Instruction: Generate impression based on findings.

Input: History of chronic hepatitis C and cirrhosis. Presents for HCC screening. ABDOMEN:LIVER, BILIARY TRACT: Prominent hepatic fissures and diffuse reticular T2 hyperintensity compatible with chronic liver disease and fibrosis. Stable punctate cyst in segment VI.The reference segment 4 lesion measures 1.1 x 1.0 cm (series 11/26), compared to approximately 1.7 x 1.3 cm previously and demonstrates poor arterial phase enhancement but no washout.The reference segment 5 lesion is grossly unchanged measuring approximately 1.3 x 1.2 cm (series 11/35), compared to 1.5 x 1.4 cm previously, again with poor arterial enhancement but no washout.These lesions demonstrate no abnormal T2-weighted signal intensity or restricted diffusion.No new arterial enhancing lesion.Stigmata of portal hypertension including borderline splenomegaly and recanalization of the periumbilical vein and body wall collaterals.The portal vein is patent.Cholelithiasis in a hydropic gallbladder without specific evidence of acute inflammation. SPLEEN: Borderline splenomegaly measuring 15 cm in length. Stable nonspecific subcentimeter hypodense splenic lesion.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Scattered degenerative endplate changes of the thoracic lumbar spine.OTHER: No significant abnormality noted.

Output: 1.Accounting for technical differences no significant change in the poorly enhancing hepatic lesions without washout. These do not meet imaging criteria for HCC.2.Cirrhotic liver morphology with fibrosis. No new liver lesion.3.Borderline splenomegaly and recanalized periumbilical vein. 4. Cholelithiasis in a hydropic gallbladder without specific evidence of acute inflammation.


Instruction: Generate impression based on findings.

Input: 74-year-old female with altered mental status. Evaluate for stroke. Large focal left hypodensity within the extra-axial space with septations and mass effect. This finding could represent a chronic subdural hematoma. Further imaging evaluation with MRI may be considered, if clinically warranted. Mild microangiopathic changes of indeterminate age.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Large focal hypodensity may be due to chronic subdural hematoma but would be better evaluated with MRI, if clinically warranted.


Instruction: Generate impression based on findings.

Input: Male, 3 years old, status post traumatic brain injury resulting in left hemiparesis and gait disturbances. Evidence of prior left-sided craniotomy is again seen. No intracranial hemorrhage or any abnormal extra axial fluid collection is seen. Diffusion-weighted images are within normal limits.Areas of encephalomalacia are seen including along the left superior frontal sulcus, the left posterior medial temporal lobe, and the left medial occipital lobe, corresponding to areas which were diffusion restricting on prior studies. Patchy T2 hyperintensity is also seen within the periventricular white matter adjacent to the frontal horns and the left more than right periatrial regions. There may be mild curvilinear FLAIR hyperintensity within the left uncus but this could also be artifactual.No evidence of active parenchymal edema or mass effect is seen. Brain morphology and overall brain volume are within normal limits. Apart from ex vacuo dilatation of the left atrium, the ventricular system is within normal limits.

Output: Findings are seen compatible with chronic parenchymal injury including areas of encephalomalacia within the left frontal lobe, the left posterior temporal and left occipital lobes. Scattered small foci of additional signal abnormality in the periventricular white matter may also represent sequelae of parenchymal injury. There is a questionable small area of abnormal signal within the left uncus.


Instruction: Generate impression based on findings.

Input: 65-year-old male with history of cirrhosis, HCC, status post TACE/RFA. Evaluate for liver lesions. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology. Extensive posttreatment changes of the segment 6 lesion without evidence of nodular hepatic arterially enhancing lesions to suggest recurrence or residual disease. There is intrinsic T1 hyperintensity within the cavity, likely related to posttreatment changes. Right posterior portal vein branch is diminutive, may be secondary to ablation. The previously noted 5 mm arterially enhancing lesion at the anteromedial aspect of the ablation cavity is not seen on the current examination. No other enhancing nodules identified.SPLEEN: Mild splenomegaly.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Paraesophageal varices are again noted.BOWEL, MESENTERY: Small fat-containing umbilical hernia. Degenerative changes of the spine.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Cirrhotic liver morphology with posttreatment change from the segment 6 lesion. No evidence of recurrent or residual disease.2.Mild splenomegaly and esophageal varices.


Instruction: Generate impression based on findings.

Input: Reason: evaluate for lupus cerebritis or other changes related to lupus History: new diagnosis of lupus, retinopathy on exam, hypertension. MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:There is narrowing of the proximal right m1 segment and distal right ICA.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.There is no evidence for intracranial aneurysm.The anterior communicating artery is identified and is medium size. The posterior communicating arteries are identified and are small . The vertebral arteries are asymmetric - left smaller than right.MRV brain:The dural venous sinuses are patent. Straight sinus, internal cerebral veins and basal veins are identified and appear patent.

Output: 1.Findings suggest significant narrowing at the origin of the right MCA and distal right ICA. This can be confirmed using a CTA.2.No evidence for intracranial aneurysm.3.MR venogram of the brain is within normal limits4.No evidence for intracranial mass lesion.


Instruction: Generate impression based on findings.

Input: Diagnosis: Cerebral infarction, unspecifiedClinical question: subacute cvaSigns and Symptoms: cva, ams MRI of the brainThere is a focus of diffusion restriction present along the inferomedial aspect of the left cerebellar hemisphere measuring approximately 37 x 30 mm in axial dimensions. It is bright on T2 and FLAIR.. There is an additional punctate focus of diffusion restriction present in the left occipital lobe along the left cuneus. There is volume loss associated T2 and FLAIR signal change along the anteromedial and inferior aspects of the frontal lobes bilaterally involving the anterior aspects of the gyrus rectus and adjacent orbital gyri. There is more involvement on the right side than the left. There is some associated susceptibility effect present. These represent foci of encephalomalacia.A small focus of susceptibility effect is present adjacent to the aqueduct.The visualized portions of the paranasal sinuses demonstrate mild mucosal thickening. The visualized portions of the mastoid air cells are partially opacified. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal right vertebral artery, the basilar artery and the proximal anterior, middle and posterior cerebral arteries. The left vertebral artery is not readily identified on this exam.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. The left A1 segment is smaller than the right A1 segment. The posterior communicating arteries are not readily identified.

Output: 1.Subacute infarct involving the posterior, inferior and medial aspect of the left cerebellar hemisphere.2.Microinfarct involving the left occipital lobe in the cuneus.3.A small focus of encephalomalacia is present along the right cerebellar hemisphere. One possibility is that this is related to an old focus of infarction4.Small foci of encephalomalacia are present involving the medial right orbital gyrus and gyrus rectus and to a lesser degree left gyrus rectus and a small portion of the adjacent left orbital gyrus. Its location could suggest prior trauma. Please correlate with clinical history.5.The left vertebral artery is not identified on small occlusion of the left vertebral artery.


Instruction: Generate impression based on findings.

Input: 46-year-old male presents with a left lower extremity chronic wound, evaluate for osteomyelitis. There is ulceration of the lateral soft tissues of the lower leg just above the ankle. The underlying subcutaneous fat is replaced with abnormal signal intensity and enhancement likely representing a combination of edema and scarring. The abnormal enhancement extends to the cortex of the distal fibula. There is circumferential chronic appearing thick periosteal new bone formation likely reflecting sequela of prior infection. There is mild increased signal intensity of the distal fibula on the fat-suppressed T2-weighted images with mild enhancement of the marrow following contrast administration. However, normal fatty signal intensity of the distal fibula is preserved on the T1-weighted images. Therefore, these findings are more suggestive of a combination of prior infection and reactive osteitis rather than acute osteomyelitis. Signal intensity of the proximal fibula and tibia are normal.Severe fatty atrophy of multiple muscles of the leg. There is mild edema type signal intensity affecting other muscles that may reflect a relatively subacute phase of atrophy. Bandlike low signal intensity extending along several of the muscles likely reflects scarring. No intra or intramuscular fluid collection to indicate an abscess.

Output: Soft tissue ulceration with findings suggesting prior infection of the fibula and reactive osteitis, but preservation of normal fatty signal intensity on T1-weighted images argues against acute osteomyelitis. Other findings as described above.


Instruction: Generate impression based on findings.

