of thecal sac causing mild canal narrowing. There is incompletely imaged biforaminal stenoses.T11-T12 (only incidental imaging): There is no spinal canal or neural foraminal stenosis.T12-L1: Minimal disc bulge, moderate ligamenta flava thickening and mild facet arthropathy result in minimal, if any, spinal canal stenosis and mild biforaminal stenoses.L1-L2: Moderate, eccentric to the left disc bulge associated with moderate-to-severe ligamenta flava thickening and mild-to-moderate facet arthropathy result in mild-to-moderate spinal canal stenosis and mild-to-moderate right and mild left neural foraminal stenoses. L2-L3: Moderate, eccentric to the right disc bulge associated with mild-to-moderate ligamenta flava thickening and facet arthropathy results in mild central spinal canal stenosis, right subarticular recess stenosis and moderate right and mild left neural foraminal stenosis.L3-L4: The disc uncovering/bulge, subluxation, moderate facet arthropathy and ligamenta flava thickening result in mild-to-moderate central spinal canal stenosis as well as obliteration of the subarticular recesses as well as moderate right and mild-to-moderate left neural foraminal stenoses.L4-L5: The disc and covering/bulge, subluxation and moderate ligamenta flava thickening and facet arthropathy result in mild central spinal canal stenosis right more than left subarticular recess stenosis. There is also moderate-to-severe right and moderate left neural foraminal stenosis.L5-S1: The disc bulge and the associated osteophytes as well as ligamenta flava thickening and facet arthropathy result in mild central spinal canal stenosis, left subarticular recess stenosis as well as moderate-to-severe left and mild right neural foraminal stenoses.There is right hydronephrosis and hydroureter.PELVIS:The examination is markedly limited by patient motion and inadequate coverage of the lumbosacral plexus. The sacroiliac joints are notable for subchondral hypointense signal, probably reflecting degenerative sclerosis. On the left, along the inferior aspect of the iliac side of the joint, there is a T1-hypointense lesion that measures up to 13 mm and shows contrast enhancement. This was present on the prior examination from February 29, 2016. Otherwise, there is no marrow replacing/destructive lesion in the sacrum or included parts of the iliac bones. There is no epidural tumor.There is no presacral soft tissue mass. The ventral sacral foramina are unremarkable. Increased STIR and contrast enhancement in the dependent dorsal soft tissues, which may reflect congestive process. There is no abnormal contrast enhancement in this soft tissues otherwise. The proximal lumbosacral roots are grossly symmetric and show no focal lesion or abnormal signal. However, the more distal parts of the lumbosacral plexus, including the pudendal nerve, are not adequately covered.

Output: 1.Multilevel degenerative lumbar spondylosis is most pronounced in the lower 3 levels. Though central spinal canal stenosis is mild, there is multilevel subarticular recess and neural foraminal stenoses as described above. Foraminal stenosis is moderate on the right at L1-L2, L2-L3, L3-L4, and L4-L5 and on the left at L4-L5 and L5-S1. The subarticular stenoses are present on the right at L2-L3, bilaterally at L3-L4, right more than left at L4-L5 and on the left at L5-S1.2.While there is no spinal osseous metastasis and no lumbosacral epidural tumor, the contrast-enhancing left iliac lesion adjacent to the sacroiliac joint corresponds to sclerosis on the previous CT and is nonspecific, with osseous metastasis not excluded. 3.Due to motion degradation and thick slices, the pudendal nerve is not well assessed. No obvious mass or signal abnormality involving the proximal lumbosacral plexus is evident.4.Right hydronephrosis and hydroureter were present on a previous CT scan from May 27, 2016.


Instruction: Generate impression based on findings.

Input: Reason: Eval bony changes. History: MRI and CT. Would like to see bone on XR. The patient has undergone disarticulation of the right hip. There is gas density adjacent to the remaining proximal femur reflecting extension of underlying ulceration as seen on the prior MRI examination with periosteal reaction along the proximal femur likely representing a combination of acute and chronic osteomyelitis. There is also chronic deformity of the right iliac wing. A segment of the ischium is not visualized perhaps due to prior surgery or long-standing osteomyelitis. There is also deformity of the left ischium that appears chronic on this radiograph. Please note that the left greater tuberosity is not included in the field of view of this study. There are posterior stabilization rods affixing the lumbosacral spine which are incompletely imaged on this examination. Note is made of a left lower quadrant colostomy. There are surgical clips projecting over the right hemipelvis.

Output: Disarticulation of the right hip with gas density adjacent to the right femur and findings suggestive of osteomyelitis as well as other findings as described above.


Instruction: Generate impression based on findings.

