Instruction: Generate impression based on findings.

Input: 50 year-old male with left temporal mass. Evaluate extent of tumor. Rule out lung metastases. CT of the soft tissues of the neck with infusion:Large destructive mass extending from approximate the level of the left submandibular region superiorly with complete involvement of the left infratemporal fossa and right massive involvement of the left orbit with associated extensive bony destruction, significant bony destruction of Petrus bone on the left and with further superior extension into the left anterior and middle cranial fossa and with invagination into the brain parenchyma is again identified. The mass has multiple internal cystic components and demonstrates enhancement. Within the left middle cranial fossa the tumor appears to extend into the left cavernous sinus, left skull base and left sphenoid sinus. Extensive bony destruction of Petrus bone and with post obstructive opacification of mastoid air cells and middle cavity is noted. There is interval increase in the intracranial component of the tumor since prior exam. This in particular appears as multiple expansile cystic in the uppermost visualized portion of the tumor within the intracranial space. Very significant mass effect with resultant significant anterior displacement of the left globe is again identified. The carotid artery is along the dorsal aspect of the tumor and does not appear to be encased however there is significant mass-effect and posterior displacement of the carotid. Extensive postoperative changes of partial mandibulectomy with a metallic prosthesis is again identified. In comparison with the prior examination there is further erosion of the bone specifically at the level of the glenoid cavity which was identified on prior exam to overlap the head of the prosthesis. The no detectable pathologic adenopathy in the neck is seen.CT of brain with infusion:Interval increase in the size of the intracranial component of the tumor in the left anterior and middle cranial fossa and within the left and trigger frontal and left anterior and mid temporal lobe. Extensive bony destruction is again identified involving the left orbit, left Petrus bone, left frontal bone and temporal bone. There is vasogenic edema surrounding the tumor and significant mass-effect and midline shift. This is study is compared with the most recent MRI examination of brain dated 4 -- 15 -- 2009 which demonstrates significant increase in the midline shift and mass-effect. There is also slight interval increase in the size of right lateral ventricle concerning for early onset of hydrocephalus.68 cc of Omnipaque 350 was utilized for the above studies.

Output: Increase in the size of patient's known tumor in particular in its intracranial component and with associated increase in edema, mass effect, mid line shift and right-sided ventriculomegaly.


Instruction: Generate impression based on findings.

Input: Diagnosis: Other mechanical complication of other internal orthopedic devices, implants and grafts, subsequent encounter. Other mechanical complication of other internal orthopedic devices, implants and grafts, subsequent encounter Five lumbar type vertebral bodies are presumed to be present. The patient was previously status post posterior laminectomies and posterior and anterior fusion at L4-5. The patient is status post more recent anterior fusion using disc spacers at multiple levels which include the lower thoracic and upper lumbar spine disk spaces. Anterior fusion levels visualized on this exam include the T11-T12, T12-L1 and L1-L2 . Since the prior exam additional pedicle screws have been placed at L1 and L2 bilaterally and the interconnecting rods have been extended from the lower thoracic region down to the L2 level.There is contrast enhancement at the vertebral bodies of L2, L1 and T12 and irregularity along the discs at L1-L2, T12-L1 and T11-T12. There is associated perivertebral soft tissue enhancement. Perivertebral soft tissue enhancement appears to extend towards the neural foramina in the upper lumbar spine and lower thoracic spine.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is loss of disc space height, disc desiccation and a diffuse disc bulge at this level. There is bilateral facet hypertrophy present at this level.At L4-5 there is no significant compromise to spinal canal or neural foramina. The L4 and L5 vertebral bodies are fused.At L3-4 there is no significant compromise to spinal canal. There is a left far lateral broad-based disc protrusion present at this level which encroaches on the left-sided exiting nerve roots. There is is associated facet hypertrophy. There is some loss of disc space height present. Overall there is no significant change compared to the prior examAt L2-3 there is no significant compromise to spinal canal. There is a mild posterior subluxation of L2 on L3 which was also present on the previous exam. There is encroachment of the exiting nerve roots bilaterally. The pedical screws appear to be traversing the neural foramina at this level.At L1-2 there is significant artifact which obscures visualization of the spinal canal and neural foramina at this level. To the extent of visualization there is not appear to be spinal stenosis at this level. There is narrowing of the neural foramina bilaterally at level. There is contrast enhancement along the L1 and L2 vertebral bodies and some destruction of the endplates especially the superior endplate of L2.At T12-L1 imaging is obscured by artifact. The neural foramina are narrowed significantly at this level in the spinal canal is mildly narrowed. There is paravertebral soft tissue swelling present and enhancement along the disc space and surrounding the disc spacer. There is some destruction of the superior aspect of the L1 vertebral body and inferior aspect of the T12 vertebral body.There are multiple small renal cysts redemonstrated in the kidneys.There is artifact in the IVC suggesting IVC filter.

Output: 1.The patient is status post additional instrumentation along the lower thoracic and upper lumbar spine. Findings raise the question of discitis and osteomyelitis at the surgical levels especially at the T12-L1 and L1-L2. Imaging is partially degraded by metal artifact which may obscure more subtle abnormalities and partly obscures visualization of the lower thoracic spine and upper lumbar spine. Please refer to CT of the lumbar spine from 12/12/2015 for further comments especially with regards to hardware placement.2.There are degenerative changes present in the lower lumbar spine with some encroachment of the left-sided exiting nerve roots at L3-4 related to a disk protrusion. The patient is status post L4-5 anterior and posterior fusion.


Instruction: Generate impression based on findings.

Input: 4 year old male with status epilepticus. Rule out structural abnormalities. No restricted diffusion to indicate an infarct. No susceptibility weighted abnormalities to indicate hemorrhage. There is diffuse increased prominence of the sulci and ventricles compatible with diffuse parenchymal atrophy, most severe within the temporal lobes. No mass effect, midline shift or herniation. No edema or evidence of a focal lesion. There are no extraaxial fluid collections or subdural hematomas. Diffuse nonspecific mucosal thickening involves the maxillary, ethmoid and sphenoid sinuses. Fluid is noted in the left mastoid air cells.

Output: 1.No evidence of intracranial hemorrhage, edema, mass effect or focal lesion.2.Evidence of diffuse parenchymal atrophy, particularly severe in the temporal lobes.


Instruction: Generate impression based on findings.

Input: 53 years Female (DOB:6/14/1963)Reason: lumbar radiculopathy History: lumbar radiculopathyPROVIDER/ATTENDING NAME: MICHAEL J LEE MICHAEL J LEE Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is mild right-sided facet hypertrophy present.At L4-5 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: No compromise to lumbar spinal canal or neural foramina. There are mild degenerative changes present in the lumbar spine.


Instruction: Generate impression based on findings.

Input: Secondary malignant neoplasm of brain [C79.31] / Secondary malignant neoplasm of other parts of nervous system [C79.49] / Cerebral aneurysm, nonruptured [I67.1], Reason for Study: ^Reason: Brain mets. s/p SRS and WBRT. History: brain mets There is focal enhancing lesion at the right frontal lobe precentral gyrus (series 14, image 137) with surrounding edema indicating possible metastatic lesion. The enhancing lesion appears to be connected with precentral sulcus area. Surrounding T2/FLAIR high signal intensities also appear to be slightly enlarged since prior scan. Reviewing prior scans (10/14/2012 and 4/23/2014), the lesion location is exactly the same as previously noted metastatic lesion. Constellation of above findings suggest the lesion to be a recurrence of the metastatic lesion especially involving cortical surface of precentral gyrus. Differential diagnosis include focal cortical vein thrombosis or subacute ischemic infarction at the pre central gyrus which are less likely.Another enhancing lesion at the left side foramen Luschka area, which is grossly unchanged.Diffuse bihemispheric dural thickening and enhancement are seen, unchanged since prior scan.There is no other new abnormal enhancing lesion.Significant metallic artifacts are seen due to right side surgical clip, unchanged. Left occipital approach catheter is again seen, the catheter tip position is unchanged. The left middle frontal gyrus T2/FLAIR high signal intensity is again seen, unchanged since prior scan and there is no abnormal enhancement.Multifocal FLAIR high signal intensities on bilateral hemispheres unchanged 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 paranasal sinuses and mastoid air cells are clear.

Output: 1. New nodular and curvilinear enhancing lesion at the right precentral gyrus and extends to precentral sulcus implying possible recurrence of metastatic lesion as described above.2. Enhancing lesion at the left side foramen Luschka, diffuse bihemispheric dural enhancement, left occipital approach catheter and multifocal FLAIR high signal intensities are unchanged since prior scan.


Instruction: Generate impression based on findings.

Input: Female 56 years old Reason: 56 yo with PSC please eval for lesion History: none ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. No suspicious hepatic lesions. Hepatic and portal veins are patent. Redemonstrated is the stricture involving the common hepatic duct measuring approximately 2 cm in length. There is mild narrowing of scattered intrahepatic bile ducts. No dominant mass is identified.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Bilateral renal cysts. No hydronephrosis.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Sacral Tarlov cysts.OTHER: No significant abnormality noted.

Output: 1.2 cm stricture of the common hepatic duct without focal mass. Scattered intrahepatic biliary strictures.


Instruction: Generate impression based on findings.