Input: 64 year old male with high degree heart block and episodes of VT, concern for infiltrative disease Left VentricleThe left ventricle is normal in size with mildly reduced systolic function. The overall LV ejection fraction is 51%. The LVEDV is 247 ml (normal range 142+/-34), the LV end diastolic volume index is 115 ml/m2 (normal range: 74+/-15), the LVESV is 122 ml (normal range 47+/-19) and the LV end systolic volume index is 57 ml/m2 (normal range 25+/-9). The LV mass is 245 g (normal range 164+/-36) and the LV mass index is 114 g/m2 (normal range 85+/-15). There are no regional wall motion abnormalities present. T2 STIR images suggest the presence of diffuse edema/inflammation at the base of the heart. There is presence of late gadolinium enhancement in the mid to basal inferior and inferolateral myocardial wall, suggesting the presence of an underlying fibrosing, infiltrative, or inflammatory process. There is an area in the basal septum that could represent late gadolinium enhancement however this finding could also represent partial volume artifact due to LV outflow tract. Left AtriumThe left atrium is normal. Right VentricleThe right ventricle is normal in size with normal function. The overall RV ejection fraction is 57%. The RVEDV is 212 ml (normal range 142+/-31), RV end diastolic volume index is 99 ml/m2 (normal range 82+/-16), the RVESV is 91 ml (normal range 54+/-17), and the RV end systolic volume index is 42 ml/m2 (normal range 31+/-9).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve is trileaflet, opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is 39mm in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is a small pericardial effusion. There is also evidence of patchy edema/inflammation of the pericardium at the level of the mid-inferolateral and apical lateral wall on T2 STIR images. There is mild thickening of the pericardium. Extracardiac FindingsThere is evidence of mediastinal adenopathy present. There is also presence of axillary adenopathy. Possible pleural thickening at lung bases. 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. Left ventricle is normal in size with mildly reduced LV ejection fraction at 51%. There are no wall motion abnormalities. 2. Right ventricle is normal in size with normal RV ejection fraction at 57%3. T2 STIR images suggest the presence of diffuse edema/inflammation at the base of the heart. This is consistent with an inflammatory process in the myocardium. 4. There is late gadolinium enhancement extending from the mid to basal inferior and inferolateral myocardial walls suggesting the presence of an underlying fibrosing, infiltrative, or inflammatory process. There is an area in the basal septum that could represent late gadolinium enhancement however this finding could also be due to LV outflow tract partial volume artifact. 5. There is a small pericardial effusion with evidence of patchy edema/inflammation in the mid-inferolateral and apical lateral wall on T2 STIR images. 6. Mild thickening of the pericardium. 7. This constellation of findings is suggestive of cardiac sarcoid given the clinical context with acute pericarditis and evidence of myocarditis. Other causes of myocarditis and pericarditis should be included in the differential.8. See extracardiac findingsI personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: unresponsive episodes, known prior infarctions. No evidence of acute ischemic or hemorrhagic lesion.There are lenticular shaped tissue losses on bilateral external capsules, associated with susceptibility artifacts on gradient echo images indicating chronic hemorrhagic lesions.Left basal ganglia and bilateral pons lesions show increased signal intensities on FLAIR images indicating chronic ischemic infarctions.Bilateral centrum semiovale high signal intensities on FLAIR images indicate non specific small vessel ischemic lesions.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. Likely chronic hemorrhagic lesions on bilateral external capsules and left basal ganglia.3. Likely chronic ischemic lesions on bilateral pontine lesions.4. Non specific small vessel lesions on bilateral centrum semiovale.


Instruction: Generate impression based on findings.

Input: 56-year-old male with calf pain. Evaluate for gastrocnemius tear. TENDONS: There is thickening, deformity, and increased fluid signal abnormality within the proximal Achilles tendon consistent with moderate to severe tendinosis and partial thickness tearing. It should be noted that the insertion of the Achilles tendon on the calcaneus is not included in the field of view of this examination.ARTICULAR SURFACES AND BONE: No bone marrow signal abnormality is identified. ADDITIONAL

Output: Findings consistent with moderate to severe Achilles tendinosis and partial-thickness tearing of the proximal tendon. It should be noted that the distal Achilles tendon and insertion on the calcaneus are not included in the field-of-view of this examination. If concern for distal tearing/rupture of the Achilles tendon a dedicated MRI ankle examination could be considered. Extensive nonspecific subcutaneous edema about the leg.


Instruction: Generate impression based on findings.

Input: High-grade glioma status post craniotomy, chemotherapy, radiation therapy. Treated with Avastin. Please note that a dedicated brain tumor protocol was inadvertently not obtained. Therefore, perfusion imaging was also not performed.There are numerous new foci of susceptibility along the left frontal centrum semiovale, with other stable scattered foci elsewhere in the brain both supratentorially and infratentorially, noted previously and likely posttreatment related.There is redemonstration of postoperative changes along the left parietal operculum. Minimal associated curvilinear intrinsic T1 hyperintensity with areas of hemosiderin staining remain. The extent of surrounding abnormal T2 hyperintensity appears similar even dating back to 9/19/2014.There is additional treated recurrent tumor in the left frontal lobe, with mild encephalomalacia anteriorly. There is been significant interval increased extent of abnormal T2/FLAIR hyperintensity throughout the frontal deep white matter with extension into the body of the corpus callosum which now appears thickened, previously measuring 5 mm and now measuring 8 mm. The previous signal in the genu of the corpus callosum is not as well appreciated on the current exam. The previously noted somewhat ill-defined area of subcortical T2 hyperintensity along the left superior frontal gyrus is now more conspicuous on 10/26.Other patchy areas of abnormal FLAIR hyperintensity in the deep and subcortical white matter, left greater than right side appear stable. No new enhancing lesions are seen. There is no midline shift or mass effect. Ventricular system is stable, including left ventricular atrial ex vacuo dilatation. There is a right maxillary sinus mucosal retention cyst.

Output: 1.Progression of nonenhancing FLAIR hyperintensity of the previously seen left paramedian superior frontal gyrus subcortical white matter with now confluent involvement of bilateral centrum semiovale in the frontal lobes extending into the significantly thickened body of the corpus callosum. Findings are nonspecific but are most concerning for continued disease progression. Patient may be recalled for additional MR perfusion imaging at no additional cost, for further evaluation as clinically indicated. Associated posttreatment/inflammatory changes are also possible.2.New foci of punctate susceptibility along the left body of the corpus callosum, which may be posttreatment related or represent petechial hemorrhage relating to underlying neoplasm.3.Stable treated disease in the left parietal operculum and left anterior frontal lobe.


Instruction: Generate impression based on findings.

Input: 91-year-old female status post fall without loss of consciousness. Evaluate for bleed or fracture. There is no evidence of intracranial hemorrhage, mass or edema. Multiple diffuse hyperdensities in a periventricular distribution consistent with advanced small vessel disease, age indeterminate. There is a focus of hyperdensity within the right frontal horn which may represent calcification but we cannot rule out the remote possibility of hemorrhage. If further evaluation is clinically warranted MRI may be considered. Small lacunes are noted within the bilateral basal ganglia consistent with chronic ischemic changes.Prominent sulci in proportion to ventricles are within normal limits for age. The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. Advanced small vessel disease, age indeterminate. If there is clinical concern for acute ischemia, an MRI may be considered.2. A small focus of hyperdensity within the right frontal horn is likely due to calcification but a focus of hemorrhage cannot be ruled out.


Instruction: Generate impression based on findings.

Input: 41-year-old female with biopsy proven phyllodes tumor in the right breast presents for MRI evaluation. There is extreme amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.An irregularly shaped enhancing mass, 30 x 26 x 26 mm (AP x LR x CC) at posterior 9:00 position. This is a known phyllodes tumor. A marker clip is present at posterior lateral aspect within the mass.No abnormal enhancement is seen in left breast. No abnormal lymph nodes are identified in either axillary region.

Output: 1. A single enhancing mass at posterior 9:00 position which is a known phyllodes tumor2. No MRI evidence of malignancy in left breast3. No abnormal lymph nodes in either axillary regionBIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Neurodegenerative disease, altered mental status, and rigidity. There is marked atrophy of the bilateral caudate nuclei. There is a background of moderate diffuse cerebral volume loss. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is scattered cerebral and pontine white matter T2 hyperintensity. There are defects in the right centrum semioval and bilateral thalami and corona radiata and with degeneration in the left midbrain. There is encephalomalacia in the left inferior cerebellar hemisphere. There is no abnormal intracranial enhancement. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is mild scattered paranasal sinus mucosal thickening and secretions. There is a probable Thornwaldt cyst that measures up to 14 mm.

Output: 1. Disproportionate volume loss of the bilateral caudate nuclei is suggestive of Huntington disease.2. Chronic small vessel ischemic disease and lacunar infarcts in the left cerebellum and bilateral thalami and corona radiata with left-sided Wallerian degeneration, but no evidence of acute intracranial hemorrhage, mass, or acute infarction.


Instruction: Generate impression based on findings.

Input: There is redemonstration of small cortically based foci of scattered FLAIR hyperintense signal appearing similar to prior. No evidence of calcification. There are no new foci of identified abnormal enhancement.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranialhemorrhage is identified. No edema is identified within the brain parenchyma. Norestricted diffusion.Major intracranial vascular flow voids are present.The visualized portions of the paranasal sinuses are clear. The visualized portions ofthe mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: Findings are unchanged since the previous study of 8/9/2013. No new findings.


Instruction: Generate impression based on findings.

Input: History of cT2N0 squamous cell carcinoma of the posterior hypopharynx, HPV negative s/p chemoradiation completed 10/20/14 and now presenting with recurrent disease at the posterior pharyngeal wall. There are post-treatment findings in the neck, with swelling and diffuse enhancement in the hypopharyngeal region, stranding of the subcutaneous tissues and other fat planes, as well as hyperenhancement of the submandibular glands. There appears to be a more focal subcentimeter plaque-like area of mucosal enhancement and thickening along the left posterior pharyngeal wall. However, the prevertebral space appears to be intact. There is no evidence of significant cervical lymphadenopathy based on size criteria. The thyroid appears to be unremarkable. The cervical spine appears to be unremarkable. The major cervical arterial flow voids appear to be intact. The imaged intracranial structures are unremarkable.

Output: Post-treatment findings in the neck with swelling and diffuse enhancement in the hypopharyngeal region. A more focal subcentimeter plaque-like area of mucosal enhancement and thickening along the left posterior pharyngeal wall may represent recurrent tumor, but is otherwise nonspecific. However, the prevertebral space appears to be intact.


Instruction: Generate impression based on findings.