Input: 64-year-old male with cachexia and bright red blood per rectum. Evaluate for malignancy and also for pancreatic pseudocyst; patient has experienced weight loss. ABDOMEN: LUNG BASES: New small bilateral pleural effusions with associated lower lobe volume loss bilaterally. Cachexia.LIVER, BILIARY TRACT: Hepatomegaly, the liver measures more than 20 cm craniocaudally. Diffuse fatty infiltration throughout the liver. The presence of fat limits the ability to see liver masses. If liver masses are of concern, MRI examination would be recommended. Heterogeneous soft tissue density is seen in the lateral segment of left lobe and in the right lobe described on the previous examination are most likely due to focal sparing from fat deposition due to lack of displacement of vessels.Gallstones and biliary sludge are present. No gallbladder wall thickening. No intrahepatic or extrahepatic biliary duct dilatation. Multiple subcentimeter hepatic hypodensities are too small to characterize.SPLEEN: No significant abnormality notedPANCREAS: Punctate focal calcification in the head of the pancreas. These were not present on 2008 examination and may be the sequela of pancreatitis. Pancreatic parenchyma otherwise appears normal with no mass is identified. No pancreatic ductal dilatation is seen.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No hydronephrosis. Subcentimeter left lower pole renal cortical hypodensity is most likely due to a simple cyst..RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Diffuse osteopenia without focal mass. Degenerative changes throughout the lumbar spine.OTHER: Small amount of ascites is new.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: A large soft tissue mass protrudes from the anus measuring 3 cm in diameter at coronal image 16/74. This may be due to rectal prolapse or prominent external hemorrhoids or both. The marked contrast enhancement most likely represents inflammatory change and possible bleeding focus in this mass.BONES, SOFT TISSUES: Bony ankylosis of the sacroiliac joints. Degenerative changes in the lumbosacral spine and pelvis.OTHER: Small amount of ascites is present.

Output: 1. Hepatomegaly. Diffuse fatty infiltration of the liver. 2. Gallstones and biliary sludge without acute cholecystitis. 3. New bilateral pleural effusions and small amount of ascites have developed since the prior exam. 4. Rectal prolapse and/or external hemorrhoids are probable source of melena. See above.


Instruction: Generate impression based on findings.

Input: Followup of CNS toxoplasmosis: fever/weight loss. PER EPIC: "ESRD 2/2 HTN now s/p kidney transplant in 2009,on immunosuppressive therapy, CKD, HTN, PUD, mild LV diastolic dysfunction and myopic degeneration." There is slight interval decrease in size of ovoid lesions with restricted diffusion in the right occipital lobe and associated vasogenic edema. There is also substantial decrease in size of lesions with surrounding vasogenic edema in the right frontal corona radiata, left periatrial white matter, and left superior frontal gyrus and paracentral lobule. There is increased susceptibility effect associated with the right corona radiata and posterior right occipital lobe lesions. There is otherwise an unchanged background of nonspecific punctate foci of cerebral white matter T2 hyperintensity. The ventricles are unchanged in size. There is no midline shift or herniation. The major cerebral flow voids are intact. There is staphylomatous deformity of the bilateral globes and a left orbital implant. The mastoid air cells, skull, and scalp soft tissues are grossly unremarkable. There is a lobulated lesion in the left nasal cavity and ethmoid sinuses with low T1 and T2 signal. There is otherwise scattered mild paranasal sinus mucosal thickening.

Output: 1. Overall interval decrease in size of the multifocal brain lesions with associated vasogenic edema likely related to an infectious process, in which some have decreased more dramatically than others. However, increased susceptibility effect associated with the right corona radiata and posterior right occipital lobe lesions may represent hemorrhage. Assessment is otherwise limited due to the lack of intravenous contrast, acknowledging the ESRD contraindication.2. Material within the left nasal cavity and ethmoid sinuses may represent chronic secretions or perhaps a neoplasm. Endoscopy may be useful for further evaluation.3. Bilateral elongation of the globes related to myopia.


Instruction: Generate impression based on findings.

Input: 35 year old female with 2 left breast carcinomas undergoing chemotherapy. There is extreme amount of fibroglandular tissue in both breasts.Minimal parenchymal enhancement is noted bilaterally.RIGHT BREAST: Interval decrease in degree of enhancement and slight decrease in extent of enhancement of the clumped segmental nonmass enhancement in the central lateral right breast. On the current exam, non-mass enhancement extends 6.9 x 3.3 x 5.3 cm (AP x ML x CC), previously 9.3 x 6.6 x 5.3 cm. No new areas of abnormal enhancement. A few medial foci of enhancement are again seen.In the right axilla, there is a lymph node with normal morphology. No abnormal lymph nodes.LEFT BREAST: Diffuse cutaneous thickening has decreased compared to prior. Significant interval decrease in size and enhancement of retroareolar lobulated rim enhancing mass with nipple involvement, currently measuring 1.1 x 1.2 x 1.2 cm (AP x ML x CC), previously 2.9 x 2.0 x 2.8 cm. Interval decrease in size and degree of enhancement of 6 o'clock position far posterior depth spiculated heterogeneously enhancing mass which extends to although separate from the fascia overlying the pectoralis muscle. This mass measures 3.2 x 2.8 x 1.7 cm (AP x ML x CC), previously 5.6 x 3.7 x 2.7 cm.Nonenhancing biopsy proven 1.3 cm fibroadenoma in 1:30 position, mid depth is unchanged. Previously seen enhancing 1.2 cm rounded mass in the 2 o'clock position, posterior depth does not demonstrate enhancement on the current examination, although remains visualized on T2 sequence. No lymph nodes, abnormal or otherwise are seen in the left axilla.