Input: Left toe pain, recurrent, sharp, in the dorsal aspect of the toe around the base of the nail. Question of neuroma or other structural cause of chronic left great toe pain. Subjectively, the nail bed of the great toe appears slightly thickened, but the clinical significance is uncertain and we see no discrete mass. The underlying distal phalanx appears normal. A small amount of fluid is noted in the first interphalangeal and first metatarsophalangeal joints of unlikely clinical significance. There is perhaps mild edema within the medial sesamoid bone beneath the first metatarsal head which may represent a mild stress reaction, but this is of uncertain clinical significance. The flexor and extensor tendons of the great toe appear normal. The remainder of the forefoot appears normal. We see no significant enhancement. We see no neuroma.

Output: Slight subjective thickening of the nail bed is noted, but of questionable clinical significance. We see no mass or other specific findings to account for the patient's pain.


Instruction: Generate impression based on findings.

Input: 47-year-old female with Roux-en-Y, bile duct stricture ABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy and Roux-en-Y. There is very mild intrahepatic biliary ductal dilatation. There is a very short common hepatic duct with trifurcation of the intrahepatic biliary ducts. There is poor delineation of the thin anastomosis to small bowel although no stricture is felt to be present. There is a small T2 hyperintense focus with adjacent probable surgical clip at the porta hepatis corresponding to a cystic collection seen on recent CT. This focus does not demonstrate enhancement and there are no surrounding inflammatory changes.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Moderate prominent porta hepatis lymph nodes.BOWEL, MESENTERY: Status post Roux-en-Y.BONES, SOFT TISSUES: Midline abdominal incision and T2 signal within the subcutaneous tissue of the right anterior abdominal wall may represent changes of surgery.OTHER: No significant abnormality noted.

Output: 1.Status post Roux-en-Y. No stricture is felt to be present at the hepaticojejunostomy. Very mild intrahepatic biliary ductal dilation. 2.Small T2 hyperintense focus adjacent to a probable surgical clip at the porta hepatis corresponding to a cystic collection seen on recent CT. This focus has no surrounding inflammatory changes and does not enhance. Findings favor a residual duct or cystic duct remnant without evidence of complication.


Instruction: Generate impression based on findings.

Input: Clinical question: Reexploration posterior fossa, removal of hardware, placement of 4 ventricular shunt with connection to distal left ventriculoperitoneal shunt and craniotomy Signs and symptoms: Postop follow-up.. Nonenhanced cervical/thoracic MRI:Examination demonstrates extensive postoperative changes of suboccipital midline decompression and extensive metallic hardware placement for craniocervical fusion which results in extensive artifact. There is a catheter/stent device in the fourth ventricle with the superior tip at the superior aspect of the fourth ventricle on the left and the inferior extent appears to lie either within the left cerebellar tonsil or immediately medial to the tonsil. The position of catheter/stent demonstrate no significant change since prior exam however previously noted focus of FLAIR hyperintensity/edema surrounding the catheter is no longer identified likely due to complete resolution. Similar to prior exam the fourth ventricle remains within normal size.Examination demonstrates interval increased size of a previously known expansile syrinx of entire cervical cord with resultant further reduced CSF space throughout the cervical spine.The significantly expansile cervical syrinx extends inferiorly to T7-T8 disc level. There are no prior thoracic MRI exam for comparison. Very extensive postoperative changes and including bilateral transpedicular screw placement throughout the thoracic spine makes precise assessment difficult. Within this limitation there is no convincing evidence of syrinx inferior to T7-T8 disc level.Nonenhanced brain MRI:Examination demonstrates postoperative changes of suboccipital midline decompression with extensive metallic hardware artifact for craniocervical fusion.Diffusion weighted series are severely compromised due to metallic hardware artifact however within this limitation no evidence of restricted diffusion is detected.Linear foci of hemorrhagic FLAIR hyperintensity (L>R) consistent with tracts of previously removed ventricular catheters are again noted. The signal intensity of brain parenchyma is otherwise within normal on all MRI sequences. The ventricular system remains within normal size and with maintained midline. The gray-white matter differentiation is normal.

Output: 1.Nonenhanced MRI of cervical and thoracic spine demonstrate interval increased size of significantly expansile syrinx of entire cervical cord and extending inferiorly to thoracic cord to T7-T8 disc level. Postoperative changes decompression and placement of a catheter/stent within the fourth ventricle demonstrate no significant change and with normal size of fourth ventricle. Previously noted FLAIR hyperintensity surrounding the stent/catheter demonstrate interval resolution. There are no prior thoracic MRI for comparison.2.Nonenhanced brain MRI demonstrate chronic changes secondary to bilateral frontal approach ventricular catheters as detailed, extensive postoperative changes of suboccipital decompression and metallic hardware artifact from craniocervical fusion. Unremarkable exam otherwise and with stable normal sized ventricular system.


Instruction: Generate impression based on findings.

Input: 27-year-old female. Chronic right thumb pain. Evaluate for right thumb basilar joint. LIGAMENTS: Ligaments are normal in signal intensity and morphology without evidence of a tear.TENDONS: Normal signal intensity and morphology of the tendons of the thumb.BONES: No evidence of a fracture. ADDITIONAL

Output: No specific findings to explain the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Right hand weakness which started 2 weeks ago with prior history of stroke. There is interval appearance of a punctate T2 hyperintense lesion in the left precentral gyrus involving the putative hand center without discernible restricted diffusion. There is unchanged encephalomalacia in the right middle cerebral artery territory involving the frontal, parietal, and temporal lobes. There is also encephalomalacia within the bilateral cerebellar hemispheres, left larger than right. There is scattered patchy high T2 signal in the cerebral and pontine white matter. There are probable enlarged perivascular space in the bilateral basal ganglia. There is no evidence of an acute infarct. There is ex vacuo dilatation of the lateral ventricles superimposed on a background of diffuse cerebral volume loss. There is unchanged susceptibility effect in the left superior frontal gyrus, which is compatible with chronic hemorrhage. There is no evidence of mass, midline shift or mass effect. The imaged paranasal sinuses and mastoid air cells are unremarkable. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Interval appearance of a punctate lesion in the left precentral gyrus involving the putative hand center may represent a subacute infarct. Otherwise, extensive areas of chronic infarcts in multiple vascular territories are unchanged.


Instruction: Generate impression based on findings.

Input: 51-year-old male patient with NASH cirrhosis, history of hypoechoic lesions seen on abdominal ultrasound. Evaluate for HCC. ABDOMEN:LIVER, BILIARY TRACT: The liver is cirrhotic in morphology with a nodular contour. There is diffuse interlacing high T2 signal compatible with hepatic fibrosis. Mildly decreased signal on out of phase imaging is compatible with hepatic steatosis. No suspicious arterially enhancing lesion is identified to suggest hepatocellular carcinoma. A subcentimeter T2 hyperintense focus in the caudate lobe is compatible with a cyst. The hepatic veins and portal vein are patent.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Cirrhotic morphology of the liver without suspicious lesion to suggest hepatocellular carcinoma.


Instruction: Generate impression based on findings.

Input: Clinical question: 74 year old male with glioblastoma multiforme. On anticoagulation for acute DVT. Now with acute decline in mental status. Signs and symptoms: Obtunded. Nonenhanced CT of brain:Very poor study due to extensive motion artifact. New since prior examination is a large area of vasogenic edema in the left anterior, mid and posterior temporal lobe with significant effacement of adjacent cortical sulci. There is no significant mass effect on the lateral ventricle and no midline shift is detected. Findings are concerning for increased/recurrence of tumor and should be further evaluated with a dedicated MRI examination.Ventricular system remain within normal size and stable since prior study. No additional findings.

Output: 1.Significant new area of vasogenic edema in the left temporal lobe concerning for increase in the size of patient's known left temporal lobe glioblastoma. 2.No evidence of midline shift or hydrocephalus or any additional findings.3.Follow-up with an enhanced MRI is recommended.


Instruction: Generate impression based on findings.

Input: Female, 14 years old, with Chiari and syrinx, new syrinx growth on recent MRI. The cerebral tonsils descend approximately 5 mm below the level of the foramen magnum, unchanged from prior. Moderate crowding of foramen magnum is redemonstrated. Biphasic CSF flow is noted at the tonsillar tips, without demonstrable flow posteriorly, unchanged.A syrinx cavity is redemonstrated within the central aspect of the cervical cord. The most prominent component begins at the mid C6 level and continues inferiorly to the upper T1 level. At its point of maximum caliber, the syrinx measures up to 4 mm transverse x 3 mm AP which is unchanged. A smaller thoracic syrinx is present demonstrating a skip morphology, extending as far inferiorly as T10/11. The most prominent component is posterior to T4 measuring 2 mm transverse by 1-2 mm AP.Straightening of the cervical lordosis is likely positional. Alignment is otherwise unremarkable. Vertebral body height and morphology are within normal limits. No pathologic marrow replacement or edema is detected. No significant abnormalities of the intervertebral discs are seen. The central canal and neural foramina are patent. The conus is normal in appearance and morphology and terminates at L2.

Output: 1.The cerebral tonsils descend approximately 5 mm below the level of the foramen magnum, unchanged from prior. Biphasic CSF flow is noted at the tonsillar tips, without demonstrable flow posteriorly, unchanged.2.A syrinx cavity is redemonstrated within the central aspect of the cervical cord. The most prominent component begins at the mid C6 level and continues inferiorly to the upper T1 level. At its point of maximum caliber, the syrinx measures up to 4 mm transverse x 3 mm AP which is unchanged. 3.A smaller thoracic syrinx is present demonstrating a skip morphology, extending as far inferiorly as T10/11. The most prominent component is posterior to T4 measuring 2 mm transverse by 1-2 mm AP.