Input: Left renal mass. Weight loss and anorexia. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in size, morphology and signal intensity. No focal suspicious liver lesion or biliary ductal dilatation. The vessels appear patent. Minimally distended gallbladder.SPLEEN: The spleen measures 11.4 cm in length.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: The left adrenal gland is mildly thickened without a discrete lesion.KIDNEYS, URETERS: There is a very large mass replacing a large portion of the left kidney with a large exophytic component, measuring approximately 16 x 15 cm maximal cross-section 20 cm in craniocaudal dimension. There are regions of reniform enhancement anteriorly and inferiorly with tumor infiltrating throughout the renal parenchyma. The mass is multilobulated and heterogeneous in signal intensity and demonstrates heterogeneous postcontrast enhancement with central and posterolateral regions of nonenhancement consistent with regions of necrosis. The mass causes mass effect on the spleen superiorly, the stomach pancreas, small bowel, duodenum and descending colon anteriorly. The mass abuts and displaces the pancrease and duodenum. There is mass affect on the left psoas muscle. The mass encases and narrows the left renal artery and abuts the anterior left lateral aspect of the aorta. The left renal vein is nondistended. A large feeding vessel off the anterior aspect of the distal abdominal aorta courses through an exophytic lobular component of the tumor inferiorly (series 1301, image 560) and gives off feeding vessels to the mass anteriorly.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small left pleural effusion. PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The appendix is thickened up to 2.2 cm with nodular thickening at its base. Ascites.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Large left renal mass resulting in extensive regional mass effect and adjacent organ abutment. No distal metastatic disease is evident.2. Thickened appendix up to 2.2 cm which nodular thickening at its base. This may represent a mucocele or a mucinous adenocarcinoma of the appendix. 2. Small left pleural effusion.


Instruction: Generate impression based on findings.

Input: Bilateral leg pain and history of neurofibromatosis type 1. There is lack of the usual lordosis. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. There is a 1 mm wide ventriculus terminalis, which is situated at the L1 level. The imaged portions of the spinal cord otherwise displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: No evidence of neurofibromas in the lumbar spine region, although the assessment is limited by the lack of intravenous contrast.


Instruction: Generate impression based on findings.

Input: Male, 73 years old, with hip pain and pain radiating down the back of the leg. History of prostate cancer. A grade 1 retrolisthesis of L4 relative to L5 is demonstrated. Transitional morphology of the L5 vertebral body is seen. Vertebral body heights are preserved. No concerning marrow replacement or marrow edema is seen.The visualized distal spinal cord, conus and nerve roots of the cauda equina are unremarkable except as discussed below. No epidural abnormalities are seen.The spinal canal is congenitally slender in the lumbar region to which prominence of the dorsal epidural fat contributes at several levels. Superimposed upon this are additional degenerative findings as follows:L1-2: Facet arthropathy and ligamentum flavum thickening. Mild disc bulge. Mild generalized spinal canal narrowing with slight crowding of the cauda equina. Mild left foraminal narrowing. L2-3: Facet arthropathy and ligamentum flavum thickening. Bulging disc. Mild generalized spinal canal narrowing with slight crowding of the cauda equina. Mild left foraminal narrowing. L3-4: Facet arthropathy and ligamentum flavum thickening. Mild disc bulging. Slight effacement of the lateral recesses but no significant generalized canal stenosis. Moderate left and mild right foraminal narrowing. L4-5: Facet arthropathy and ligamentum flavum flavum thickening. Disc bulging with a small right paracentral protrusion. Both lateral recesses are effaced, right side more than left with possible impingement of the descending L5 nerve roots. Moderate to severe bilateral foraminal narrowing. L5-S1: Facet arthropathy. No significant spinal canal stenosis. Mild right foraminal narrowing.

Output: Disc degeneration and posterior element hypertrophy affect multiple levels as discussed above. No high-grade generalized spinal canal stenosis is seen though some degree of narrowing with crowding of the cauda equina is noted at L1-2 and L2-3. At L4-5, the lateral recesses are narrowed, right side more than left, with possible impingement of the descending L5 nerve roots.Moderate to severe foraminal narrowing is evident bilaterally at L4-5.


Instruction: Generate impression based on findings.

Input: Primary biliary cirrhosis, elevated LFTs above baseline, right upper quadrant pain ABDOMEN:LIVER, BILIARY TRACT: Liver measures 16.6 cm in craniocaudal dimension and micronodular contour suggested, may reflect underlying cirrhosis. Hepatic segment 8 lesion measuring 1.5 x 1 cm, image 22 series 301. Lesion demonstrates imaging characteristics suspicious for metastatic disease. Lesion is mildly T2 hyperintense and demonstrates restricted diffusion (image 325 series 701), associated enhancement suggested (subtraction sequences suboptimal due to motion), atypical hemangioma another differential consideration.Marked intrahepatic and extrahepatic biliary duct dilatation. Common bile duct measures up to 1.7 cm. Distal intraluminal abnormal signal seen, measuring approximately 1.2 cm in transverse dimension by 1.2 cm in AP dimension by 2.5 cm in craniocaudal dimension, image 4 series 301 and image 10 series 401, may reflect blood clot or debris/stones, but underlying neoplastic extension a consideration. Lesion demonstrates intrinsic T1 hyperintensity, which would favor hemorrhagic products, assessment for associated enhancement on subtraction sequences suboptimal due to motion.Hydropic gallbladder, measuring 5.2 cm in transverse dimension. Large amount of layering sludge/complex material suggested within the gallbladder, corresponding increased T1 signal seen. SPLEEN: Splenomegaly present, spleen measures up to 15 cm in craniocaudal dimension. PANCREAS: Marked pancreatic duct dilatation present, measuring up to 11 mm, intraductal debris present, particularly near level of ampulla. Smaller subcentimeter T2 hyperintense foci seen in pancreatic body may reflect tiny intraductal papillary mucinous neoplasms (IPMNs) versus sidebranch ectasia. Please note that entirety of pancreas was not imaged on axial imaging. In coronal plane, common bile and pancreatic ductal dilatation seen to level of nonspecific T2 hypointense lobulated signal near junction of ampulla and duodenum, measures approximately 3 x 1.5 cm (image 11 series 401), appearance suspicious for obstructing masslesion. Mild fluid containing prominence of bowel proximally.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Renal T2 hyperintense foci, most likely cysts. One of these foci medially located in right kidney, measuring 9 x 8 mm, image 9 series 601, contains internal heterogeneity, may be related to some complexity/internal septation.RETROPERITONEUM, LYMPH NODES: Enlarged gastrohepatic and portacaval/peripancreatic lymphadenopathy, small juxtaphrenic lymph nodes also seen. Areas of peripancreatic restricted diffusion presumably related to enlarged adenopathy versus underlying masslesion. BOWEL, MESENTERY: Bowel thickening, nonspecific in setting of ascites.OTHER: Small to moderate ascites incompletely imaged. Heart borderline in size.

Output: 1. Marked biliary and pancreatic ductal dilatation, to level of lobulated signal near duodeno-ampullary junction, suspicious for obstructing ampullary or periampullary (e.g., pancreatic head) masslesion, with hepatic and nodal metastatic disease suggested. Correlation with patient's clinical history and further characterization with ERCP and/or histologic sampling recommended.2. Hepatic segment 8 lesion demonstrating imaging characteristics suspicious for metastatic disease. Background of cirrhosis and stigmata of portal hypertension.3. Enlarged upper abdominal lymphadenopathy, may be metastatic.4. Hydropic gallbladder.5. Small to moderate ascites incompletely imaged.


Instruction: Generate impression based on findings.

Input: Female, 63 years old, with GBM status post clinical investigation. Postoperative findings are redemonstrated status post lesion resection from the left parieto-occipital junction. A thin surgical tract through this region appears similar to prior. Rim-enhancing tissue in this region has not significantly changed. As before, enhancement extends along the ependyma of the left occipital horn. The degree of T2 hyperintensity and edema within the surrounding brain parenchyma, which involves portions of the parietal, occipital and temporal lobes, and the left genu of the corpus callosum, is also unchanged. No new enhancing lesions are seen. The left ventricular atrium remains displaced and partially effaced by lesional edema. Elsewhere, the ventricular system is within normal limits.

Output: 1.Redemonstration of postoperative changes related to prior lesion resection from the left parieto-occipital junction.2.The size and morphology of residual enhancing tissue in this area, as well as associated T2 signal abnormality, are unchanged.3.No definite disease progression is seen.


Instruction: Generate impression based on findings.

Input: Brain: No structural abnormalities are appreciated. No focal parenchymal signal abnormalities. Sulcation and myelination appear age-appropriate. Midline structures including the corpus callosum, brainstem, and cerebellum appear within normal limits. No evidence of ischemia or hemorrhage. No intracranial mass or mass effect. Ventricles are normal in size. No extra-axial collections. There is nonspecific opacification of the partially pneumatized paranasal sinuses. Calvarium and remainder of the extracranial soft tissues are unremarkable. Major flow-voids are preserved.Orbits: The globes appear within normal limits. No abnormal mass or abnormal enhancement is seen in the orbits. No abnormal signal intensity is evident involving the optic nerves or chiasm. No retrobulbar mass, chiasmatic mass, or parasellar abnormality is seen. Extraocular muscles are also unremarkable.

Output: No structural abnormalities in the brain or orbits are appreciated.


Instruction: Generate impression based on findings.

Input: 29-year-old female with neutropenic fever, sore throat for 1 week and an enlarged lymph node in the right neck. Evaluate for abscess. Enlarged right cervical lymph node near the carotid bifurcation (image 47, series 10535) does not appear necrotic and measures 15 mm in short dimension, indicating inflammation. No other enlarged lymph nodes or evidence of abscess.Patent and unremarkable vasculature. Asymmetric prominence of the right adenoids. Nonspecific thickening of the tongue base is symmetric and may be correlated clinically for significance. Airway appears patent. Paranasal sinuses and mastoid air cells are well-pneumatized. No significant prevertebral soft tissue swelling. Cervical spine with unremarkable alignment.Visualized upper lungs are unremarkable.