Output: 1.Significant interval decrease in size and degree of enhancement of two (retroareolar and 6 o'clock posterior depth) left breast masses. 2.Previously seen enhancing 2 o'clock left breast mass does not demonstrate enhancement of the current exam.3.Stable biopsy proven 1:30 left breast fibroadenoma. 4.Interval decrease in size and degree of enhancement of non-mass enhancement in the right breast. 5.No abnormal lymph nodes in either axillae.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: 59-year-old male with newly diagnosed oral cancer, evaluate for lung metastases LUNGS AND PLEURA: Mild right basilar pleural parenchymal scarring is redemonstrated without interval change. No new pulmonary, pleural nodules or masses. No pleural effusion identified.MEDIASTINUM AND HILA: No hilar or mediastinal lymphadenopathy is identified. Cardiac size is normal. Small pericardial effusion is stable however, is new from the exam dated 6/17/10.Central venous catheter with its tip in the RA.CHEST WALL: Extensive postsurgical changes in the thoracic spine. See recent MRI of the thoracic spine.UPPER ABDOMEN: Status post cholecystectomy.

Output: No evidence of metastatic disease.


Instruction: Generate impression based on findings.

Input: There is a redemonstration of mildly expansile and infiltrative T1 hypointense and T2 hyperintense lesion within the left pons, midbrain, extending to the left thalamus, with no evidence of enhancement or diffusion restriction, which is unchanged. There is subtle mild extension into the left medial temporal lobe with mild mass effect into the left hippocampus similar to prior. There is minimal questionable FLAIR hyperintensity in the right ventral pons and some expansile convexity which may reflect subtle tumor infiltration. Abnormal T2 signal of the left lateral cerebellar hemisphere is also unchanged. There is postoperative findings within the right cerebellum with focal tissue loss, but no discernible mass lesions. There are several nonspecific punctate foci of susceptibility scattered throughout the brain parenchyma, which are unchanged. There is no evidence of acute ischemia. The ventricles are within normal limits in size and configuration. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are grossly unchanged.

Output: 1. Compared to 7/16/2015 and 4/17/2015, there is unchanged appearance of the dominant infiltrating mass involving the left pons, midbrain and left thalamus. Additional subtle foci of suspected glial neoplasm including the left lateral cerebellum and right pons are also unchanged.2. Postoperative findings within the right cerebellum. No evidence of tumor progression.


Instruction: Generate impression based on findings.

Input: Disorder of brain, unspecified [G93.9], Reason for Study: ^Reason: hx brain lesion. Eval for change History: none- surveillance There is no evidence of acute ischemic lesion.There are multifocal various sized bihemispheric susceptibility lesions including prominent left posterior temporal-parietal, left frontal and right frontal lobe lesions, unchanged since prior scan.Today's scan shows minimal peripheral enhancement of the left posterior temporo-parietal lesion which showed relatively intense enhancement.Therefore, the diagnostic possibility of the lesion goes toward a cavernous malformation than metastatic lesion. The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Interval decrease of enhancement of the left posterior temporo-parietal lobe lesion with remained susceptibility artifacts indicate possible diagnosis cavernous malformation. Follow up imaging is recommended.2. Multifocal various sized non enhancing susceptibility lesions within bihemispheric distribution suggest the diagnosis of multiple cavernous malformation.


Instruction: Generate impression based on findings.

Input: Reason: patient with TS, assess for new findings History: increased seizure activity Multiple cortically based T2 and FLAIR hyperintense lesions are scattered in both hemispheres of the supratentorial brain. These are not as readily visible on the prior exam from 2013 and appear larger on the current exam. There is redemonstration of multiple subependymal nodules which were also present on the prior exam and are unchanged.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mucosal thickening. The visualized portions of the mastoid air cells are partially opacified. The visualized portions of the orbits are intact.

Output: 1.Since the previous exam cortical tubers are more conspicuous and larger than on the prior exam. In part this increase in conspicuity may be related to brain development in the interim.2.There is redemonstration of stigmata of a tubular sclerosis.


Instruction: Generate impression based on findings.

Input: Bilateral muscle weakness Left: There is mild diffuse edema of the thigh musculature, particularly affecting the anterior and lateral compartments. Following contrast administration, there is enhancement of the muscles of the thigh most notably the rectus femoris and vastus lateralis. There is mild diffuse subcutaneous edema evident as well. The muscle caliber is consistent with the patient's age. The bone marrow signal of the femur is normal and there is no focal fluid collection.Right: There is mild diffuse edema of the thigh musculature, particularly affecting the anterior and lateral compartments. Following contrast administration, there is enhancement of the muscles of the thigh most notably the rectus femoris and vastus lateralis. There is mild diffuse subcutaneous edema evident as well. The muscle caliber is consistent with the patient's age. The bone marrow signal of the femur is normal and there is no focal fluid collection.