Instruction: Generate impression based on findings.

Input: History of right breast cancer status post lumpectomy and radiation. There is heterogeneous amount of fibroglandular tissue in both breasts.Minimal parenchymal enhancement is noted bilaterally.Right Breast: Postsurgical volume loss of the right breast is stable. Seroma cavity in the right breast 6:00 position measures 37 x 40 mm. Redemonstrated is a 7 mm oval rim-enhancing lesion (the rim enhancement measures up to 2 mm), minimally reduced from prior studies. This lesion has a high signal on T2 weighted sequence which could represent a small fluid collection/chronic inflammation. No additional areas of abnormal enhancement are present.Left breast: No abnormal enhancement is seen in left breast. No abnormal lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. Minimal interval decrease in size of rim enhancing lesion in the right breast anterior to the seroma cavity most likely representing chronic inflammation.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: There is a linear focus of T2 hyperintensity within the left cerebral hemisphere. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. There is minimal facet arthropathy and ligamentum flavum thickening at L4-L5 and L5-S1. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology with the conus terminating at L1. There is no evidence of filar thickening or fibrofatty infiltration and there is normal anterior translation of the conus upon prone positioning. . The craniocervical junction is unremarkable. The paravertebral soft tissues are unremarkable. There is a 3.2cm right adnexal follicle versus cyst.

Output: 1.Unremarkable spine MRI without evidence for Chiari malformation, syringohydromyelia, or tethered cord.2.A small linear focus of T2 hypertensity within the left cerebellar hemisphere is nonspecific and may represent a vascular space or chronic infarct.


Instruction: Generate impression based on findings.

Input: 16-year-old male with history of shoulder dislocation, evaluate for labral tear ROTATOR CUFF: Mild increased signal at the distal supraspinatus tendon consistent with tendinosis. No evidence of discrete tear. Muscles appear normal without atrophy.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: No significant abnormality noted. No definite labral tear.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: Mild distal supraspinatus tendinosis. No discrete labral tear.


Instruction: Generate impression based on findings.

Input: 66-year-old female with HCV cirrhosis ABDOMEN:LIVER, BILIARY TRACT: Marked intrahepatic and extrahepatic biliary ductal dilatation. The common bile duct measures up to 12 mm. Status post cholecystectomy.Unchanged T2 hyperintense lesions in hepatic segment five, seven, eight.Arterially enhancing subcentimeter focus in segment eight without definitive washout is not convincing for HCC (series 10, image 15).SPLEEN: No significant abnormality noted.PANCREAS: Pancreatic divisum. The main pancreatic duct is normal in caliber.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: 5 mm T2 hyperintense cyst in the superior pole of the left kidney likely reflects a benign cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Arterially enhancing segment eight subcentimeter focus without definitive washout is not convincing for HCC. Attention on subsequent studies can be given.2.Additional indeterminate nonenhancing T2 hyperintense lesions as described above.3.Pancreatic divisum.4.CBD dilation measuring up to 12 mm without choledocholithiasis. No obstructing lesion is evident. Ampullary stenosis cannot be excluded.


Instruction: Generate impression based on findings.

Input: 49 year old male patient with history of oligodendroglioma. Evaluate for growth of the grade III oligodendroglioma. There are postsurgical changes of a left superior frontal lobe resection with the resection cavity appearing similar in size compared to the prior study. A rim of T2 hyperintensity around the cavity margins which extends into the corona radiata of the left frontal lobe and inferiorly to the roof of the left lateral ventricle continues to demonstrate slight gradual progression in size across multiple prior studies. There is additional slight interval increase in T2 hyperintensity within the white matter of the right corona radiata. There is no suspicious enhancement with unchanged nodular enhancement projecting into the cavity from the midline falx and linear enhancement along the posterior inferior cavity margin. Susceptibility artifact surrounding the cavity margins is compatible with chronic blood product.A few scattered foci of non-specific T2 hyperintensity seen elsewhere in the brain are not significantly changed. There are no additional areas of pathologic enhancement or extra-axial enhancement are identified. There is no midline shift or herniation. The ventricles are stable in size and configuration.

Output: Post-surgical changes of left frontal tumor resection. There is slight gradual progression of nonenhancing T2 hyperintensity along the resection cavity margin in the left frontal lobe white matter and the contralateral right frontal corona radiata compared to the past few studies. Given history radiation, this may represents evolving post-treatment changes but recommend continued attention on follow-up.


Instruction: Generate impression based on findings.

Input: 4 years Male (DOB:9/13/2012)Reason: tethered cord protocol History: urinary incontinencePROVIDER/ATTENDING NAME: ASHLEY A AXDAHL BAKHTIAR YAMINI Five nonrib-bearing 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. The conus medullaris is anteriorly in the prone position. The inferior tip of the conus medullaris is at the L1-L2 level. There is a transitional vertebra present with partial sacralization of L5.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: No evidence for tethered cord. Please note there is a transitional vertebra present which has been labeled L5 which is partially sacralized.


Instruction: Generate impression based on findings.

Input: Diagnosis: Unspecified cerebral artery occlusion with cerebral infarctionClinical question: r/o mass or new strokeSigns and Symptoms: period of unresponsiveness and shaking There is encephalomalacia involving the right middle cerebral artery territory including right frontal lobe and right parietal lobe and much of the superior temporal gyrus. There is also involvement of the right basal ganglia and insular cortex.There is redemonstration of a small focus of encephalomalacia in the right cuneus of the occipital lobe.There is atrophy of the right middle cerebral peduncle and signal change in the right brain stem compatible with Wallerian degenerationNo new focus of cerebral infarction is identified in the left hemisphere or posterior fossaThere are punctate foci of susceptibility present in the right thalamus and to a lesser degree left thalamus.There are punctate foci of signal loss on susceptibility imaging in the right middle cerebral artery territory infarction.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.Encephalomalacia due to large right middle cerebral artery territory cerebral infarction now associated with a well-aerated degeneration.2.Remote right occipital lobe small infarct3.No evidence for acute cerebral infarction4.Thalamic microhemorrhages


Instruction: Generate impression based on findings.

Input: Acute SAH, Angio negative Brain MRI:There are multiple bihemispheric and supra and infratentorial diffusion restricted lesions indicating acute ischemic lesions. Considering the patient had prior diagnostic catheter cerebral angiography, these lesions are likely related to the procedure. The ventricles, sulci and cisterns are symmetric and unremarkable. Obliteration of bilateral temporo-occipital area sulci indicate redistribution of subarachnoid hemorrhage.There is no mass, mass effect, edema, midline shift. 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 right side of sphenoid sinus.C-Spine:There is normal cervical lordosis. The cervical spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. Degenerative changes are as follows;C12: Disc degeneration. Otherwise unremarkable. C23: Disc degeneration. Otherwise unremarkable.C34: Disc degeneration. Minimal narrowing of the right side neural foramen, otherwise unremarkable.C45: Disc degeneration. Minimal to moderate spinal stenosis due to ligamentum flavum thickening and posterior longitudinal ligament thickening. Bilateral neural foramen appear to be narrowed.C56: Disc degeneration. Minimal spinal stenosis. Diffuse narrowing of bilateral neural foraminal stenosis.C67: Disc degeneration. Otherwise unremarkable.

Output: 1. Multiple diffusion restriction lesions as described above.2. Degenerative spondylosis of C spine with multifocal various degreed neural foraminal stenosis and spina stenosis as described above.


Instruction: Generate impression based on findings.

Input: Unspecified diffuse connective tissue disease [710.9], Reason for Study: ^Reason: MCTD Cognitive impairment History: cognitive impairment No evidence of acute ischemic or hemorrhagic lesion.On FLAIR imaging, there are scattered high signal intensities on deep white matter and periventricular white matter indicating nonspecific small vessel ischemic disease, no change since prior scan.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses are clear.There are fluid collections on the right mastoid air cell.

Output: No evidence of acute ischemic or hemorrhagic lesion.Minimal nonspecific small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: Pre-Op stealth MRI prior to transphenoidal hypophysectomy. Pituitary: There is a pituitary mass with suprasellar extension that measures up to 29 mm. There is associated mass effect upon the optic apparatus, cavernous sinuses, and hypothalamus. Although the tumor abuts and perhaps partially encases portions of the internal carotid arteries, the flow voids are intact. Brain: There are two adjacent enhancing extra-axial masses along the left superior frontal convexity that measure up to 9 mm in width and 14 mm in width. The larger lesion demonstrates associated hyperostosis of the calvarium. There is no significant mass effect upon the underlying brain parenchyma. There are minimal scattered foci of nonspecific cerebral white matter T2 hyperintensity. There is no evidence of acute infarct. There are mild scattered nonspecific foci of T2 hyperintensity in the cerebral white matter. There is diffuse cerebral volume loss. There is no midline shift or herniation. There is a right scleral band and bilateral lens implants. There are secretions in the right frontoethmoid recess. There is nasal septal deviation to the left. There are fiducial markers on the scalp.