Output: Enlarged right cervical lymph node and nonspecific tongue base thickening associated with right parapharyngeal adenoidal enlargement. Please correlate with clinical exam findings.


Instruction: Generate impression based on findings.

Input: Code 65-year-old female with history of NHL. Status post transplant. Follow-up on a small subdural hematoma identified on MRI of brain. No evidence of hemorrhage, edema, mass effect, midline shift or hydrocephalus is detected. No evidence of subdural is identified as was noted on prior MRI exam. The cortical sulci, ventricular system and all CSF cisterns remain within normal limits.

Output: Normal CT of brain.


Instruction: Generate impression based on findings.

Input: Female, 26 years old, status post Chiari decompression with new symptoms in the right hand. Findings are seen compatible with Chiari decompression including suboccipital craniectomy and resection of the posterior elements of C1-C4. The CSF space below the cerebellum is widely expanded similar to prior. Adequate biphasic CSF flow is seen along the ventral surface of the brainstem through the foramen magnum. However, only minimal CSF flow is detected along the dorsal brainstem and virtually none is seen within the expanded CSF space. Swirling flow related artifact is, however, present in this space on conventional images.An extensive severe spinal cord syrinx is redemonstrated becoming most prominent at the C3 level and continuing through the entire cervical spine into the thoracic region. The syrinx measures up to 5 mm in the AP dimension and up to 12 mm in the transverse dimension. The caliber of the syrinx does not appear to have changed significantly. Only a thin rim of residual spinal cord parenchyma is seen surrounding the syrinx.Spinal alignment is anatomic. Vertebral body heights are preserved. No evidence of marrow replacement or marrow edema is detected. Mild disc degeneration is seen at C5-6 and C6-7. No significant spinal canal or foraminal compromise is detected.

Output: Findings are redemonstrated compatible with Chiari decompression. The CSF space below the cerebellum is widely decompressed, similar to the prior examination.Adequate CSF flow is seen along the ventral brainstem. Dorsally, only mild flow is seen along the brainstem and little if any detectable flow is present within the enlarged posterior CSF space. These findings could reflect turbulent or slow flow which is unable to be resolved by phase contrast technique, or perhaps restricted communication between the dorsal and ventral CSF spaces which could be related to adhesions. In any event, the findings are unchanged.Stable severe and longitudinally extensive spinal cord syrinx. No new findings are observed which account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: History of lumbar fusion: back and left leg pain. There are postoperative findings related to posterior fusion with pedicle screws and interconnecting rods at the L5-S1 level. Artifact related to the surgical hardware limits the assessment of adjacent structures. There is bilateral spondylolysis at L5 with minimal anterolisthesis of L5 upon S1, as well as mild loss of disc space height at this level. Loosening and fracture of the S1 screws is better delineated on the prior CT. There is no definite evidence of neural foraminal or spinal canal stenosis. The vertebral body heights are preserved. The imaged portions of the spinal cord and cauda equina nerve roots appear unremarkable. The vertebral bone marrow signal appears unremarkable beyond the portions obscured by surgical hardware artifact. Aside from expect postoperative findings in the lumbosacral region, the paraspinal soft tissues appear to be unremarkable.

Output: 1. Postoperative findings related to posterior fusion with pedicle screws and interconnecting rods at the L5-S1 level. Artifact related to the surgical hardware limits the assessment of adjacent structures and loosening and fracture of the S1 screws is better delineated on the prior CT. 2. Bilateral spondylolysis at L5 with minimal anterolisthesis of L5 upon S13. No definite evidence of neural foraminal or spinal canal stenosis.


Instruction: Generate impression based on findings.

Input: Reason: ?stenosis ?DDD History: bilateral upper extremity radiculopathy, weakness Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained aside from minimal C2 on C3 and C3 and C4 anterolisthesis. Bone marrow signal is benign.The cervical spinal cord has normal signal characteristics and overall morphology.Degenerative changes are seen in the cervical spine with small disc osteophyte complexes from C3-C4 to the C6-C7 levels. There is also mild facet arthropathy bilaterally throughout the cervical spine. Additional details as below: C2-3: No significant compromise to the spinal canal or neural foramina. Bilateral facet arthropathy.C3-4: No significant compromise to the spinal canal. Bilateral facet arthropathy and mild uncovertebral hypertrophy contribute to mild narrowing of the neural foramina. C4-5: No significant compromise to the spinal canal. There is mild left and minimal right neural foraminal narrowing related to uncovertebral hypertrophy and mild facet arthropathy.C5-6: No significant compromise to the spinal canal. There is mild left and minimal right neural foraminal narrowing related to uncovertebral hypertrophy and mild facet arthropathy.C6-7: Mild disc bulge and bilateral uncovertebral hypertrophy without significant spinal canal stenosis. There is moderate left and mild right neural foraminal stenosis.C7-T1: No significant compromise to the spinal canal or neural foramina. Bilateral facet arthropathy.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: 1. Mild multilevel degenerative changes without significant spinal canal stenosis at any level.2. Neural foraminal stenoses is worst at the left C6-C7 level where there is moderate stenosis and may be impingement of the left C7 nerve root. There is mild additional multilevel neural foraminal stenoses as detailed above.


Instruction: Generate impression based on findings.

Input: Diagnosis: Alzheimer's disease, unspecifiedDementia in other diseases classified elsewhere without behavioral disturbanceClinical question: Cognitive decline - assess for masses/CVAsSigns and Symptoms: Progressive global cognitive impairmentComments: Patient had surgery on her elbow many years ago and is not sure whether there is metal in her. She doesn't believe there is. | The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.There is atrophy of the brain mainly involving the parietal lobes.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.There is no evidence for intracranial mass lesion.2.No evidence for acute ischemic cerebral infarction.3.Findings suggest some brain atrophy involving the parietal lobes bilaterally. This is could be associated with Alzheimer's disease. Please correlate with clinical findings.4.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: Female 20 years old; Reason: Stress fracture distal tibia History: spontaneous pain and swelling. There is edema within the distal tibial metaphysis. There is also periosteal reaction along the posterior tibial metaphysis. While we see no discrete fracture line there is a poorly defined band-like focus of relatively low signal positioned within the edema that may represent early findings of a stress fracture. There is mild edema in the adjacent soft tissues and also posteriorly within Kager's fat pad. There is also mild edema within the distal fibula, calcaneus, and cuboid, which may reflect additional sites of relatively mild stress reaction/altered biomechanics. There are small tibiotalar and subtalar joint effusions. We see no osteochondral defects. The lateral collateral ligament complex appears intact. The distal tibiofibular syndesmotic complex is intact. The visualized component of the deltoid ligament appear intact. The spring ligament components appear intact. The Achilles tendon appears normal. There is a small amount of fluid within the sheaths of the medial tendons, which otherwise appear intact. The peroneal tendons appear intact. The anterior tendons are intact.

Output: 1. Edema within the distal tibial metaphysis is nonspecific but compatible with a stress reaction/early stress fracture. Additional milder edema is noted in the distal fibula, calcaneus, and cuboid, perhaps representing additional sites of relatively mild stress reaction/altered biomechanics.2. Other findings as above.


Instruction: Generate impression based on findings.

Input: 72 years, Female, Reason: History partial nephrectomy, positive parenchymal margin, assess for recurrence History: RCC (clear-cell) ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: Mild atrophy of the pancreatic tail.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Postsurgical changes in the right kidney. No residual mass. Left kidney is unremarkable.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Scoliosis.OTHER: No significant abnormality noted.

Output: No evidence of recurrent or metastatic disease.


Instruction: Generate impression based on findings.

Input: Headache [R51] / Malignant neoplasm of prostate [C61], Reason for Study: ^Reason: Pt is 72 y/o male wtih met small cell prostate cancer now with new headaches and head pain, evaluate for met diseaes History: met small cell prostate cancer, headaches There is inhomogenous but mainly low attenuation on T1, slightly expansile, lesion with Gad enhancement at clivus. There is no definitive evidence of associated soft tissue mass. MR signal intensity of skull appears to be within normal limits. Differential diagnosis include metastatic lesion and fibrous dysplasia. Other differential diagnosis including chondrosarcoma and chordoma can be considered but less likely based on above findings. No evidence of acute ischemic or hemorrhagic lesion.No evidence of abnormal enhancement.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. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear. Mucosal thickenings on bilateral ethmoid sinuses.Normal low signal intensity of right eye lens is not seen indicating post-surgery(cataract surgery most likely) status.

Output: 1. Slightly expansile clival lesion with enhancement as described above. Differential diagnosis include metastasis, fibrous dysplasia, chondrosarcoma and chordoma. For further imaging evaluation, sellar CT scan with covering clivus and/or bone scan can be considered.2. No evidence of acute ischemic or hemorrhagic lesion.


Instruction: Generate impression based on findings.

Input: 29-year-old male with pain over the inferior lateral malleolus after exercise. Evaluate for hindfoot coalition versus peroneal tendinopathy. TENDONS: The flexor and extensor tendons appear intact. The peroneal tendons appear intact.LIGAMENTS: The deltoid ligament appears is normal limits. The distal tibiofibular syndesmotic complex appears intact. The lateral collateral ligament complex appears intact.ARTICULAR SURFACES AND BONE: There is deformity of the sustentaculum talus of the calcaneus and corresponding medial talar articulation with cysts in the underlying medullary space and irregularity of the articular surface of the middle facet of the subtalar joint. These findings indicate a nonosseous (fibrous) coalition. There is also mild edema-type signal abnormality within the body of the talus underlying the posterior facet of the subtalar joint which may be degenerative in etiology. There is focal signal irregularity of the articular cartilage of the middle of the posterior facet of the subtalar joint which may reflect degeneration. There is mild sclerosis along the angle of Gissane. The tibiotalar joint appears within normal limits.