Output: Symmetric edema and enhancement of the thigh musculature consistent with active myositis.


Instruction: Generate impression based on findings.

Input: Pituitary macroadenoma: recent transsphenoidal hypophysectomy and left endoscopic anterior ethmoidectomy and maxillary antrostomy. Pituitary: There are recent postoperative findings related to transsphenoidal hypophysectomy and left endoscopic anterior ethmoidectomy and maxillary antrostomy. There is a 10 mm diameter cavity with presumed hemostatic material containing blood products within the residual pituitary tumor, which otherwise measures approximately 22 mm in craniocaudal dimension with persistent mass effect upon the optic apparatus and extension into the bilateral cavernous sinuses. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There is fluid and mild mucosal thickening in the left maxillary sinus, as well as partial opacification of the ethmoid air cells. Otherwise, there appears to be packing material in the posterior nasal cavity and sphenoid sinuses. The orbits are grossly unremarkable.Brain: There is no evidence of acute infarct. The brain parenchyma appears unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation.

Output: 1. Recent postoperative findings related to transsphenoidal hypophysectomy and left endoscopic anterior ethmoidectomy and maxillary antrostomy. There is a small cavity with presumed hemostatic material containing blood products within the residual pituitary tumor, which measures approximately 22 mm in craniocaudal dimension with persistent mass effect upon the optic apparatus. 2. No evidence of acute infarct.


Instruction: Generate impression based on findings.

Input: Reason: history of craniosynostosis, Chiari found on CT , evaluate for changes , yearly follow up History: yearly follow up MRI brain:Postoperative changes from prior cranioplasty in the mid to posterior calvarium with distraction osteotomy. Metal artifact obscures evaluation of the posterior fossa. Calvarium is a similar appearance to the prior exam with mild brachycephaly. There is platybasia with mild scalloping of the clivus, similar to the prior exam. No abnormal signal within the brain parenchyma. Ventricles are unchanged in size and configuration. Flow voids are intact. Again seen are findings of Chiari 1 malformation with descent of the cerebellar tonsils to the C2-C3 level measuring similar at 2.9 cm, previously 2.7 cm. Crowding of the posterior fossa at the level of the foramen magnum is unchanged. CSF flow study demonstrates diminished flow along the anterior foramen magnum with completely attenuated flow posteriorly, similar to the prior exam.MRI cervical spine:Findings of Chiari malformation as above. Alignment is anatomic. No abnormal signal within the cord. Specifically, no syrinx. No abnormal marrow signal. There is crowding at the craniocervical junction as mentioned above, without significant cervical spinal canal or foraminal stenosis inferiorly.

Output: 1.Stable findings of Chiari I malformation with cerebellar tonsils extending to the C2-C3 level with severe crowding at the foramen magnum. 2.No evidence of syrinx in the cervical spine.


Instruction: Generate impression based on findings.

Input: Male 34 years old Reason: evaluate for enterocutaneous fistula History: recurrent perianal abscess 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: There is a small fluid filled tract extending from the right gluteal cleft to the 10 o clock position of the anus consistent with an intrasphincteric fistula. Hypoenhancing granulation tissue surrounds the tract and there is associated mild thickening and induration of the right gluteal cleft. There is no intrapelvic abscess.OTHER: No significant abnormality noted.

Output: 1.Intrasphincteric fistula extending from the right gluteal cleft to the 10 o' clock position of the anus.2.No intrapelvic abscess.


Instruction: Generate impression based on findings.

Input: 72 years Female (DOB:7/21/1944)Reason: evaluate for focal ischemic deficits History: L facial droop (transient), c/f TIAPROVIDER/ATTENDING NAME: JAFAR AL-SADIR JAFAR AL-SADIR MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild to moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.On susceptibility imaging there are dictated foci of signal loss in the left cerebellar hemisphere as well as the right cerebellar hemisphere.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. Signal asymmetry from the patient size is suspected to be related to artifactMRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries. Some mild apparent narrowing at the right carotid siphon is suspected to be related to susceptibility effect from the adjacent clinoid processThere is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is small. The posterior communicating arteries are very small. There is extracranial origin of the left posterior inferior cerebellar artery. The right vertebral artery slightly larger than the left vertebral artery

Output: 1.No evidence for cerebrovascular occlusive disease.2.No evidence for intracranial aneurysm. 3.Periventricular and subcortical white matter lesions of a mild to moderate degree are nonspecific. At this age they are most likely vascular related. 4.There are several microhemorrhages present within the cerebellum which are nonspecific.


Instruction: Generate impression based on findings.