Output: 1. Pituitary macroadenoma measuring up to 29 mm with supersellar extension and mass effect upon the optic apparatus, cavernous sinuses, and hypothalamus. 2. Two adjacent meningiomas along left superior frontal convexity that measure up to 9 mm in width and 14 mm in width. 3. Nasal septal deviation to the left.


Instruction: Generate impression based on findings.

Input: 55 year old female with metastatic breast cancer who presents with left-sided blurry vision. Rule out metastases disease to the eye or brain. Expansile lytic destructive changes of calvarium consistent with metastatic lesions are again identified. There is significant interval increase in the size of lesions since prior study. There is no apparent epidural spread of tumor into the spinal canal. This can be significantly better visualized on MRI exam. The brain parenchyma remains normal in density and demonstrates no abnormal enhancement of the right parenchymal or the meninges. There is also suggestion of new additional metastatic lesions to the calvarium.Expansile mixed density left frontal bone lesion with significant extension into the right orbit is consistent with fibrous dysplasia is again identified with no interval change.CT of maxillofacial. Significant expansion of right frontal bone in all of its segments and in particular along the floor of the right anterior cranial fossa is noted. The changes extends medially and involves the fovea ethmoidalis and the left frontal bone and is contiguous with fibrous dysplasia changes of sphenoid bone. Significant expansion of the right frontal bone causes elevation of right frontal lobe. Expansile changes of right frontal bone reduces the carinal cephalad axis of the right orbit and applies mass effect on the external ocular musculature and globe. Coronal reformatted images demonstrate these findings with better advantage. There is fibrous dysplasia of left frontal bone along the floor of the anterior cranial fossa. There is mild compromise of the left optic nerve canal and likely the right optic nerve canal secondary to fibrous dysplasia changes at the level of planum sphenoidale. The retro-orbital fat, extraocular musculature and globe remains normal on the left.

Output: 1.Increase in the size of lytic destructive metastatic lesions of the calvarium with no apparent extension into the intracranial space.2.No evidence of edema brain parenchyma or abnormal enhancement of the brain or leptomeninges.3.Large fibrous dysplasia of right and to a lesser degree left frontal bones with associated changes of the orbit as detailed above.


Instruction: Generate impression based on findings.

Input: History of renal transplant and disseminated nocardia, follow-up examination. Redemonstration of multiple lesions with surrounding edema throughout both cerebral hemispheres. Interval increase in edema involving the left occipital, left parietal and right temporal lesions. These lesions again demonstrate diffusion restriction. There is been interval resolution of multiple T2/FLAIR hyperintense foci involving the right thalamus, and the right cerebellum. The remainder of the lesions appear similar to prior exam. No new lesions are identified.Few of the lesions again demonstrate minimal susceptibility artifact, but no significant intracranial hemorrhage. T2 hyperintense signal in the posterior medulla and pons appear similar to prior exam and remains of uncertain etiology. Ventricles are normal in size and stable.

Output: Redemonstration of multiple lesions within both cerebral hemispheres, with a mixed response as described above.


Instruction: Generate impression based on findings.

Input: Male, 78 years old, with right hand spasms and shaking, calcified left cerebral lesion on prior outside imaging. An ill-defined T2 hyperintense, somewhat bubbly appearing lesion is evident centered on the left perirolandic gyri. Thickened and nodular infiltrative tissue also extends inferiorly along the left periatrial region causing pinching of the atrium, as well as anteriorly into the left thalamus.The core of the lesion is coarsely mineralized as evident on CT, and there is corresponding susceptibility effect on MRI. The lesion is persistently and faintly diffusion restricting, particularly an oval component in the left paracentral lobule.On comparison with prior examinations, certain lobular components of the lesion may be slightly increased in size. However, the overall geographic involvement is not significantly changed.Portions of the lesion core are intrinsically T1 hyperintense which may reflect the known mineralization. However, clear superimposed enhancement is observed, and on comparison to the prior contrast-enhanced examination from 2015, multiple curvilinear and fingerlike areas of enhancement are new or larger.Elsewhere, numerous scattered foci of periventricular and subcortical white matter T2 hyperintensity are demonstrated. No additional enhancing lesions are seen. No acute intracranial hemorrhage is suspected. Ventricles and sulci are mildly prominent compatible with parenchymal volume loss.

Output: Redemonstrated is a coarsely mineralized, ill-defined and somewhat infiltrative lesion occupying the left perirolandic gyri, the periatrial tissues and the thalamus. Although the geographic extent of the lesion has not significantly changed when compared to prior examinations, individual components of the lesion may be slightly larger. In any event, several areas of curvilinear and fingerlike enhancement have progressed. Several components of the lesion demonstrate persistent diffusion restriction which raises concern for a hypercellular process.The differential diagnosis would include a primary brain tumor with slow progression or degeneration to a more malignant grade. Oligodendroglioma, ependymoma, and glioneuronal histologies could present in this way. Although somewhat atypical, an astrocytic tumor can also be considered. Nonneoplastic etiologies, such as a smoldering inflammatory process or a burned out vascular malformation, would be diagnoses of exclusion.


Instruction: Generate impression based on findings.

Input: Follow up pituitary adenoma treated with cabergoline. There is overall continued interval decrease in size of the pituitary tumor, particularly the suprasellar component that extends along the planum sphenoidale. Indeed, the tumor measures up to 22 mm in the craniocaudal dimension, previously 27 mm. There is consequently decreased mass effect upon the right gyrus rectus and optic apparatus. There is mild volume loss in the anterior gyrus rectus, perhaps related to chronic ischemia from mass effect. There is persistent extension of tumor in the bilateral cavernous sinuses, left greater than right, with encasement of the left cavernous internal carotid artery, but less mass effect. The infundibulum is deviated to the right.

Output: Continued interval decrease in size of the pituitary macroadenoma.


Instruction: Generate impression based on findings.

Input: There is near diffuse effacement of the CSF space within the visualized thecal sac. There is a large dorsal epidural fluid collection with CSF signal beginning possibly as high as mid C4 vertebra extending inferiorly to the thoracolumbar junction. This measures up to 7 mm in greatest thickness, with a possible additional small ventral component along the upper thoracic spine as suggested on sagittal gradient echo images. Inferior to the thoracolumbar junction, the fluid collection becomes circumferential and occupies the ventral and dorsal epidural space. The proximal thoracic cord is displaced slightly more anteriorly within the thecal sac when compared to the prior MRI cervical spine images. Gradient echo images do not suggest any significant susceptibility within the collection to suggest blood products. A small subdural component cannot be excluded. There is moderate to severe narrowing of the thecal sac with bunching of the cauda equina distal to the level of the conus medullaris. The conus terminates at the L1 level.The lumbar spine is otherwise in normal alignment, with a normal lumbar lordosis. The vertebral body and disc heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. There is no significant disc bulge or herniation within the lumbar spine. No abnormal cord signal is appreciated.The bladder is moderately distended.

Output: Extensive epidural collection at the dorsal aspect of the entire thoracic spine and surrounding the cauda equina producing moderate to severe narrowing of the distal thecal sac as well as complete effacement of CSF space along the entire thoracic cord. Possible small ventral component in the epidural space along the upper thoracic cord, with trace extension dorsally of the collection likely up to the mid C4 level. Findings are likely related to a CSF leak given the signal intensity of the fluid without definite evidence of epidural blood products. A small subdural component cannot be excluded. This collection was noted to be essentially occult on CT given its CSF density.Follow-up imaging should include the entire spine, rather than just the thoracic spine.Findings discussed with Dr. Frim by Dr. Carina Yang at the completion of the examination on 2/24/15 at 1:30 pm.


Instruction: Generate impression based on findings.

Input: Reason: Chiari 1 malformation History: headaches MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. Metal artifact from the patient's oral cavity - presumably from dental hardware - partially degrades imaging and obscures visualization of the orbits. The DWI and SWI images are significantly degraded.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate partial opacification of the visualized portions of the sphenoid sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.There is no evidence for Chiari one malformation. The cerebellar tonsils are low lying extending approximately 2 to 3 mm below the level of foramen magnumMRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal enhancing lesions are identified in the cervical spine.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.Thoracic spine:The thoracic vertebral bodies are appropriate in the overall alignment and height. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots. No abnormal enhancing lesions are identified in the thoracic spine.Lumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. No abnormal enhancing lesions are identified in the lumbar spine.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.The cerebellar tonsils are low lying. There is no convincing evidence for Chiari I malformation.2.There is no evidence for ventriculomegaly of syrinx.3.There is no compromise to the cervical, thoracic or lumbar spinal canal or neural foramina.4.Exam is somewhat degrade by metal artifact related to the patient's dentition.


Instruction: Generate impression based on findings.

Input: 32-year-old male post resection of meningioma Post operative changes is post left temporal and frontal craniotomy again noted. Epidural fluid/air collection under the craniotomy flap as well as residual air in the subarachnoid space compatible with expected postoperative changes is stable in appearance. There is no evidence of intraparenchymal or extra-axial hemorrhage. Hypoattenuation in the anterior left temporal lobe adjacent to the surgical bed time, corresponding to area of restricted diffusion seen on prior MRI, is better defined on today's exam. Again noted minimal bulge of the left temporal lobe toward the basal cistern and left perimesencephalic cistern, stable.The appearance of ventricular system and the basal cisterns is unchanged compared to prior exam. There is no midline shift or hydrocephalus. Focus of high density above the left anterior clinoid corresponds to previously identified lytic or sclerotic left supraclinoid internal carotid artery, unchanged.Again noted cystic left cerebellar structure with CSF density, unchanged.The orbits are unremarkable. Left maxillary retention cysts are noted. Otherwise the visualized paranasal sinuses and mastoid air cells are well pneumatized.