Output: Findings compatible with nonosseous (fibrous) coalition of the middle facet of the subtalar joint with associated bony deformity and other findings as described above.


Instruction: Generate impression based on findings.

Input: Reason: Assess L knee for cause of diffuse pain History: h/o L knee arthroscopy x 2 (4/2015 and 9/2015) for medial meniscal tear s/p partial medial meniscectomy x 2 and chondroplasty med fem condyle and patellofemoral joint x 2 MENISCI: There is blunting of the posterior horn and body of the medial meniscus likely representing a combination of degeneration, postsurgical change and prior tearing. There is linear increased signal abnormality within the body and posterior horn of the meniscus which extends to the femoral articular surface suspicious for a horizontal tear. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is partial-thickness articular cartilage degeneration along the weightbearing surface of the medial femoral condyle. There is relative sparing of the lateral compartment articular cartilage. There is full-thickness chondromalacia along the medial facet of the patella.LIGAMENTS: There is thickening and increased signal abnormality within the anterior cruciate ligament. The PCL appears intact. The LCL and MCL appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Blunting of the posterior horn and body of the meniscus likely representing a combination of degeneration, postsurgical change and prior tearing. There is linear increased signal abnormality within the body and posterior horn of the meniscus which extends to the femoral articular surface suspicious for a re-tear. 2. Osteoarthritis of the knee with articular cartilage degeneration most pronounced along the medial femoral condyle.3. Small joint effusion.4. Findings indicating mucoid degeneration of the ACL, although this could represent a sprain injury in the correct clinical context.


Instruction: Generate impression based on findings.

Input: T4N2, WHO type III, nonkeratinizing EBV+ nasopharyngeal cancer, status post treatment. Orbits: The globes, ocular adnexa, optic nerves, and orbital fat are unremarkable, without evidence of intraorbital mass lesions. There are post-treatment findings in the nasopharyngeal region, where there is diffuse swelling and associated persistent enhancement of the central skull base, but no measurable residual tumor in the soft tissues. There is diffuse paranasal sinus mucosal thickening and fluid within the bilateral maxillary sinuses and left sphenoid sinus. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is fluid within the bilateral mastoid air cells.

Output: 1. Extensive post-treatment findings in the nasopharyngeal region without definite evidence of measurable tumor progression in this area and no evidence of intraorbital lesions. 2. Persistent enhancement of the central skull base is likely related to sequela of skull base invasion by the tumor and superimposed treatment-effects.3. Inflammatory changes in the paranasal sinuses with evidence of acute sinusitis.4. Persistent bilateral otomastoid effusions, which may be attributable to Eustachian tube dysfunction.5. No evidence of brain metastases.


Instruction: Generate impression based on findings.

Input: Female, 71 years old, history of colon cancer with severe right greater than left back pain. Alignment is anatomic. Vertebral body height and morphology are within normal limits. No pathologic marrow replacement, edema or enhancement is seen. The distal spinal cord and conus are within normal limits. No pathologic intrathecal enhancement is seen. A left renal cyst is noted incidentally.L1-2: Minimal disc bulging. No significant compromise of the spinal canal or neural foramina. L2-3: Mild left facet arthropathy. Minimal disc bulging. No significant compromise of the spinal canal or neural foramina. L3-4: Mild bilateral facet arthropathy. Mild disc bulging. No significant compromise of the spinal canal or neural foramina. L4-5: Moderate bilateral facet arthropathy and ligamentum flavum thickening. An extruded or sequestered disc encroaches upon the right lateral recess through the length of the L4 vertebral body. The source of this herniation is difficult to identify with certainty, but it probably arises from the L4-5 disc rather than the L3-4 disc. The descending right L4 nerve root is likely displaced and impinged by this process. There is a moderate generalized spinal canal stenosis with some crowding of the cauda equina. There is a moderate to severe stenosis of the right neural foramen. L5-S1: Moderate bilateral facet arthropathy and ligamentum flavum thickening. Bulging disc. Mild generalized spinal canal stenosis. Moderate left and mild right foraminal narrowing.

Output: 1.An extruded or sequestered disc is evident effacing the right lateral recess along the L4 vertebral body. The source of this herniation is more likely to be the L4-5 disc rather than the L3-4 disc. The descending right L4 nerve root may be displaced or impinged by this process. There is, in addition, a moderate generalized spinal canal stenosis at L4-5.2.Mild degenerative findings are seen at other levels with no additional areas of significant spinal canal compromise.3.No evidence to suggest osseous metastases.


Instruction: Generate impression based on findings.

Input: Altered mental status. There is no evidence of acute intracranial hemorrhage, mass effect, or acute infarct. There are scattered punctate foci and confluent areas of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter as well as the pons, consistent with moderate chronic small vessel ischemic changes. There are scattered foci of susceptibility artifact within the left basal ganglia and bilateral thalami. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable.

Output: 1.No evidence of acute intracranial hemorrhage, mass effect, or acute infarct. 2.Moderate chronic small vessel ischemic changes.3.Multiple foci of chronic microhemorrhage particularly involving the basal ganglia and thalami, which can be seen with chronic hypertension.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Other cyst of bone, multiple sites [M85.69], Reason for Study: ^Reason: eval bone cyst of cervical fusion mass History: neck pain, bilateral upper extremity symptoms Redemonstration of anterior cervical fusion from C4 to C7 and the C6 and C7 appear to be fused. Susceptibility artifact resulting from instrumentation limiting evaluation of paravertebral soft tissues. Previously seen C6 and C7 posterior left lateral body high signal intensity lesion is still seen. There is no significant interval change since prior scan in terms of size, configuration and MR signal characteristics. On post Gad enhancement, the lesion show relatively homogenous enhancement. The lesion is well circumscribed, not expansile or no evidence of cortical disruption and not change in size since prior scan thus indicate benign or low grade slowly growing in nature.Focal central to left disc protrusion at the level of C23 which abuts thecal sac, unchanged since prior scan.There are multilevel degenerative changes of cervical spine including mild to moderate spinal canal stenosis at the level of C34 and C7T1, unchanged since prior scan.Moderate neuroforaminal stenosis bilateral C7T1 and right side C34, unchanged.

Output: 1. Redemonstration of C4 to C7 anterior fusion status.2. Relatively well defined C6-C7 vertebral body lesions with diffuse enhancement, unchanged.3. Multifocal degenerative changes of cervical spine as described above, unchanged.


Instruction: Generate impression based on findings.

Input: 62 years Female (DOB:1/2/1954)Reason: L2 blastic lesion likely 2/2 breast cancer mets History: lumbar radiculopathyPatient History: Pt. states low back pain - worse to Right side // no known injury or trauma to spine // Pt had Hx. of pain radiating into Right leg - symptoms have improved drastically recentlyPROVIDER/ATTENDING NAME: RICHARD W KANG STEVEN J. CHMURA Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. There is sclerotic lesion present within the L2 vertebral body is low signal on all pulse sequences and has some mild signal heterogeneity within it. In general the marrow has a somewhat heterogeneous appearance which is nonspecific.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is loss of disc space height, disc desiccation and diffuse disc bulge at this level associated with mild narrowing of the spinal canal. There are some mild ligamentum flavum hypertrophy at this level.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is loss of disc space height, disc desiccation and a mild disc bulge at this level associated with some ligamentum flavum hypertrophy and mild narrowing of the spinal canal.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.There is a cystic type lesion in the left kidney which is not entirely included on this exam. There is a tiny cortically based lesion along the left kidney measuring 5 mm at the inferior pole most likely representing a simple cyst. Within the liver there is a low signal focus on the scout views which is not entirely included or evaluated on this exam.

Output: 1.There is a sclerotic lesion within the L2 vertebral body. Additionally the marrow has a somewhat heterogeneous appearance to it. Metastasis cannot be excluded on the basis of this exam. Please refer to bone scan of the same date for further comments. CT may also be of further benefit in evaluating this.2.There are some incidental findings present including an apparent lesion in the liver and another one in the left kidney. The current lumbar MR imaging is not adequate to further characterize these lesions. A CT of the abdomen may be of further benefit in evaluating this. Alternatively ultrasound may help evaluate these.3.There are some mild degenerative changes present in the lower lumbar spine without significant compromise spinal canal or neural foramina.4.Findings were discussed with Dr. Kang at the time of this interpretation


Instruction: Generate impression based on findings.

Input: 77-year-old male with history of alcohol abuse,h hematemesisematemesis, biliary and,. Now drowsy. Nonenhanced head CT:Examination of assay focal area of low attenuation involving the cortex and subcortical white matter of right frontal lobe with subtle focal mass effect. Finding is most suggestive of a subacute minimally hemorrhagic right MCA frontal lobe stroke. This exam is otherwise unremarkable. Recommend follow-up with an MRI examination to exclude the remote possibility of other conditions in particular malignancy.Calvarium is intact. Limited view through the orbits are unremarkable visualized paranasal sinuses and mastoid air cells are unremarkable.The findings were discussed with the clinical service on pager number 3649 at the time of interpretation of exam.

Output: Focal area of low attenuation of the cortex and subcortical white matter of right frontal lobe suggestive of a subacute nonhemorrhagic melanotic hemorrhagic ischemic stroke. To entirely exclude remote possibility of malignancy recommend an MRI examination.


Instruction: Generate impression based on findings.