Input: Male 45 years old with medial knee pain, rule out meniscal or chondral pathology. MENISCI: The menisci are intact.ARTICULAR CARTILAGE AND BONE: There is irregularity and thinning of the articular cartilage over the patellar eminence and irregularity and near full-thickness cartilage loss over the medial patellar facet. There is full-thickness fissuring in the trochlear groove and along the medial trochlear facet. In the medial compartment there is near full-thickness cartilage loss over the weightbearing surface of the femoral condyle and tibial plateau with underlying marrow edema. In addition, there is a 7 mm full-thickness cartilage defect along the posterior medial femoral condyle. The articular cartilage of the weightbearing surfaces of the lateral compartment is intact however there is an approximately 1.2 cm full-thickness cartilage defect along the posterior lateral femoral condyle.A subchondral cyst in the anterior mid tibial plateau is also likely degenerative. There are tricompartmental osteophytes.LIGAMENTS: The cruciate and collateral ligaments are intact EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1.The menisci are intact.2.Tricompartmental osteoarthritis and full thickness cartilage loss as described above.3.Moderate effusion and Baker's cyst.


Instruction: Generate impression based on findings.

Input: 32-year-old male with history of knee pain. The right knee appears normal with no specific radiographic findings to account for the patient's pain. The left knee likewise appears normal on the frontal views.

Output: Normal exam with no radiographic findings to account for the patient's pain.


Instruction: Generate impression based on findings.

Input: Clinical question: Rule out radiculopathy. Signs and symptoms: Weakness, back pain. Nonenhanced lumbar MRI:T11-T12 is unremarkable.T12-L1 is unremarkable other than mild degenerative changes.T2-T3 demonstrate mild degenerative changes and unremarkable otherwise.T3-T4 demonstrate mild degenerative disc disease and mild bilateral facet and ligamentum flavum hypertrophy. There is no central spinal stenosis or neural foraminal compromise.L4-L5 demonstrate mild disc disease and loss of disc height, mild bilateral facet and ligamentum flavum hypertrophy and including mild right facet effusion. No central spinal stenosis or neural foraminal compromise.L5-S1 demonstrate moderate disc disease and loss of disc height, grade 1 anterolisthesis, mild bilateral facet and ligamentum flavum hypertrophy and including mild left facet effusion. No central spinal stenosis however severe left and moderate to severe right neural foraminal compromise is detected.There is normal signal intensity and caliber of the lower most visualized thoracic cord. There is normal signal intensity of the cauda equina.Unremarkable paraspinal soft tissues.

Output: 1.Degenerative changes at L5-S1 with resultant grade 1 anterolisthesis, significant bilateral neural foraminal compromise ( L>R ) and without central spinal stenosis.2.Mild degenerative changes at other levels however without spinal stenosis or neural foraminal


Instruction: Generate impression based on findings.

Input: 56-year-old male with metastatic small cell lung carcinoma status post radiation therapy. Neck mass. Headache. There is a 1.7 x 1.5 cm ring enhancing mass within the right high parietal convexity, with surrounding hypodensity consistent with a metastatic lesion with surrounding vasogenic edema. There are also questionable punctate enhancing lesions within the left frontal lobe and the left high parietal convexity. Brain MRI with contrast is recommended for more sensitive evaluation of these lesions. No midline shift or intra-cranial hemorrhage is seen. 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.The neck demonstrates a 2.8 x 2.7 x 3.1 cm enhancing mass within the right neck, with mass effect and compression of the right internal jugular vein. This likely represents a deep cervical nodal metastasis. In addition, there are multiple sclerotic lesions within the C3, T1, T3, T5, and T6 vertebral bodies, as well as the right posterior elements of C5. Within the visualized lung, there is bilateral pleural thickening and left-sided fibrosis and focal calcification. Please refer to dedicated chest CT for further discussion.

Output: Multiple intracranial, osseous, and deep cervical metastatic lesions as described above. Brain MRI with contrast is recommended for more sensitive characterization of intracranial lesions.


Instruction: Generate impression based on findings.

Input: 84-year-old female who was noted to have soft tissue posterior to the bladder with focus of air in the pelvis on CTE. Evaluate for possible colovesicular fistula or vesicovaginal fistula. PELVIS:UTERUS, ADNEXA: Status post hysterectomy.BLADDER: There is no evidence of colovesicular fistula or vesicovaginal fistula. Partially visualized moderate hydroureter bilaterally. Previously noted air posterior to the bladder is likely the vaginal cavity.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Nonspecific few T1 hyperintense and T2 hypointense foci in the cul-de-sac without evidence of enhancement (series 5, image 20; series 6, image 20; series 10, image 69).BONES, SOFT TISSUES: Small amount of free fluid is noted in the pelvis. There is mild to moderate soft tissue edema, right greater than left anteriorly. Additionally, there is fluid tracking in the pubic symphysis and extending into the anterior soft tissues. Small fat-containing ventral hernia is present.OTHER: No significant abnormality noted.

Output: 1.No evidence of colovesicular fistula or vesicovaginal fistula. Previously noted air posterior to the bladder is most likely within the vaginal canal.2.Bilateral partially visualized moderate hydroureter.