Output: 1.Expected postoperative changes status post left frontal and temporal craniotomy as described above.2.Evolutionary change of left temporal lobe hypoattenuation corresponding to previously seen restricted diffusion compatible with infarct in left middle cerebral artery distribution.3.Unchanged posterior cranial fossa cyst.


Instruction: Generate impression based on findings.

Input: Reason: C6 vertebral body lesion, no abnormality on CT scan, and only site of uptake on bone scan History: above Serial CT images obtained during the biopsy procedure demonstrate the needle placement within the C6 vertebra. Post biopsy images do not demonstrate a hematoma

Output: C6 vertebral bone biopsy under CT guidance. A total of seven samples in three containers were delivered to pathology for analysis.


Instruction: Generate impression based on findings.

Input: Hamartoma and gelastic seizures: for use during laser ablation There are interval findings related to repeat laser ablation of the hypothalamic hamartoma with peripheral enhancing along the margins of the ablation zone and perhaps slight increase in size of the hamartoma. There is mass effect upon the optic apparatus, although it demonstrates normal signal. There is a non-enhancing T2 hyperintense focus in the region of the right anterior frontal lobe subcortical white matter that measures up to 12 mm, which has gradually increased in size. There is no evidence of acute cerebral infarction or hemorrhage. The ventricles are unchanged in size. There are findings related to prior frontal craniotomy and transcallosal surgery. There are small retained secretions within the left sphenoid and ethmoid sinuses. There is a small amount of persistent high T2 signal within the right mastoid tip air cells.

Output: 1. Expected findings related to repeat MRI guided laser ablation of a hypothalamic hamartoma. 2. A nonspecific lesion in the region of the right frontal lobe that measures up to 12 mm has gradually increased in size. This may represent a hamartoma of low-grade neoplasm.


Instruction: Generate impression based on findings.

Input: Male 61 years old Reason: elevated PSA History: elevated PSA PELVIS:PROSTATE:Prostate Size: 4.6 x 3.9 x 5.1 cmPeripheral Zone: No significant abnormality noted.Central Gland: Heterogeneous. There is a poorly defined area of T2 hypointense signal at the level of the mid prostate in the right central gland (series 901, image 10) which measures approximately 1.9 x 1.4 cm. This enhances with the transition zone and is mildly dark on the ADC map.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: Trace fluid in the bilateral hip joints. Trace fluid in the right inguinal canal.OTHER: No significant abnormality noted.

Output: 1.Focal area of T2 hypointense signal within the right central gland. While this may represent benign prostatic hypertrophy given its ill definition and the patient's elevated PSA prostatic carcinoma cannot be excluded.


Instruction: Generate impression based on findings.

Input: Clinical question: History of breast cancer. Patient complaining of headaches and nausea. Status post chemotherapy. Signs and symptoms: History of breast cancer. Complaining of headaches and nausea. Status post chemotherapy. Pre and post enhanced brain MRI:Negative diffusion weighted series.Examination demonstrate normal anatomical development, morphology and signal intensity of brain on all MRI sequences.Unremarkable cerebral cortex, cortical sulci, ventricles or system, CSF spaces and brain myelination.There is no detectable abnormal parenchymal or leptomeningeal enhancement to suggest metastatic disease.Unremarkable images through the orbits including axial fat sat post enhanced series.Calvarium demonstrate normal signal intensity and without abnormal enhancement.The signal voids of major intracranial arterial branches are identified.The signal intensity of intracranial venous sinuses are within normal and with normal pattern of enhancement.

Output: 1.Unremarkable pre and post enhanced brain MRI.2.Unremarkable calvarium, paranasal sinuses and mastoid air cells.


Instruction: Generate impression based on findings.

Input: Left hip pain The exam is limited by motion artifact.Tendons: The gluteus medius and gluteus minimus tendinous insertions on the greater trochanter are intact. The iliopsoas tendon is intact. The hamstring tendon origin is intact.Joints: The hip joints are normal. No cartilaginous defect is seen. The acetabular labrum is intact. The sacroiliac joints appear unremarkable and without evidence of erosion or significant degenerative change. The pubic symphysis is unremarkable.Joint effusion/Bursa: No evidence of joint effusion. No trochanteric bursitis present.Muscles: No muscle atrophy or tear seen.Nerves: The sciatic nerve bundles are intact and unremarkable.Bone marrow: No focal marrow replacing lesions are identified. There is no fracture.Internal organs: Limited evaluation of the internal organs of the pelvis does not demonstrate a focal abnormality, although note is made that the study is tailored for evaluation of the musculoskeletal structures of the pelvis.

Output: Normal MRI of the pelvis and hips.


Instruction: Generate impression based on findings.

Input: 19-year-old male with hypertrophic obstructive cardiomyopathy. Baseline exam for heart transplant evaluation. LIVER:The liver measures 15.1 cm in length. Normal echogenicity of the hepatic parenchyma. Dilated hepatic veins are compatible with history of heart failure. No suspicious lesions. The main portal vein demonstrates normal hepatopedal flow and velocity measuring 19.8 cm/s.GALLBLADDER, BILIARY TRACT: The distal CBD measures 3.5 mm in diameter, and the common bile duct at the porta hepatis measures 3 mm in diameter. No intra or extrahepatic biliary ductal dilatation. Normal distention of the gallbladder without intraluminal stones or wall thickening.PANCREAS: The visualized aspect of the pancreas is within normal limits. Incomplete visualization of the pancreatic body and tail due to overlying bowel gas.SPLEEN: The spleen measures 9.5 cm in length. Normal echogenicity.KIDNEYS: The right kidney measures 9.6 cm in length. No hydronephrosis. Normal echogenicity. The left kidney measures 10 cm in length. No hydronephrosis. Normal echogenicity. ABDOMINAL AORTA: Patent abdominal aorta with normal spectral Doppler waveforms. Abdominal aortic diameter measurements include:Proximal aorta: 2.1 x 2.1 cmMid aorta: 1.7 x 1.5 cmDistal aorta: 1.4 x 1.4 cmRight iliac artery: 1.1 x 1.1 cmLeft iliac artery: 1.1 x 1 cmINFERIOR VENA CAVA: The IVC is patent and has a normal waveform.OTHER: The urinary bladder is distended and shows no acute abnormality.

Output: Dilated hepatic veins are compatible with history of heart failure. Otherwise, normal abdominal ultrasound.


Instruction: Generate impression based on findings.

Input: Left parietal lesion and right pulsatile tinnitus. MRI: There is an unchanged subcentimeter globular enhancing focus in the left cerebellopontine angle cistern that appears to be continuous with the left petrosal sinus. There is an unchanged non-enhancing patchy area of white matter T2 hyperintensity in the left parietal lobe with blurring of the grey-white matter junction. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is moderate scattered paranasal sinus mucosal thickening.MRA: There is no evidence of significant steno-occlusive lesions or arteriovenous malformations.

Output: 1. Unchanged left parietal lobe lesions may represent focal cortical dysplasia, sequela of prior injury, and perhaps less likely neoplasm, for example.2. Subcentimeter left cerebellopontine angle varix versus less likely an aneurysm. Otherwise, no evidence of cerebral significant steno-occlusive lesions or arteriovenous malformation, within the limits of the modality.3. Scattered paranasal sinus mucosal inflammatory disease.


Instruction: Generate impression based on findings.

Input: Reason: H/o smoldering MM, re-staging CT/PET needed. History: H/o smoldering MM, re-staging CT/PET needed. There is slight diffuse heterogeneity of the bone marrow signal intensity, but we see no focal bone marrow lesions. We see no abnormal enhancement of the bone marrow or the visualized joints. The musculature of the pelvis is unremarkable. There is a 2.8 cm right adnexal focus of with fluid signal intensity likely representing a physiologic cyst in a patient of this age. Note is made of nabothian cysts.

Output: Slight heterogeneity of the bone marrow signal intensity is nonspecific and could simply represent red marrow or low tumor burden, but we see no focal lesions.


Instruction: Generate impression based on findings.

Input: Female, 71 years old, with history of brain metastases, assess for interval changes. Irregular enhancement along the cortex of the right inferior parietal lobule has subjectively become slightly more prominent with slightly increased FLAIR hyperintensity. A punctate focus of enhancement along the cortex of the left postcentral gyrus has not significantly changed. No new enhancing lesions are seen.No significant generalized parenchymal edema or mass effect is noted. No abnormal extra-axial fluid collections are observed. The ventricles remain normal in size and morphology.

Output: 1.The previously treated left precentral gyrus lesion remains stable relative to the prior examination.2.Irregular enhancement along the cortex of the right inferior parietal lobule has very slightly increased in prominence with a slight associated increase in FLAIR hyperintensity. Although this minimal degree of change is probably not adequate to allow for a confident diagnosis of progressive metastatic disease, close interval follow-up is advised.3.No new intracranial lesions are detected.


Instruction: Generate impression based on findings.