Input: Left knee pain MENISCI: No significant abnormality noted. No discrete meniscal tear is seen. ARTICULAR CARTILAGE AND BONE: A small focus of signal abnormality in the posteromedial distal femoral metaphysis is probably of no clinical significance. No focal cartilage defects are seen.LIGAMENTS: No significant abnormality noted. The cruciate and collateral ligaments are intact.EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: No specific findings to account for the patient's pain.


Instruction: Generate impression based on findings.

Input: There is a 2 cm craniocaudal x 1.5 cm AP x 1.5 cm transverse dimension heterogeneous and noncystic mass involving the midline nasopharynx.There is slight reversal of upper cervical curvature. 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 positionC2/3: Mild disc bulge without cord encroachment or stenosisC3/4: There is a small focal disc protrusion which indents the anterior midline cord surface without intrinsic cord signal abnormality.C4/5: Posterior osteophyte disc complex containing a left paramedian disc protrusion component as well as bilateral uncinate hypertrophy. There is slight flattening of the left anterior hemicord without intrinsic cord signal abnormality. There are no significant stenoses.C5/6: Posterior osteophyte disc complex, bilateral uncinate hypertrophy, and ligamentum flavum thickening. There is mild central, severe left neural foraminal, and moderate to severe right neural foraminal stenosis.C6/7: Mild posterior osteophyte disc complex and uncinate hypertrophy as well as slight ligamental flavum thickening. There is mild bilateral neural foraminal stenosis.C7/T1: Unremarkable

Output: 1.There is a 2 cm craniocaudal x 1.5 cm AP x 1.5 cm transverse dimension heterogeneous and noncystic mass involving the midline nasopharynx. This should be considered nasopharyngeal carcinoma till proven otherwise, and direct visualization is recommended.2.C5/6: Mild central, severe left neural foraminal, and moderate to severe right neural foraminal stenosis.3.C6/7: Mild bilateral neural foraminal stenosis.4.Findings were discussed with Dr. Crain on 10/5/2015 at approximately 12:05 AM.


Instruction: Generate impression based on findings.

Input: Reason: Pt s/p whipple for ampulla IPMN 12/2014. Post-op course complicated by pancreatic duct leak. Pt is s/p EIS guided pancreatico-gastrostomy 3/2015. Pt with persistent wound drainage. Secretin Stimulating MRCP History: Persistent wound drainage. ABDOMEN:LIVER, BILIARY TRACT: Postsurgical changes of a Whipple procedure. Mild intrahepatic biliary ductal dilatation, unchanged.SPLEEN: No significant abnormality noted.PANCREAS: Postsurgical changes of a Whipple procedure. Prominent pancreatic duct measuring up to 4 mm, unchanged. Focal stricturing immediately proximal to the anastomosis is unchanged. New focal stricture at the level of the body (series 1701 image 1). Interval resolution of previously seen probable pancreatitis. Previously seen small fluid collection along the inferior margin of the liver has increased in size, measuring 4.7 x 2.6 cm (series 601 image 11), previously 2.4 x 2.0 cm. This collection appears to communicate with the pancreatic-jejunal anastomosis. Previously seen drain entering this collection has been removed in the interval. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Focal abnormal signal involving the anterior abdominal wall may represent cellulitis. No abnormal fluid collection to suggest abscess. OTHER: No significant abnormality noted.

Output: 1.Interval increase in size of abnormal subhepatic collection with interval removal of percutaneous drain.2.Stable prominent pancreatic duct with stable proximal stricture. New stricture at the level of the body.3.Interval resolution of diffuse pancreatic inflammation. 4.Focal anterior abdominal wall inflammation. Correlate with cellulitis. No evidence of abscess.


Instruction: Generate impression based on findings.

Input: Left gluteal pain. Evaluate for left hamstring tear. The proximal hamstrings and their tendons appear normal. The signal intensity of the gluteal musculature as well as the remaining visualized musculature is within normal limits. Bone marrow signal intensity is normal. The left hip appears normal with no evidence of effusion, no cartilage defect and a normal-appearing labrum. The pubic symphysis and SI joints appear normal, as does the lower lumbar spine.There is a small synovial herniation pit in the right femoral neck.

Output: Normal-appearing hamstrings and left hip without findings to account for the patient's pain


Instruction: Generate impression based on findings.

Input: Squamous cell carcinoma of the scalp , status post surgery at outside hospital. There are postoperative findings in the left occipital scalp, where there is a wide skin defect at the incision that extends to the underlying dura. There is diffuse patchy enhancement along the margins of the defect and more discrete subcentimeter nodules inferior to the defect. There is also diffusely enhancing tissue between the scalp flap and underlying dura, especially posteriorly, where it measures up to 15 mm in thickness. There is patchy bone marrow enhancement along the margins of the craniotomy and the underlying dura is also diffusely thickened, In addition, there is wispy enhancement along the surface of the underlying left cerebellar hemisphere, with scattered areas of high T2 signal and restricted diffusion. There is also a small area of encephalomalacia in the left cerebellar hemisphere. There are also areas of encephalomalacia in the right corona radiata, right basal ganglia, and left thalamus. There is a background of patchy cerebral white matter T2 hyperintensity. The ventricles are normal in size. There is no midline shift. There are bilateral lens implants. There is mucosal thickening and retention cyst formation in the left maxillary sinus.

Output: 1. Postoperative findings in the left occipital scalp, where there is an open would that extends to underlying dura with diffusely enhancing tissue between the scalp flap and underlying dura, which likely represents granulation and/or inflamed tissue, with what may represent adjacent osteomyelitis and pachymeningitis. Subcentimeter nodules inferior to the defect may represent mildly reactive lymph nodes, although neoplastic deposits remain a potential consideration. Wispy enhancement along the surface of the underlying left cerebellar hemisphere, with scattered areas of high T2 signal and restricted diffusion may represent cerebritis with ischemia.2. Chronic lacunar infarcts in the left cerebellar hemisphere, right corona radiata, right basal ganglia, and left thalamus.


Instruction: Generate impression based on findings.

Input: 55 year old female with primary right ventricular myopathy. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 65%. The LVEDV is 94 ml (normal range 109+/-23), LV end diastolic volume index is 48 ml/m2 (normal range: 65+/-11), LVESV is 32 ml (normal range 31+/-10), and LV end systolic volume index is 17 ml/m2 (normal range 18+/-5). The LV mass is 79 g (normal range 114+/-24) and the LV mass index is 41 g/m2 (normal range 67+/-11). There are no regional wall motion abnormalities present. There is diastolic flattening of the interventricular septum suggesting the presence of right ventricular volume overload. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.There is no LV thrombus. Left AtriumThe left atrium is normal in size. No evidence of atrial septal defect. Right VentricleThe right ventricle is severely dilated with normal systolic function. The overall RV ejection fraction is 61%, the RV end diastolic volume index is 151 ml/m2 (normal range 69+/-14), the RVEDV is 295 ml (normal range 110+/-24), the RV end systolic volume index is 59 ml/m2 (normal range 22+/-8), and the RVESV is 116 ml (normal range 35+/-13). No evidence of focal aneurysm or fatty infiltration.Right AtriumThe right atrium is severely dilated. Aortic ValveThe aortic valve is trileaflet, opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe septal leaflet is apically displaced (1.6cm), relative to the mitral valve plane. There is severe malcoaptation of the leaflets. There is severe tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC is normal in size and drains normally into the right atrium. Severe dilation of the IVC.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. Normal left ventricular size and systolic function (LVEF 65%) without evidence of underlying myocardial fibrosis inflammation or infiltration.2. Severe right ventricular dilation with normal systolic performance (RVEF 61%) without evidence of focal wall motion abnormality or fatty infiltration.3. Severe right atrial dilation4. Severe tricuspid regurgitation with mild coaptation of the tricuspid leaflets. The septal leaflet of the tricuspid valve is apically displaced relative to the mitral valve plane which is somewhat consistent with an Ebstein-like abnormality.5. Severe IVC dilation. 6. No evidence of atrial septal defect. No evidence of anomalous pulmonary venous return.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: chronic pain right shoulder History: as above ROTATOR CUFF: There is low-grade bursal surface fraying at the junction of the supra- and infraspinatus, approximately 12 mm from the insertion. Additionally, there is intrasubstance tearing of the anterior supraspinatus at its insertion, extending over a width of 11 mm, involving greater than 50% of tendon thickness. The subscapularis and teres minor are within normal limits. The rotator cuff musculature is within normal limits.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is branching signal abnormality within the anterior superior labrum, consistent with a SLAP tear.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: 1.Intrasubstance tear of the supraspinatus at its insertion.2.SLAP tear of the glenoid labrum.3.Moderate osteoarthritis of the AC joint.


Instruction: Generate impression based on findings.

Input: Multiple myeloma not having achieved remission [C90.00], Reason for Study: ^Reason: h/o Multiple Myeloma; new onset low back pain, >1 year since prior imaging, please compare to prior imaging. History: h/o Multiple Myeloma; new onset low back pain, >1 year For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. There are multiple variable sized enhancing vertebral body lesions throughout lower thoracic, lumbar and sacral vertebral bodies as well as right ilium indicate multiple myeloma involvement.There is normal lumbar lordosis. The spine alignment is anatomic. The vertebral body height is preserved. The signal of the visualized cord is normal. The conus medullaris terminates at the L1 level.There is no evidence of 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: AP diameter of spinal canal appears to be slightly shorter than usual (9.7mm) minimal bulging of disc with bilateral ligamentum flavum thickening results mild spinal canal stenosis.L3-L4: AP diameter of spinal canal appears to be slightly shorter than usual (8.5mm), diffuse bulging of disc with ligamentum flavum thickening results moderate spinal canal stenosis. L4-L5: diffuse bulging of disc associated with broad based eccentric disc bulging toward right neural foramen narrows right neuroforamen. L5-S1: diffuse bulging of disc, otherwise unremarkable.