Instruction: Generate impression based on findings.

Input: Female 13 years old with a history of congenital hypothyroidism with gland. Please assess for size of gland and location.EXAMINATION: Sonogram thyroid 4/6/2016 RIGHT LOBE MEASUREMENTS: 1.3 x 1.2 x 3.0 cmLEFT LOBE MEASUREMENTS: 1.3 x 0.9 x 2.4 cmISTHMUS MEASUREMENTS: 2 mmRIGHT LOBE: Diffusely heterogeneous without discrete nodule.LEFT LOBE: Diffusely heterogeneous without discrete nodule.ISTHMUS: Diffusely heterogeneous without discrete nodule.PARATHYROID GLANDS: Not identified.LYMPH NODES: There are a few prominent bilateral cervical lymph nodes with normal morphology.OTHER: The thyroid gland is in the expected anatomic location.

Output: Small, heterogeneous thyroid gland without discrete nodule.


Instruction: Generate impression based on findings.

Input: Male, 77 years old, history of forehead squamous cell carcinoma status post CRT. Postoperative findings are again seen compatible with left orbital exenteration with soft tissue flap repair, left frontal craniectomy with cranioplasty, left uncinectomy and ethmoidectomy, and resection of the left nasal turbinates.These postoperative alterations show no significant interval change. A layer of debris is evident within the left maxillary sinus which was not present previously. The left maxillary sinus demonstrates thin peripheral mucosal thickening which is similar to prior.Dural thickening subjacent to the cranioplasty is stable and within expected postoperative limits. More inferiorly, thickened enhancing tissue within the orbital exenteration bed, which wraps along the undersurface of the soft tissue flap as well as around and back along the posterior exenteration cavity, shows no significant interval change favoring this to be a postoperative phenomenon.Patchy ill-defined enhancement seen on the prior examination within the left frontal lobe, immediately subjacent to the craniectomy bed, has decreased in conspicuity.Also noted is a generalized decrease in left frontal lobe edema. There remains diffuse ill-defined T2 hyperintensity within the left frontal parenchyma, but the frontal horn of the left lateral ventricle has reexpanded.Some generalized progression of periventricular T2 hyperintensity is seen, favored to represent a treatment related change. No other pathologic parenchymal enhancement is detected.Numerous small parenchymal defects are evident within the cerebral white matter, the deep gray nuclei, and the cerebellum, perhaps representing prior small vessel ischemic lesions. Encephalomalacia and hemosiderin staining in the right parietal lobe and to a lesser extent in the right occipital lobe likely represent chronic territorial ischemia. A new small focus of apparent restricted diffusion is seen within the white matter immediately above the left lateral ventricle. No other restricted diffusion is seen.

Output: 1.Stable postoperative findings including left orbital exenteration with soft tissue flap repair, left frontal craniectomy and cranioplasty, as well as left sinonasal resection.2.Thick enhancing tissue within the orbital exenteration bed is unchanged and favored to represent a postsurgical phenomenon. Previously seen patchy enhancement within the left frontal parenchyma subjacent to the craniectomy has decreased in conspicuity.3.Generalized left frontal edema has improved. A mild interval increase in extent of ill-defined periventricular T2 hyperintensity is seen, favored to represent a treatment related effect.4.A small focus of restricted diffusion just above the left lateral ventricle may indicate an acute or subacute incidental small vessel ischemic lesion, or an ischemic sequela of therapy.


Instruction: Generate impression based on findings.

Input: There is significant interval worsening of intracranial tumor burden in the right temporal lobe, as well as new mass in the genu and rostrum of the corpus callosum crossing the midline. There is extensive increased nonenhancing confluent T2 signal abnormality in the right temporal lobe extending into the right periatrial white matter with a significantly larger enhancing mass in the right temporal lobe measuring 28 x 26 mm with a 7-mm exophytic nodule along the anterolateral contour of the mass. There is increased mass effect on the right temporal horn and the right atrium of the lateral ventricles with partial effacement. On the previous exam, the larger mass measured less than 15 mm in maximal dimension. There is a new mass centered in the genu and rostrum of the corpus callosum crossing the midline measuring 10 x 11 mm with associated mild mass effect on the frontal horns. There is mild periventricular and subcortical white matter T2 hyperintensity with involvement of the central pons which is nonspecific, likely representing a combination of small vessel ischemic changes and post treatment changes.There is no acute infarct or midline shift.

Output: 1.There is significant interval worsening of intracranial tumor burden in the right temporal lobe, as well as new mass in the genu and rostrum of the corpus callosum crossing the midline.2.Worsened vasogenic edema in the right temporal lobe and mass effect on the right lateral ventricle.Findings were communicated to the Hematology/Oncology Dr. Veneris over the telephone by Dr. Pranay Uppuluri at 3:45 PM today.


Instruction: Generate impression based on findings.

