Instruction: Generate impression based on findings.

Input: Clinical question: 64-year-old male with prostate cancer, rising PSA, history of cervical spine stenosis, evaluate for progression. Signs and symptoms: Prostate cancer, rising PSA. Pre- and post enhanced cervical MRI:Examination demonstrates no detectable marrow signal abnormality or enhancement to suggest metastatic disease to the vertebral column. Minimal enhancement of the articulating facets at C2-C3 on the left in a linear pattern is highly suggestive of enhancement secondary to degenerative disease (sagittal post enhanced series 1301 image 3). Examination is a status post anterior cervical fusion at C4, C5 and C6 levels.Foramen magnum is unremarkable.C2-C3 demonstrate mild degenerative changes and results in mild right neural foraminal compromise. Stable since prior study.C3-C4 demonstrate mild degenerative changes with resultant significant neural foraminal compromise (R>L) and no central spinal stenosis and without significant change since prior exam.C4-C5 demonstrate mild to moderate disc disease and loss of disc height and mild hypertrophic changes of posterior elements (right greater than left). There is significant right and moderate left neural foraminal compromise without central spinal stenosis. No significant change since prior exam.C5-C6 demonstrate postoperative changes of anterior fusion. There are significant bilateral neural foraminal (left greater than right) compromise and without central spinal stenosis. There is evidence of myelomalacia of the cord bilaterally at this level which were also present on prior exam.C6-C7 demonstrate extensive degenerative disc disease and postoperative changes of anterior fusion. Previously noted ventral epidural defect suggestive of disc protrusion and ligamentum flavum hypertrophy posteriorly are no longer identified (presumed to interval surgery) with resultant resolution of central spinal stenosis at this level. Small foci of myelomalacia of the cord at this level is also noted similar to prior exam.C7-T1 demonstrate mild degenerative changes without spinal stenosis or neural foraminal compromise.Upper most visualized thoracic spine and thoracic cord is unremarkable.There is no detectable abnormal enhancement of the cord or the left meninges.

Output: 1.Examination demonstrate no evidence of metastatic disease.2.Interval resolution of previously noted central spinal stenosis at C6/C7 as detailed above.3.Postoperative changes of anterior fusion and no evidence of central spinal stenosis at any level.4.Extensive degenerative changes with resultant multilevel neural foraminal compromise (some significantly) as detailed per level above.5.Foci of myelomalacia of the cord without definitive interval change as detailed above.


Instruction: Generate impression based on findings.

Input: Patient's known left lower extremity vascular malformation is described in the MRI report dictated by Dr. Baad.RIGHT LEG: Anomalous origin of the right anterior tibial artery off of the popliteal artery. Otherwise, the popliteal artery, peroneal and posterior tibial arteries are patent to the level of the ankle joint.LEFT LEG: The distal SFA, profunda femoris, popliteal artery, anterior tibial, peroneal and posterior tibial arteries are patent to the level of the ankle joint.

Output: 1.Patent left lower extremity three-vessel runoff to the level of the ankle joint as above.2.Anomalous origin of the right anterior tibial artery off of the popliteal artery.3.Left lower extremity vascular malformation as described in the MRI report.


Instruction: Generate impression based on findings.

Input: Clear cell ependymoma (grade 3) s/p craniotomy x 2 and radiation therapy. There are postoperative findings related to left frontal craniotomy for tumor resection. There is a lobulated enhancing tumor in the medial aspect of the resection cavity that measures up to approximately 12 mm, which is not significantly changed. Likewise, there is no significant change in the extent of patchy areas of T2 hyperintensity in the white matter surrounding the resection cavity. However, there is slight interval increase in size of the cystic space anterior to the tumor. There is no evidence of acute infarction. The ventricles are stable in size and configuration. There is no midline shift. The major cerebral flow voids are grossly intact. The skull and extracranial soft tissues are unchanged.

Output: Stable treated tumor measuring in the left frontal lobe resection cavity, but continued slight interval increase in size of a cystic space anterior to the tumor, which may represent an peritumoral cyst of prominent perivascular space.


Instruction: Generate impression based on findings.