Output: 1. Multifocal bony involvements of known multiple myeloma including lower thoracic, lumbar, sacral and right ilium as described above.2. No evidence of vertebral compression fracture. Spinal cord signal intensity is normal.3. Multifocal degenerative changes of lumbar spine. Especially at the level of L34 and L45, there are mild not moderate degree spinal stenosis. 4. Shorter AP diameter of L34 and L45 spinal canal suggest associated possible congenital spinal canal stenosis.


Instruction: Generate impression based on findings.

Input: 62 years Female (DOB:10/26/1953)Reason: Evaluate for lumbar radiculopathy/impingement History: Sciatica, intermittent R foot dropPROVIDER/ATTENDING NAME: SACHIN DILIP SHAH SACHIN DILIP SHAH Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall height. The conus medullaris on sagittal imaging is grossly intact. There is multilevel disc desiccation present.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is a mild disc bulge and some mild facet hypertrophy at this level.At L4-5 there is a moderate degree of facet hypertrophy present associated with ligamentum flavum hypertrophy mild anterior subluxation of L4 and L5, loss of disc space height, disc desiccation and a minor disc bulge. There is some partial effacement of the fat at the lateral recess bilaterally at this level there is some triangulation of the thecal sac and some crowding of the nerve roots. Overall there is a mild degree of spinal stenosis at this level.At L3-4 there is loss of disc space height, disc desiccation and ligamentum flavum hypertrophy. There is epidural fat present at this level which bulges against the posterior aspect of the thecal sac. The thecal sac is narrowed at this level and there is crowding of the nerve roots within the thecal sac.At L2-3 there is no significant compromise to spinal canal or neural foramina. There is mild ligamentum flavum hypertrophy at this levelAt L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: There are degenerative changes present in the lower lumbar spine with some mild subluxation of L4-5 and some mild spinal stenosis at this level. Additionally there is a mild to moderate degree of spinal stenosis at L3-4 related to ligamentum flavum hypertrophy and epidural fat accumulation.


Instruction: Generate impression based on findings.

Input: History of brainstem epidermoid and pituitary adenoma for surveillance. Redemonstrated is a lobulated nonenhancing T2 hyperintense mass centered in the right cerebellomedullary angle cistern that extends into the right foramen of Luschka and encases the right vertebral and posterior inferior cerebellar arteries. The mass is unchanged in size and measures approximately 25 x 25 x 25 mm (AP x TR x CC). There is persistent mass effect on the right middle cerebellar peduncle and brainstem. There is no definite associated diffusion restriction.There is an unchanged pituitary mass that measures up to 16 mm in craniocaudal dimension, which abuts the undersurface of the optic chiasm, left greater than right side. This has progressed in the CC dimension since the more remote exam from 2008.There is no evidence of intracranial hemorrhage or acute infarct. The ventricles are unchanged in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable.

Output: 1. Stable appearance of mass centered within the right cerebellomedullary angle cistern, which likely represents an epidermoid.2. Stable appearance of pituitary mass, which likely represents a macroadenoma.


Instruction: Generate impression based on findings.

Input: Male 55 years old Reason: intermediate risk prostate cancer s/p biopsy oct 2014 History: none PELVIS:PROSTATE:Prostate Size: 2.4 x 4.4 x 4.9 cm Peripheral Zone: Diffuse loss of the normal T2 hyperintense signal throughout the peripheral zone. Small subcentimeter foci of T2 hypointense signal, dark on ADC map lesions in the left mid gland and apex. For example, series 503, image 244, measuring 7 mm. These may correspond to patient's known foci of prostatic carcinoma.Central Gland: Heterogeneous.Seminal Vesicles: No seminal vesicle invasion.Extracapsular Extension: No extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Trace pelvic free fluid.

Output: Subcentimeter hypodense foci within the left peripheral zone which may correspond to patient's known small foci of prostatic adenocarcinoma. No dominant lesion. No evidence of extracapsular extension or seminal vesicle invasion.


Instruction: Generate impression based on findings.

Input: NSCLC brain metastases status post WBRT and SRS to caudate lesion. Now on TMZ+crizotinib. There are innumerable supratentorial and infratentorial metastases, the majority of which demonstrate associated susceptibility effect and ring-enhancement. There has been interval decrease in size of the lesion centered in the right caudate head, which now measures up to 16 mm, previously 19 mm. While most of the other lesions have not significantly changed, there has been slight increase in size and associated edema of a few lesions. There is also progressive leptomeningeal extension associated with some of the lesions and along the partially-imaged cervical spine. There is no evidence of intracranial hemorrhage or acute infarct. There is no midline shift or herniation. The ventricles are unchanged in size and configuration. The skull appears unchanged. However, there has been interval increase in size of a left masseter muscle lesion, now measuring up to 12 mm, previously 8 mm.

Output: 1. Innumerable supratentorial and infratentorial metastases. The lesion centered in the right caudate head has decreased in size. While most of the other lesions have not significantly changed, there has been slight increase in size and associated edema of a few lesions.2. Progressive leptomeningeal extension associated with some of the lesions and along the partially-imaged cervical spine suggestive of leptomeningeal carcinomatosis. 3. Interval increase in size of a probable metastasis in the left masseter muscle.


Instruction: Generate impression based on findings.

Input: A patient submitted outside study for review. Submitted for review are digital mammographic images of right breast (1/6/16, 12/22/15), images from canceled stereotactic biopsy of right breast (1/8/16), images from wire localization for right breast and specimen radiograph (1/25/16), breast MRI (6/17/15) performed at Cerner Imaging. For comparison, breast MRI (12/1/14, 11/14/14), digital mammographic images (11/21/14, 7/23/14, 7/22/13, 1/21/13), ultrasound images (11/21/14) are available. DIGITAL MAMMOGRAPHIC IMAGES OF RIGHT BREAST (1/6/16, 12/22/15):The breast parenchyma is heterogeneously dense (BiRADS Density Category C), unchanged in pattern and distribution. A cluster of developing coarse 5 mm calcifications is present in the right anterior 12:00 position in the right breast. A marker clip is seen at the posterior superior aspect in the right breast.IMAGES FROM CANCELED STEREOTACTIC BIOPSY OF RIGHT BREAST (1/8/16):Stereotactic biopsy of the right breast was canceled due to the presence of vein at close proximity of the target calcifications.IMAGES FROM WIRE LOCALIZATION FOR RIGHT BREAST AND SPECIMEN RADIOGRAPH (1/25/16):Single wire localization was performed for right breast calcifications. A wire was placed by superior - inferior approach. Specimen radiograph demonstrates the target calcifications at the central portion of the specimen. Per pathology report, the result was benign and concordant.BREAST MRI (6/17/15):Breast MRI was performed with a protocol outlined in the outside radiology report. Moderate motion artifacts are seen in the right breast at subtraction images. There are no suspicious enhancing lesions in either breast.

Output: Status post right benign lumpectomy. Screening mammogram for the left breast has not been done for more than one year.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Routine Screening Mammogram.


Instruction: Generate impression based on findings.

Input: 51 year old female with a personal history of benign right breast biopsy. She also has a history of a right thigh liposarcoma. She has a family history of breast cancer in her mother, two maternal aunts, and maternal grandmother. There is heterogeneous amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally. Bilateral cysts are again noted.No new or suspicious enhancement is seen in either breast. There is stability of benign enhancing areas in each breast, including the left inner breast mass, right inner breast non mass enhancement and thin peripheral enhancement around some cysts. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: 50 year-old female with history of pharynx cancer, melanoma. Evaluate for recurrence. Rule out long metastases CT of soft tissues of the neck with infusion:Images through the skull base and including cavernous sinuses remain within normal limits. Mastoid air cells and paranasal sinuses are unremarkable.Images through the neck demonstrate extensive posttherapy and surgical changes on the left side of the neck.Postoperative changes at the level of the left hypopharyngeal wall, left submandibular region and extending to the floor of the mouth and region of the left piriform sinus is associated with some soft tissue fullness in these regions. In comparison with the prior examination there is suggestion of possible slight reduction in the amount of soft tissue fullness in history area. I detect no definitive tumor in this location. Significant distortion of the anatomical landmarks and soft tissue adhesion in the surgical site makes precise evaluation difficult with however as mentioned above no definitive evidence of tumor is detected. This recurrence of tumor is concerned follow up with PET scan or an MRI is recommended. A submental node in the midline is again identified and measures 12.2 x 13.4-mm which is identical to prior examination.No evidence of any pathologic adenopathy in the neck is detected. The bony structures of the area of exam are unremarkable.Limited images of the apices of the lungs demonstrate minimal apical scarring.Limited view of mediastinum is negative. Please review the dictated report of CT of chest performed the same date.CT of brain with infusion:Examination demonstrate no abnormal enhancement of the brain parenchyma or leptomeninges. Cortical sulci, ventricular system and all CSF cisterns remain within normal. Calvarium is intact. No definitive evidence of any abnormality of the soft tissues of the scalp is identified60 CT of Omnipaque 350 was utilized for the above studies.

Output: 1.No detectable tumor or or pathologic adenopathy in the neck.2.Stable prominent submental node as detailed.3.Negative CT of brain and calvarium with infusion.


Instruction: Generate impression based on findings.