Input: Reason: Is there a stroke or metastatic lesion? History: altered mental status in lung cancer patient There is significant motion artifact present which may obscure subtle abnormalities. Faster sequences were used.No foci of diffusion restriction are identified in the brain parenchyma.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Incidental note is made of a developmental venous anomaly along the medial aspect of the right parietal lobeBiventricular diameter is 43 mm and previously was the same. They are slightly large. In 2010 it was 36 mm.SWI images are suboptimal . A previously noted right temporal lobe microhemorrhage cannot be evaluated on the current exam.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.The ventricles are disproportionally large compared to the sulci (they have enlarged since 2010). The possibility of normal pressure hydrocephalus cannot be excluded.2.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 3.There is no evidence for acute ischemic cerebral infarction.4.To the extent of visualization no brain metastases are appreciated.5.There is significant motion artifact present which may obscure subtle abnormalities. Faster sequences were used which are not as sensitive as conventional sequences.


Instruction: Generate impression based on findings.

Input: Right lumbar radicular pain Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: No compromise to lumbar spinal canal or neural foramina.


Instruction: Generate impression based on findings.

Input: 70 year old female patient with history of RCC x 4 with a right renal mass and right flank pain. ABDOMEN:LIVER, BILIARY TRACT: Multiple scattered lobulated T2 hyperintense hepatic lesions likely represent hemangiomas when compared to an OSH MRI with contrast from 7/23/2012.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Status post left adrenalectomy.KIDNEYS, URETERS: Status post left nephrectomy without specific evidence of disease recurrence in the left nephrectomy bed.A heterogeneous and complex lesion in the right interpolar region continues to slowly enlarge measuring approximately 2.1 x 1.9 cm (image 28, series 7), previously 1.8 x 1.6 cm. A septated right inferior pole cystic lesion is grossly stable measuring 1.8 x 1.0 cm (image 33, series 7), previously 1.6 x 1.0 cm. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Bilateral breast prostheses are partially imaged.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: The uterus is atrophic or absent.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Progressive enlargement of a right interpolar complex lesion which most likely represents renal cell carcinoma.2.No specific evidence of disease recurrence on the left.


Instruction: Generate impression based on findings.

Input: Cervical spine:Alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign. The cervical cord is normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.C2/3: Unremarkable and unchangedC3/4: Unremarkable and unchangedC4/5: Unremarkable and unchangedC5/6: Mild disc bulge and mild left uncinate hypertrophy. There is mild left neural foraminal stenosis. This findings are unchanged.C6/7: Unremarkable and unchangedC7/T1: Unremarkable and unchangedThoracic spine:There is a smooth, physiologic thoracic kyphotic curve. The vertebral body heights and disc spaces are maintained. Marrow signal intensity is benign throughout. The spinal cord has a smooth contour and is without focal atrophy, edema, or myelomalacia. There are no masses.A small Schmorl's node involves the superior endplate of T5.T1/2 demonstrates no significant disc bulge or cord encroachment.T2/3 demonstrates no significant disc bulge or cord encroachment. T3/4 demonstrates no significant disc bulge or cord encroachment. T4/5 demonstrates no significant disc bulge or cord encroachment. T5/6 demonstrates no significant disc bulge or cord encroachment.T6/7 demonstrates no significant disc bulge or cord encroachment. T7/8 demonstrates no significant disc bulge or cord encroachment. T8/9 demonstrates no significant disc bulge or cord encroachment. T9/10 demonstrates no significant disc bulge or cord encroachment.T10/11 demonstrates no significant disc bulge or cord encroachment. T11/12 demonstrates no significant disc bulge or cord encroachment. T12/L1 demonstrates no significant disc bulge or cord encroachment. Lumbar spine:Alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign. The conus is normal in signal and morphology and terminates at an appropriate level. The visualized intra-abdominal and paraspinal contents are unremarkable.L1/2: Unremarkable and unchangedL2/3: Unremarkable and unchangedL3/4: Unremarkable and unchangedL4/5: Unremarkable and unchangedL5/S1:Mild disc bulge without stenosis, unchanged

Output: 1.C5/6: Mild left neural foraminal stenosis, unchanged.2.A small Schmorl's node involves the superior endplate of T5.3.L5/S1:Mild disc bulge without stenosis, unchanged


Instruction: Generate impression based on findings.

Input: 32-year-old male with history of Crohn's disease. 16 years ago, now presenting with new right scrotal pain ABDOMEN:LUNG BASES: There is and 19 x 13 mm air space opacity in the right lower lobe. There are smaller, round opacities in the right lower lobe around this larger opacity. Further evaluation of these lesions with chest CT is recommended. Linear atelectasis at the left lung base.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Left lower quadrant ileostomy. No evidence of bowel obstruction.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Subtle, linear increased density in the left ischiorectal fossa. This may represent inflammatory changes, however, a fistula tract cannot be excluded. Further evaluation with MRI in helpful.

Output: Multiple airspace opacities in the right lower lobe, one of them measuring approximately 2 cm.. Given the young age of the patient, these may represent inflammatory/infectious changes, however, neoplasm cannot be excluded. Further evaluation with chest CT is recommended.Inflammatory changes in the pelvis, more prominent on the left side. MRI of the pelvis may be helpful for better characterization of these changes and to evaluate for a possible fistula.


Instruction: Generate impression based on findings.

Input: Diagnosis: Secondary malignant neoplasm of brainClinical question: history of metastatic RCC to brain s/p resection. MRI for radiation treatment planningSigns and Symptoms: headacheComments: MRI must be down with contrast even with low GFR. | MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate opacification of the sphenoid sinuses and scattered opacities in the posterior ethmoid air cells. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI pituitary:There is a 16 x 12 mm sagittal dimension sellar and suprasellar mass which bulges into the medial aspects of the cavernous sinuses. It is associated with superior displacement of the optic chiasm. This has not changed substantially in size compared to the prior exam.The patient status post transsphenoidal surgery.The cavernous sinuses are intact bilaterally.

Output: 1.Compared to the prior exam from December 16, 2015 there is no significant change in the size of the patient's sellar and suprasellar mass which is known to represent metastatic clear cell renal cell carcinoma.2. The patient is status post transsphenoidal surgery.3.There is no evidence for brain metastases.


Instruction: Generate impression based on findings.

Input: Cirrhosis. Recent CT demonstrating a 12 mm enhancing nodule without washout. ABDOMEN:LIVER, BILIARY TRACT: Nodular contour and diffuse reticular T2 hyperintensity compatible with cirrhosis. Multiple subcentimeter T2 isointense arterially-enhancing lesions without washout are seen, compatible with regenerative nodules, including the 10 mm segment 8 lesion seen on the prior CT (series 10, image 20). A 9 mm arterially enhancing lesion in the anterior aspect of segment 3 (series 10, image 31) demonstrates washout on delayed phase and lack of uptake on hepatobiliary phase (series 10, image 225), compatible with hepatocellular carcinoma.No biliary ductal dilation. Trace perihepatic ascites. SPLEEN: Mild splenomegaly.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1.Cirrhotic liver morphology with a 9 mm enhancing lesion in segment 3 demonstrating washout, compatible with hepatocellular carcinoma.2.Multiple subcentimeter arterial enhancing lesions most compatible with regenerative nodules.


Instruction: Generate impression based on findings.

Input: 77-year-old male with left adrenal mass which is hypermetabolic on recent PET scan. ABDOMEN:LIVER, BILIARY TRACT: 1.8 x 1.9 cm cystic lesion in segment 4a/b with thin internal septations and no significant enhancement, most likely a benign complex cyst (series 801/21). Additional scattered subcentimeter T2 hyperintense lesions are too small to characterize but likely benign cysts.SPLEEN: Small splenule noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: 3.3 x 3 cm left adrenal mass demonstrating loss of signal on opposed phase images and most compatible with benign adenoma (series 801/22).KIDNEYS, URETERS: Subcentimeter T2 hyperintense lesions in both kidneys are too small to characterize but likely benign cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Left adrenal mass is most compatible with a benign adenoma, but a single follow-up in 12 months is recommended given its size.2. No evidence of metastatic disease in the abdomen.


Instruction: Generate impression based on findings.

Input: Posterior instability ROTATOR CUFF: No significant abnormality noted.SUPRASPINATUS OUTLET: There are surgical changes relating to subacromial decompression/Mumford procedure. There is slight widening of the acromioclavicular joint with fluid present within the joint itself.GLENOHUMERAL JOINT AND GLENOID LABRUM: No significant abnormality noted. The posterior labrum demonstrates a thickened and rounded appearance reflecting mild congenital dysplasia of the posterior glenoid. There is no evidence of a labral tear.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: 1. No evidence of intra-articular pathology.2. Postsurgical changes relating to subacromial decompression. There is a mild amount of fluid within the acromioclavicular joint which is also widened. These findings are nonspecific but may relate to a mild bursitis or recent intervention.


Instruction: Generate impression based on findings.

Input: Patient with history of breast cancer. And question of brain mass. Complains of headaches and nausea An anatomical venous anomaly in high convexity left parietal output should clinical significant is noted. Heavily calcified mass at the level of pineal gland measures 14.7 mm times 16-mm on axial image 15. The calcification has a ring appearance with central area of non-enhancing tissue on this examination. Further evaluation with a dedicated post infused MRI of the brain is recommended. There is no evidence of any associated edema with this findings. No areas of hydrocephalus is detected. Large area of low-attenuation adjacent to the left lateral ventricle and extending inferiorly into the basal ganglia is consistent with an old stroke. No evidence of hemorrhage, edema, mass-effect, midline shift or hydrocephalus is present. No evidence of metastatic lesion is detected. Calvarium, mastoid air cells and paranasal sinuses are also unremarkable.