Input: Radiographs for measurement of leg length discrepancy Bilateral total knee arthroplasties with asymmetric radiolucent limb supports. Ossific density adjacent medial to the medial femoral condyle likely reflects old MCL injury. Bone length measurements as follows:Right femur: 47 cmRight tibia: 28.5 cmLeft femur: 46.5 cmLeft tibia: 28 cm

Output: Bilateral total knee arthroplasties with asymmetric radiolucent limb supports. Lower extremity bone length measurements as above.


Instruction: Generate impression based on findings.

Input: Female, 49 years old. Reason: incidental thyroid nodule RIGHT LOBE MEASUREMENTS: 2.1 x 1.7 x 5.1 cmLEFT LOBE MEASUREMENTS: 1.3 x 1.5 x 3.2 cmISTHMUS MEASUREMENTS: 0.1 cmRIGHT LOBE: Mildly heterogeneous echotexture. A nodule at the posterior aspect of the mid right thyroid measures 1.2 x 1.1 x 0.9 cm, heterogeneous, with cystic and solid components, bright internal echoes, and minimal internal vascularity. An additional nodule at the posterior aspect of the inferior right thyroid measures 1.3 x 1.1 x 1.3 cm, solid and hypoechoic, noncalcified, without significant internal vascularity.LEFT LOBE: Mildly heterogeneous echotexture. A left mid thyroid nodule measures 0.6 x 0.3 x 0 .7 cm, spongiform consistent with colloid nodule.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Two indeterminate nodules, both approximately 1cm in diameter at the posterior aspect of the right thyroid lobe, as described above.


Instruction: Generate impression based on findings.

Input: 73-year-old male with back pain that is better with getting up and walking. Alignment is anatomic. Vertebral body heights are within normal limits. Scattered areas of T1 hyperintensity in the vertebral bodies likely represent focal fat or hemangiomas. The conus medullaris is normal in position. Left renal cysts are also noted. The paraspinous soft tissues are otherwise within normal limits. Multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. No significant spinal canal or neural foraminal stenosis. L2-L3: Mild facet arthropathy. Reduced T2 signal of the disc without loss of disc height or disc bulge. No significant spinal canal or neural foraminal stenosis.L3-L4: Moderate facet arthropathy. Reduced T2 signal of the disc with mild loss of disc height. In addition to a mild, predominantly lateral disc bulge, this results in mild bilateral neural foraminal stenosis. No significant spinal canal stenosis.L4-L5: Moderate facet arthropathy and ligamentum flavum thickening. Reduced T2 signal of the disc without significant loss of disc height. In addition to a mild disc bulge, this results in moderate left and mild right neural foraminal stenosis. The left lateral recess is effaced, greater than the right, with crowding of the descending L5 nerve roots. No significant spinal canal stenosis.L5-S1: Moderate facet arthropathy. Reduced T2 signal of the disc without significant loss of disc height. In addition to a mild disc bulge, this results in mild bilateral neural foraminal stenosis. No significant spinal canal stenosis. Right subarticular annular fissure is also noted.

Output: Relatively mild degenerative changes of the lumbar spine without high-grade spinal canal or neural foraminal stenosis. At worst, there is moderate left neural foraminal stenosis at the L4-5 level.


Instruction: Generate impression based on findings.

Input: Reason: s/p distal pancreatectomy/splenectomy in 2013 for IPMN - please eval for recurrence History: IPMN ABDOMEN:LIVER, BILIARY TRACT: Punctate T2 hyperintense lesions, likely cysts. No suspicious hepatic lesions. No intrahepatic or extrahepatic biliary ductal dilatation.SPLEEN: Status post splenectomy.PANCREAS: Postsurgical changes of distal pancreatectomy and splenectomy.Subcentimeter cystic lesions within the pancreatic body which appear to communicate with the main pancreatic duct are overall stable. The largest of these measures 1.6 x 0.8 cm (8/36), previously 1.6 x 0.7 cm. The main pancreatic duct is nondilated. No enhancing components.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral T2 hyperintensities, likely cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: A nonenhancing T2 hyperintense collection along the anterior abdominal wall is decreased in size measuring 0.7 x 5.0 cm (4/30), previously 2.0 x 6.2 cm. There is decreased T1 signal compared to the prior exam likely representing evolution of blood products.OTHER: No significant abnormality noted.

Output: 1.Cystic lesions in the pancreatic body are stable and likely represent side branch IPMNs. No suspicious features or dilatation of the main pancreatic duct.2.Chronic hematoma along the anterior abdominal wall is decreased in size.


Instruction: Generate impression based on findings.