Input: 16-year-old male with wrist pain, ulnar sided. Evaluate TFCC. LIGAMENTS: We see no contrast extending from the radiocarpal joint into the midcarpal joint to indicate a tear of the scapholunate or lunotriquetral ligaments.TRIANGULAR FIBROCARTILAGE COMPLEX: Contrast extends from the radiocarpal joint through a small defect in the articular disc of the triangular fibrocartilage into the distal radioulnar joint. The defect is situated approximately 2 mm medial to the distal radius. The ulnar attachment of the triangular fibrocartilage appears intact as do the ulnolunate and ulnotriquetral ligaments.TENDONS: The flexor and extensor tendons appear intact. BONES: The bone marrow signal intensity is within normal limits.

Output: Tear of the articular disc of the triangular fibrocartilage just medial to its radial attachment.


Instruction: Generate impression based on findings.

Input: 84-year-old man with metastatic prostate cancer to lung, liver and lymph nodes. ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in size and smooth in contour. There is an indeterminate T2 hyperintense lesion in hepatic segment 6, unchanged. Hepatic steatosis. The hepatic vasculature appears patent.Status post cholecystectomy with expected prominence of the intra and extrahepatic biliary ducts. SPLEEN: Note is made of small splenule.PANCREAS: There is fatty atrophy of pancreas.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: The kidneys are mildly atrophic and contain multiple bilateral T2 hyperintense cysts which are not significantly changed.RETROPERITONEUM, LYMPH NODES: No suspicious or enlarged lymph nodes.BOWEL, MESENTERY:Stable postsurgical changes of right ileal conduit formation.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Anterior mediastinal lymph node is unchanged (series 5, image 9).

Output: Stable examination with no evidence of recurrent or metastatic disease.


Instruction: Generate impression based on findings.

Input: Clinical question: Facial droop, rule out stroke. Signs and symptoms: Facial droop Not infused CT of brain:A subtle suspected low attenuation of cortex and subcortical white matter of the left inferior frontal lobe and possibly the operculum of left frontal lobe is noted. I cannot entirely rule out possibility of an artifact. Follow-up exam with an MRI is recommended if this finding could explain presenting symptoms. Provided clinical data is not detailed.This finding is notice on axial image 17 through 19.This examination is otherwise unremarkable. Cortical sulci, ventricular system and all CSF cisterns are within normal limits.Calvarium, paranasal sinuses, mastoid air cells and middle ear cavities are well visualized and unremarkable.

Output: 1.Suspected area of low-attenuation in the left frontal lobe may represent an ischemic stroke, possibility of an artifact in this case can not be entirely ruled out. Follow-up with an MRI is recommended.2.Negative CT of brain otherwise.


Instruction: Generate impression based on findings.

Input: Female, 61 years old, with left lower extremity pain status post spinal fusion. Posterior fusion instruments are in place at L5 and S1. Evidence of left partial laminectomy/facetectomy is also seen at this level. Spinal alignment is anatomic. Vertebral body heights are grossly preserved. No concerning marrow replacement or evidence of marrow edema is seen.Visualized distal spinal cord, conus and nerve roots of the cauda equina are within normal limits. No epidural abnormalities are suspected. Tarlov cysts are seen within the sacral spinal canal and along the left S2 nerve root.L1-2: Unremarkable. L2-3: Mild facet hypertrophy and ligamentum flavum thickening. Otherwise unremarkable. No interval changes. L3-4: Mild facet hypertrophy and ligamentum flavum thickening. Otherwise unremarkable. No significant changes. L4-5: Moderate facet hypertrophy and ligamentum flavum thickening. No significant spinal canal stenosis. Possible mild bilateral foraminal narrowing. L5-S1: Postoperative findings as above. Ill-defined soft tissue thickening is seen within the left facetectomy bed extending to some degree into the left neural foramen. Prominent dark signal within the disc space and endplate irregularity are compatible with interbody fusion. There is a small central disc protrusion and perhaps also a small left foraminal protrusion. No significant generalized spinal canal stenosis is seen. The left neural foramen is partly obscured by metallic artifact, though some degree of foraminal narrowing is suspected. The right neural foramen is only mildly narrowed.

Output: 1.Evidence of instrumented posterior fusion and interbody fusion is seen at L5-S1.2.Findings compatible with left facetectomy are also noted at L5-S1. The left neural foramen is partially obscured by metallic artifact, but at least some degree of left foraminal narrowing is suspected. This may be due to a combination of residual disc disease and scarlike soft tissue thickening within the operative bed.3.No significant spinal canal or foraminal stenosis is seen at any other level.


Instruction: Generate impression based on findings.

Input: Clinical question: Cord compression. Signs and symptoms: Metastatic NSCLC, bilateral thigh weakness. Nonenhanced total spine MRI:Examination demonstrate normal anatomical alignment of vertebral column.There is no evidence of a spinal canal compromise or stenosis and no detectable mass effect on the cord or the cauda equina.The signal intensity and caliber of the cord and cauda equina remains within normal.Examination demonstrates a tiny focus of T1 hypointense and T2 STIR hyperintense in the T4 vertebral body, tiny similar lesion in the superior body of L1 and inferior body of T12 and a larger focus with similar signal change in the vertebral body of L5 which considering history of malignancy they could represent small intraosseous metastatic lesions.No detectable. Spinal soft tissue abnormalities.

Output: 1.No evidence of cord compression.2.Small foci of T2 STIR hyperintensity in the vertebral bodies of T4, T12, L1 and L5 which considering patient's history of malignancy possibility of metastatic disease should be considered. Follow-up with further studies is recommended.


Instruction: Generate impression based on findings.

Input: Elevated PSA, history of prostatic malignancy PELVIS:PROSTATE:Prostate Size: Measures 5.2 cm in transverse dimension x 3.4 cm in AP dimension x 4.3 cm in craniocaudal dimension. 1.3 x 0.8 cm ill-defined lesion involving anterior fibromuscular stroma demonstrating low T2 signal and ADC signal, indeterminant but suspicious for malignancy (see key images).BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Ill-defined focus involving anterior fibromuscular stroma demonstrating low T2 signal and ADC signal, indeterminant but suspicious for malignancy


Instruction: Generate impression based on findings.

Input: 56-year-old male with history of alcoholism, hematemesis, leukocytosis, and equivocal ultrasound for cholecystitis. Evaluate. ABDOMEN:LUNG BASES: Small left and moderate right pleural effusions with overlying subsegmental right and left lower lobe atelectasis.LIVER, BILIARY TRACT: Liver measures 21 cm in length. Gallbladder is collapsed with cholelithiasis. No intra hepatic ductal dilatation. There is mild prominence of the common bile duct measuring up to 6 mm.SPLEEN: No significant abnormality noted.PANCREAS: Mild prominence of the pancreatic duct in the pancreatic body is not significantly changed. No evidence of a pancreatic mass.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Moderate volume ascites.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No evidence of cholecystitis.2.Mild prominence of the common bile duct and the pancreatic duct. Findings may be secondary to benign stricture at the level of the ampulla.3.Moderate volume ascites.4.Small left and moderate right pleural effusions with left lower lobe and right subsegmental atelectasis.5.Hepatomegaly.


Instruction: Generate impression based on findings.

Input: History of fever, rash, altered mental status. Rule out meningitis. Rule out abscess, edema. No definitive evidence of any area of low attenuation in the brain parenchyma to suggest presence of edema however the ventricular system is very small and slitlike and there is almost no visualization of cortical sulci and several of the cisterns including quadrigeminal cistern and pineal cisterns appear very small. There is also crowding of the cerebellar tonsils at the level of foramen magnum. The findings are concerning for increased intracranial pressure and possible diffuse cerebral edema. There is also suggestion of enhancement of the leptomeninges overlying the cerebellum and the vermis and possibly some in the bilateral frontal and temporal lobes. Further evaluation with an MRI is highly recommended. There is no evidence of any abscess formation or any extra axial fluid collection.The bony density of calvarium remains within normal. Mastoid air cells, middle ear cavities and all visualized paranasal sinuses remain unremarkable.

Output: Findings highly suspicious for meningitis and possible cerebral edema as detailed above. Further evaluation with an MRI is highly recommended.


Instruction: Generate impression based on findings.

Input: 65-year-old male with HCV cirrhosis complicated by HCC status post treatment. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology is redemonstrated with small amount perisplenic fluid.Redemonstrated is a segment six ablation cavity with intrinsic T1 hyperintensity reflecting expected postablation changes. There is no evidence of arterial enhancement within the ablation cavity or elsewhere in the liver.Cholelithiasis is again noted.SPLEEN: Splenomegaly.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Scattered gastrohepatic, periportal, and retroperitoneal lymph nodes mildly prominent and unchanged.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Limited examination as described in the technique section above.2.Segment 6 lesion treatment cavity without evidence of recurrent or residual disease. No new suspicious liver lesion evident.


Instruction: Generate impression based on findings.

Input: Altered mental status There is restricted diffusion on the right middle and inferior frontal gyrus 8 sulcal effacement indicating acute to subacute ischemic infarct. There is no evidence of hemorrhagic transformation.Redemonstration of multifocal chronic ischemic infarct with encephalomalacia involving right frontal lobe, right temporal occipital lobe, left occipital lobe left precuneus. In addition, there are extensive periventricular white matter high signal intensities on FLAIR imaging indicating nonspecific small vessel ischemic disease. Multiple scattered signal void areas on gradient echo which are associated with encephalomalacia indicate hemorrhage transformation foci. These findings do not show any significant interval change since prior scan.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear. Retention cyst on the left maxillary sinus

Output: Newly right middle and inferior frontal gyri subacute to acute ischemic infarct as described above without evidence of hemorrhage transformation.No change of multifocal chronic ischemic infarct with encephalomalacia.