Output: 1.No evidence of metastatic disease to the brain.2.Heavily calcified ring lesion with no definitive enhancement at the level of the hiatal gland that should be further evaluated with a dedicated MRI. This finding has a benign appearance.


Instruction: Generate impression based on findings.

Input: History of acute lymphocytic leukemia. Status post chemotherapy and cranial radiation. Follow-up of a small right frontal extra-axial contrast-enhancing lesion. The examination is limited because of the presence of the vagal nerve stimulator which technically limits the examination.While neck MRI was also requested, test sequence was performed and the neck was completely obscured by lack of signal.There is no evidence of acute intracranial hemorrhage, mass, or acute infarct. Foci of susceptibility effect overlying the right parietal lobe and the undersurface of the left temporal lobe remain unchanged. T2 FLAIR hyperintensity in the periventricular cerebral white-matter remain unchanged and probably reflects previous treatment. The dural-based right frontal contrast-enhancing lesion has not changed, measures transaxial 1.3 cm x 0.9 cm and is most compatible with a small meningioma. Minimal adjacent skull change is present but no gross erosion. There is no abnormal intracranial enhancement otherwise. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits and scalp soft tissues are grossly unremarkable. There is mild mucosal thickening in the paranasal sinuses.

Output: 1.Examination is limited because of the vagal nerve stimulator.2.No acute intracranial findings and no convincing evidence of new finding since prior study.3.Unchanged mild T2 FLAIR hyperintensity in the cerebral white-matter, most likely represent post therapy change. 4.The small right frontal, dural based contrast-enhancing lesion is unchanged and most probably represents a small convexity meningioma.


Instruction: Generate impression based on findings.

Input: 30-year-old female with left knee pain and swelling. Evaluate for meniscal tear. Small amount of high signal within the prepatellar soft tissues immediately anterior to the patella is due to injection of contrast in this location during preceding arthrogram.

Output: Interval postsurgical changes of partial lateral meniscectomy and posterolateral femoral condyle microfracture/chondroplasty. No evidence of complication.


Instruction: Generate impression based on findings.

Input: 71-year-old male. Prostate cancer. PELVIS:PROSTATE:Prostate Size: 5.6 x 6.3 x 4.2 cm.Peripheral Zone: In the right base, the T2 hypointense 10 x 7 mm lesion demonstrating diffusion restriction is unchanged, consistent with prostate cancer. Two foci of marked ADC hypointensity in the transitional zone (series 1004, image 204), unchanged and remain suspicious for prostate cancer. Central Gland: Hypertrophied central zone consistent with BPH.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: None.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Right prostate base lesion consistent with prostate carcinoma, unchanged. 2. Two foci of restricted diffusion in the transitional zone, unchanged and remain suspicious for prostate cancer. These are amenable to MRI guided biopsy if clinically warranted.


Instruction: Generate impression based on findings.

Input: Lupus cerebritis: new onset headache. There is no evidence of intracranial hemorrhage or acute infarct. There are unchanged foci of T2 hyperintensity in the left frontal lobe deep white matter. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. Unchanged left frontal lobe white matter lesions that may represent chronic manifestations of lupus cerebritis, but no evidence of acute infarct. 2. No significant change in the subcentimeter left frontal convexity extra-axial lesion that may represent a meningioma.


Instruction: Generate impression based on findings.

Input: 38-year-old woman with history of rectal pain, evaluate for intersphincteric abscess. PELVIS:UTERUS, ADNEXA: Bilateral follicular cysts are noted. The ovaries are otherwise unremarkable. Clustered nabothian cysts are seen in the cervix.BLADDER: No significant abnormality noted.LYMPH NODES: Small inguinal lymph nodes are likely reactive. No significant lymphadenopathy noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: There is an area of increased T2 signal, diffusion restriction, and enhancement measuring approximately 12 x 9 x 9 mm (series 41, image 32). A T2 hyperintense tract is seen extending to this lesion from the right gluteal cleft (series 401, images 26-32) and there is linear enhancement extending to the rectal wall at the 7:00 position (series 902, image 44). Very mild presacral soft tissue edema is noted.OTHER: A very small amount of free fluid is seen in the pelvis, likely physiologic.

Output: Fistulous tract extending from the 7:00 position of the rectum (best seen on postcontrast imaging) to the right gluteal cleft with an intersphincteric abscess seen measuring up to 12 mm.


Instruction: Generate impression based on findings.

Input: Patient with neurofibromatosis 1, slowly growing left thumb mass, please check an evaluate for ganglion versus solid soft tissue abnormality There is a multilobulated cystlike structure observed adjacent to the base of the first metacarpal along the volar and radial aspect. This discrete well marginated abnormality is superficial and does not appear to than or involve the underlying osseous structure. The focus measures collectively approximately 1.9 x 0.7 cm (image 31 series 5) axially and approximately 2 cm in craniocaudal dimension (image 5 series 8). Not all of these structures appear to communicate. No associated enhancement.Surrounding tendons and soft tissue structures are mildly deviated without direct involvement. Underlying osseous structures are also otherwise significant for moderate degenerative changes and an appearance that is grossly similar to the prior plain films. Marrow signal unremarkable.

Output: Multilobulated ganglion cyst adjacent to the first CMC articulation


Instruction: Generate impression based on findings.

Input: 64 year old female with a history of AL Amyloidosis. She is referred for cardiac MRI to rule out cardiac involvement. Left VentricleThe left ventricle is normal in size and function. The overall LV ejection fraction is 77%, the LV end diastolic volume index is 68 ml/m2 (normal range: 65+/-11), the LVEDV is 151 ml (normal range 109+/-23), the LV end systolic volume index is 16 ml/m2 (normal range 18+/-5), the LVESV is 35 ml (normal range 31+/-10), the LV mass index is 62 g/m2 (normal range 67+/-11), and the LV mass is 139 g (normal range 114+/-24). There are no regional wall motion abnormalities present. The basal anteroseptum is 14mm, slightly increased from 11mm. Stable enhancement of the basal to mid inferior wall. No intracardiac thrombus.Left AtriumThe left atrium is dilated.Right VentricleThe right ventricle is normal in function. The overall RV ejection fraction is 69%, the RV end diastolic volume index is 72 ml/m2 (normal range 69+/-14), the RVEDV is 160 ml (normal range 110+/-24), the RV end systolic volume index is 22 ml/m2 (normal range 22+/-8), and the RVESV is 49 ml (normal range 35+/-13). Right AtriumThe right atrium is dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mitral regurgitation, estimated to be mild.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a common origin of the innominate and left common carotid arteries. The thoracic aorta is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is a small pericardial effusion.Extracardiac FindingsStable hepatic and left renal cyst. The pancreas was not included in this field of view.

Output: 1. The left ventricle is normal in size and function. There is stable enhancement of the basal to mid inferior wall, atypical for amyloid. This may be related to prior scar from myocarditis. In this clinical setting with small pericardial effusion and slight increase in wall thickness, the possibility of localized cardiac amyloid cannot be excluded.3. The right ventricle is normal in function. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 46-year-old male with posterior medial knee pain. Evaluate for meniscus or chondral injury. MENISCI: There is increased signal abnormality within the posterior horn of the medial meniscus consistent with intrasubstance degeneration. The medial meniscus appears intact. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is full-thickness articular cartilage degeneration along the lateral facet of the patella with underlying subchondral signal abnormality likely degenerative in etiology. There is a near full-thickness cleft of the articular cartilage, along the lateral facet, centrally. There is near full-thickness articular cartilage degeneration along the medial facet of the femoral trochlea, appearing progressed when compared to the prior study. There is full-thickness articular cartilage degeneration, centrally, affecting the femoral trochlea.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: Articular cartilage degeneration most pronounced along the patellofemoral joint which has progressed slightly when compared to the prior study.


Instruction: Generate impression based on findings.

Input: History of head and neck cancer status post chemotherapy and radiation. Indeterminate lesion in the right hepatic lobe. Please further characterize. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology. The background parenchyma has normal signal characteristics.There are innumerable T2 bright nonenhancing foci throughout the liver measuring up to 10 mm in diameter likely benign cysts.In the subcapsular right lobe liver there is a focal area of decreased T2 signal. There is ill-defined peripheral enhancement on the postcontrast images. The total area of enhancement measures 4.7 x 2.5 cm. Appearance is most compatible with a metastasis. There is adjacent signal abnormality compatible with macroscopic fat deposition which may relate to chronic perilesional inflammation.No intrahepatic or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Horseshoe kidney. Multiple bilateral peripelvic cysts. No focal lesion or hydronephrosis.RETROPERITONEUM, LYMPH NODES: No upper abdominal lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Basilar scarring/infiltration.

Output: 1.Findings most compatible with a metastasis in the right lobe of the liver as described.2.Horseshoe kidney.


Instruction: Generate impression based on findings.