Input: Back pain, fevers, neutropenia and history of multiple LPs. For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. There is normal lumbar lordosis. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. The epidural space, thecal sac, and spinal cord are preserved with no evidence of spinal canal/neural foraminal narrowing. The conus medullaris terminates at the T12-L1 level. The paraspinal soft tissues are unremarkable.There is no evidence of abnormal enhancement, cord compression or mass. Degenerative changes are specified by the intervertebral level as follows: T12-L1: no neuroforaminal narrowing or spinal stenosis. L1-L2: no neuroforaminal narrowing or spinal stenosis. L2-L3: no neuroforaminal narrowing or spinal stenosis. L3-L4: Minimal bulging of disc otherwise unremarkableL4-L5: Diffuse urging of disc with mild disc desiccation, minimal spinal stenosis without evidence of bilateral neural foraminal stenosis. L5-S1: no neuroforaminal narrowing or spinal stenosis.

Output: No evidence of abnormal enhancement.Disc desiccation with diffuse disc bulging at the level of L4-5 as described above.Otherwise unremarkable.


Instruction: Generate impression based on findings.

Input: 60-year-old man with history of prostate cancer on active surveillance. PELVIS:PROSTATE:Prostate Size: 58 x 44 mm.Peripheral Zone: There are scattered areas of increased T1 signal on the precontrast images suggestive of postbiopsy hemorrhage. Within the left para midline mid peripheral zone (series 1101, image 15) there is a 6 x 6 mm of ill-defined T2 hypointensity. No abnormality on ADC map is seen to correlate to this region.Central Gland: Marked benign prostatic hypertrophy.Seminal Vesicles: The seminal vesicles appear normal.Extracapsular Extension: N/ABLADDER: The bladder appears normal.LYMPH NODES: No significant lymphadenopathy noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Questionable focus of abnormal T2 signal in the left paramidline mid peripheral zone without corresponding ADC map abnormality. While this may be within normal limits/related to normal periurethral soft tissue signal, attention on follow-up imaging is warranted.2.No additional suspicious foci.


Instruction: Generate impression based on findings.

Input: 63 years, Male, with a history of small cell lung cancer and numerous brain metastases now status post chemotherapy. Evidence of treatment response with multiple previously seen enhancing lesions no longer appreciated. Interval postsurgical changes from left frontoparietal and right parietal approach. The left posterior frontal resection cavity is filled with blood products and there is minimal residual nodular enhancement in the posterior aspect of the middle frontal gyrus that may be consistent with residual metastasis. The right temporoparietal cavity has nodular enhancement in its medial aspect suggestive of residual tumor. There is new susceptibility effect in the region of the previously seen right cerebellar and right posterior temporal metastases and may be related to mineralization and/or chronic blood products.The left frontal calvarial lesion is smaller measuring 5 mm versus previously 12 mm. The enhancing nodule within the right paraspinal muscles remains, but is incompletely visualized on this exam.Redemonstration of encephalomalacia in the bilateral basal ganglia and corona radiata. There is no evidence of acute ischemia. There is mild diffuse cerebral volume loss. There is no mass effect, edema, hydrocephalus or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable. There are secretions and mucosal thickening throughout the left maxillary sinus.

Output: 1. Evidence of treatment response with marked regression of previously seen multiple supratentorial and infratentorial lesions. Small residual areas of enhancement are seen along the margin of the right temporal parietal resection cavity as well as just lateral to the left posterior frontal resection cavity. 2. Left frontal calvarial enhancing lesion is also smaller. Previously seen right paraspinous soft tissue lesion is partially imaged.3. No significant edema or evidence of intracranial mass effect on the current study.


Instruction: Generate impression based on findings.

Input: Findings are seen compatible with Chiari decompression including suboccipital craniectomy and resection of the posterior arch of C1.Apparent reversal of cervical lordosis may be artifactual due to susceptibility from orthodontic braces versus positional. Thoracic spine is normal in alignment. Size, shape, and signal of the vertebra and intervertebral disks are normal, aside from resection of posterior arch of C1. There is flow anterior to the brainstem and the cord but no significant flow posteriorly; this finding is unchanged compared to prior examination.Cervical and thoracic cord demonstrates normal signal. There is re-demonstration of central cervical canal prominence at C6/7 measuring up to 2.5 mm in diameter, previously 2.4 mm. Stable prominence of the spinal cord centrally at the conus which may be a small syrinx versus a normal variant terminal ventricle. No evidence of disk herniation, thecal sac effacement, or foraminal narrowing in the cervical or thoracic spine. The visualized extraspinal soft tissue structures are unremarkable.

Output: 1.Stable C6/7 central spinal cord prominence.2.Stable prominence of the spinal cord centrally at the conus which may be a small syrinx versus a normal variant terminal ventricle.3.Stable appearance of cervicocranial junction following suboccipital decompression.


Instruction: Generate impression based on findings.

Input: 44 years, Male. Reason: assess if ileus, History: distended abdomen, septic shock Patient cannot suspend respiration. Some blurring due to respiratory motion.Paucity of bowel gas. Single distended loop of small bowel in the left midabdomen 3.8 cm is nonspecific favor ileus. Given limitation of supine view no obvious intramural or free air. Air is seen in the nondistended stomach.Bilateral pulmonary opacities.

Output: Limited exam. Probable ileus. Bilateral opacities in lung bases.