Input: 78-year-old male with history of elevated LFTs. History of metastatic rectal melanoma. ABDOMEN:LIVER, BILIARY TRACT: In segment 5, there is a lesion with intermediate T2 and high T1 signal abnormality lesion measuring 2.2 x 2.2 cm with mild enhancement (image 21 of series 4).Nonenhancing left hepatic lobe simple cyst.The common bile duct measures 5 mm. No evidence of abnormal filling defects.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Small left adrenal nodule with fat representing an adenoma.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Mildly enhancing Left perirenal nodule measuring 2.1 x 1.6 cm (Image 17 of series 8).BOWEL, MESENTERY: Left lower quadrant colostomy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Segment 5 hepatic lesion with imaging characteristics of metastatic melanoma appearing similar to prior PET/CT.2. Left perirenal nodule also likely representing metastatic disease.3. Left adrenal adenoma.


Instruction: Generate impression based on findings.

Input: Other symptoms and signs involving cognitive functions and awareness [R41.89], Reason for Study: ^Reason: assess for hemispheric lesions History: increasing cognitive dysfunction There is no evidence of acute ischemic or hemorrhagic lesion.Previously recognized left side of planum sphenoidale extra axial L enhancing mass likely represent meningioma shows interval increase in size, measured sized today was 11.4 mm x 12.6 mm x 7.2 mm which was measured about 10.7mm x 8.9mm x 5.3mm.There is no other abnormal enhancement on the scan.Scattered somewhat patchy high signal intensity lesions on periventricular white matter on FLAIR/T2 weighted images indicate nonspecific small vessel disease. No change since prior scan. Pituitary gland appears to be within normal limits.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1.Interval increase in size of anterior cranial fossa (left side planum sphenoidale) since prior scan: current measurement of size:11.4 mm x 12.6 mm x 7.2 mm.2. No change of non specific small vessel ischemic disease since prior scan.


Instruction: Generate impression based on findings.

Input: Complex partial seizure consisting of staring, but normal EEG study on 1/2/15. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears unremarkable, including the corpus callosum and hippocampi. The pituitary gland appears unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, orbits, and scalp soft tissues are unremarkable. There is diffuse moderate paranasal sinus mucosal thickening.

Output: 1. No evidence of potential seizure foci.2. Diffuse moderate paranasal sinus mucosal thickening may indicate sinusitis.


Instruction: Generate impression based on findings.

Input: There is a well-defined, spherical, 5 mm diameter periapical lesion with mildly increased T2 signal in the left maxilla associated with the root of left second maxillary molar tooth. There is mild mucosal thickening along the floor of the left maxillary sinus. The other paranasal sinuses are unremarkable. The bilateral mastoids air cells and the middle ear cavity are grossly unremarkable. The orbits appear to be intact. The previously demonstrated left frontal convexity extra-axial subcentimeter lesion is not as apparent on this exam due to technique. There are foci of T2 hyperintensity in the left frontal lobe deep white matter.

Output: 1. A subcentimeter periapical lesion associated with tooth #14 likely represents a periapical abscess, perhaps with mild reactive mucosal inflammation in the inferior left maxillary sinus.2. The previously demonstrated left frontal convexity extra-axial subcentimeter meningioma is not as apparent on this exam due to technique.3. Left frontal lobe white matter lesions that may represent chronic manifestations of lupus cerebritis.


Instruction: Generate impression based on findings.

Input: History of lumbar diskitis/osteomyelitis in 2013. There are chronic changes related to prior discitis/osteomyelitis of the lower lumbar spine, with loss of the L3-4 disc, severe disc height loss at L4-5, and superimposed postoperative findings at these levels. There is also bony fusion of the L3-4 vertebral bodies. There is no disc or vertebral body enhancement to suggest current active infectious or inflammatory process. There is marked bilateral neural foraminal narrowing at L4-5 and mild bilateral neural foraminal narrowing at L3-4. At L2-3, there is diffuse disc bulge and extensive uncovertebral joint hypertrophy/ligamentum flavum thickening with associated severe spinal canal narrowing, as well as moderate bilateral neural foraminal narrowing at this level. There are subcentimeter peripherally enhancing fluid collections posterior to the bilateral L2-3 facet joints. At L5-S1, there is diffuse disc bulge with a left paramedian disc extrusion, leading to marked bilateral neural foraminal narrowing and moderate spinal canal narrowing. This is stable to slightly progressed from the prior study. The imaged portions of the spinal cord are unremarkable.

Output: 1.Degenerative changes at L2-3, with associated severe spinal canal stenosis, L4-5, with marked right neural foraminal narrowing, and moderate bilateral foraminal narrowing and at L5-S1, with marked bilateral neural foraminal narrowing and moderate spinal canal narrowing.2.Chronic changes related to prior discitis/osteomyelitis, with deformity of L4 and L5 and fusion of L3 and L4.3.Subcentimeter peripherally enhancing fluid collections posterior to the bilateral L2-3 facet joints may represent inflamed synovial cysts. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Male, 56 years old, with anaplastic astrocytoma, status post re-RT, now on TMZ/Avastin. No significant interval change is seen in the previously biopsied, treated tumor centered on the left thalamus. As before, this tissue is intrinsically T1 hyperintense with no clear superimposed enhancement.The centrally necrotic, faintly rim-enhancing lesion within the right posterior paramedian frontal lobe is for the most part stable to slightly smaller than on the prior examination. However, this lesion does infiltrate into the underlying corpus callosum, and the callosal component of the lesion has become progressively thicker.Areas of mild tumoral thickening within the left insula, along the left ventricular atrium, and in the left posterior temporal cortex, with associated ill-defined and ribbonlike enhancement, are not appreciably changed.No new enhancing lesions are identified. Ill-defined T2 hyperintensity in the left periventricular white matter is unchanged. No evidence of significant generalized mass effect is seen. Ventricles are stable in size and morphology.

Output: 1.Although the centrally necrotic tumor component within the right posterior paramedian frontal lobe is largely unchanged in size, there is progressive extension of tumor from this lesion into the underlying corpus callosum.2.Other areas of tumor remain stable, and no entirely new lesions are detected.


Instruction: Generate impression based on findings.

Input: Please note that diffusion weighted images are not available. There is moderate motion degradation of the postcontrast 3-D T1 images limiting evaluation. There is no suspicious enhancement, or mass. There are periventricular and subcortical white matter T2/FLAIR hyperintensities which are nonspecific, likely representing mild chronic microvascular ischemic changes. There is mild age-related sulcal prominence. There is no midline shift or herniation. There is nonspecific high T2 signal in left greater than right scattered mastoid air cells. There is a small right maxillary sinus mucosal retention cyst. The skull and extracranial soft tissues are unremarkable.

Output: 1. No acute intracranial abnormality with mild chronic small vessel ischemic changes, although please note that diffusion weighted images are not available for review and postcontrast images are limited by motion.2. Nonspecific fluid in left greater than right mastoid air cells. Please correlate clinically.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 11 month old female patient with hypertonia. The brain parenchyma and pituitary gland appear unremarkable. There is no evidence of intracranial hemorrhage, mass, or acute infarct. Myelination is within normal limits for the patient's age. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and paranasal sinuses are grossly unremarkable.

Output: MRI of the brain within normal limits for the patient's age.


Instruction: Generate impression based on findings.

Input: Multiple sclerosis [G35], Reason for Study: ^Reason: please do dr javed MS protocol, compare to prior History: facial numbness and parotid pain, numb left side of tongue, abnormal taste in mouth on left side Multiple FLAIR high signal intensity lesions were seen on bilateral hemispheres and brain stem.Most of them were seen on prior MRI and some of them show brighter signal intensity comparing to prior scan including a focal lesion at the left superior temporal gyrus mesial aspect just inferior-anterior aspect of the left gyrus of Heschl. However, due to technical differences between two examinations, their clinical implication of these imaging finding cannot be determined.There are, however, at least one new lesion on the right superior frontal gyrus on today's scan. The ventricles, sulci and cisterns are symmetric and unremarkable. There is no abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: Grossly unchanged multiple FLAIR high signal intensity lesions with some lesions showing higher signal intensity than prior exam. In addition, there is one new lesion at the right superior frontal gyrus on today's scan.


Instruction: Generate impression based on findings.

Input: 56-year-old male with history of pain near myotendinous junction. There is mild edema within the anterior central fibers of the soleus muscle at the level of the midcalf. Additionally, there is a small elongated collection of high signal intensity anterior to the soleus muscle situated between the soleus and flexor hallucis longus muscles measuring 1.5 x 0.5 cm in transverse dimensions which tracks cranially towards the soleus origin. These findings suggest a mild myofascial strain with adjacent small hematoma. The gastrocnemius muscle appears normal. We see no signal abnormality within the deep posterior, anterior, or peroneal compartment musculature. The Achilles tendon is normal. There is mild edema in the pre-Achilles fat and mild subcutaneous edema of the lower leg and ankle. The visualized portions of the medial, lateral, and anterior ankle tendons appear normal although due to modification of the study we do not see their full extent. There is a subcentimeter collection of fluid signal intensity along the posteromedial margin of the tibial plafond which may represent a small ganglion just lateral to the posterior tibial vessels. This study was not protocoled for the evaluation of the ligaments of the ankle, although the visualized portions appear intact. The bones appear normal.

Output: Findings compatible with a mild anterior myofascial strain of the soleus with small adjacent hematoma. The Achilles tendon is normal.