Input: 62 year old male with newly diagnosed heart failure presenting for evaluation of nonischemic cardiomyopathy Left VentricleThe left ventricle is moderately dilated and with severely reduced systolic function. The overall LV ejection fraction is 22%, the LV end diastolic volume index is 132 ml/m2 (normal range: 74+/-15), the LVEDV is 278 ml (normal range 142+/-34), the LV end systolic volume index is 103 ml/m2 (normal range 25+/-9), the LVESV is 218 ml (normal range 47+/-19), the LV mass index is 72 g/m2 (normal range 85+/-15), and the LV mass is 153 g (normal range 164+/-36). The left ventricular dysfunction is global with regional variation. There is a moderate burden of late gadolinium enhancement in the basal inferior and inferoseptal walls suggesting the presence of an underlying fibrosing, infiltrative, or inflammatory process. This is in a non-coronary infarct type distribution. Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is mildly dilated with mildly reduced systolic function. The overall RV ejection fraction is 44%, the RV end diastolic volume index is 119 ml/m2 (normal range 82+/-16), the RVEDV is 252 ml (normal range 142+/-31), the RV end systolic volume index is 67 ml/m2 (normal range 31+/-9), and the RVESV is 141 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly dilatedAortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve are tethered and there is trace mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is mildly dilated.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is a trace pericardial effusion.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Moderate LV dilation with severely reduced systolic function (LVEF 22%) with evidence of a moderate burden of late gadolinium enhancement involving the mid-myocardium of the basal inferior and inferoseptum. The pattern is atypical for prior myocardial infarction and suggests the presence of myocardial fibrosis, inflammation, or infiltration. The differential diagnosis of this finding is broad and includes various types of myocarditis (viral, sarcoid, etc) among other things.2. Mild RV dilation with mildly reduced systolic function (RVEF 44%).3. Severe left atrial dilation.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Palpable mass on the left ankle in a patient with history of metastatic melanoma. Corresponding to the FDG positive lesion seen on prior PET/CT, there is a approximately 1.2 x 2.1 predominantly rim/heterogeneously enhancing lesion just posterior to the distal tibial metaphysis. There is displacement, but no frank invasion between the mass and underlying vascular/ligamentous structures.There is focal subcentimeter enhancement within the marrow of the distal fibula and tibia with mild enhancement of uncertain significance.

Output: 1. Although radiographic findings of soft tissue tumors are relatively nonspecific, within the context of this patient's history and previous PET/CT, the enhancing lesion just posterior to the distal tibial metaphysis is concerning for metastatic involvement. There is displacement but no frank invasion of underlying structures.2. Focal subcentimeter enhancement within the marrow of the distal fibula and tibia is of uncertain significance but may be representative of further metastatic involvement.


Instruction: Generate impression based on findings.

Input: 88-year-old female with partial cystic mass in the pancreatic neck. Assess for worsening en masse ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Several hypodense lesions throughout the liver largest measuring 1.3 x 0.9-cm in the left lobe on image number 24, series number 3 are unchanged. Homogeneously hyperdense lesion measuring 1 cm in diameter image number 51, series number 3 likely representing a benign lesion is also unchanged.SPLEEN: No significant abnormality notedPANCREAS: Predominantly cystic mass with heterogeneous enhancement which represent thin internal septations in the pancreatic neck is unchanged measuring 2.8 x 2.3 cm image number 42, series number 3. This mass is not associated with pancreatic ductal dilatation. Its not clear whether this lesion communicates with the pancreatic duct. MRI may be helpful for further evaluation.ADRENAL GLANDS: Mild bilateral adrenal thickening and a small nodule in the left adrenal gland are unchanged.KIDNEYS, URETERS: Right upper pole enhancing mass measures 3.2 x 2.8-cm on image number 32, series number 3, unchanged.Right lower pole enhancing mass is also unchanged and measures 16 x 16 mm on image number 54, series number 3. Similar lesion in the mid pole of the left kidney is also unchanged and measures 10 mm in diameter in image number 32.Numerous additional hypodense lesions in both kidneys are most likely cysts but some are too small to adequately characterize.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Several foci of loculated fluid attenuation lesions are seen in the abdomen with the largest collection the right lower quadrant measuring approximately 4 x 2.5 cm image number 74, series number 3 are unchanged. No wall thickening or dilatation.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: No significant change from previous study. Liver lesions are most likely benign.Heterogeneous cystic mass in the pancreatic neck may represent a serous cystadenoma or a branch type intrapancreatic mucinous neoplasm. MRI may be helpful for differentiation by demonstrating the relation between the cystic mass and the pancreatic duct.Bilateral enhancing renal masses consistent with renal cell carcinoma.Fluid attenuation lesions in the time. There clinical significance is unknown but metastatic disease cannot be excluded.


Instruction: Generate impression based on findings.

Input: Acute mental status changes. Nonverbal. Question bleed. There is no evidence of intracranial hemorrhage, mass or or midline shift. Extensive areas of subcortical and periventricular white matter hypodensity likely represent small vessel ischemic disease, age indeterminate by CT. If there is concern for an acute stroke, an MRI may be considered for further evaluation. A lacunar infarct is noted in the left basal ganglia. Prominence of the sulci and ventricles is consistent with corticomedullary volume loss.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Small vessel ischemic disease, age indeterminate. No evidence of acute infarction by CT. However, an MRI may be considered if there is concern for acute stroke.


Instruction: Generate impression based on findings.

Input: 52-year-old female status post right mastectomy in 2012 for mammographically occult invasive lobular carcinoma presents for screening left whole breast ultrasound. Left breast ultrasound was performed. At the one o'clock position of the left breast, 5 cm from the nipple, there is an anechoic cyst, with posterior acoustic enhancement, measuring 0.8 x 0.7 x 0 .7 cm, corresponding to findings on prior MRI examination. There is mild duct ectasia of the left retroareolar region. There is no evidence for intraductal mass or debris. Elsewhere, no solid or cystic mass is identified in the remainder of the left breast.

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


Instruction: Generate impression based on findings.

Input: Metastatic thyroid cancer, status post resection on April 20, 2014. There are postsurgical findings related to a right pterional craniotomy with unchanged mild enhancement superimposed upon the mild intrinsic T1 hyperintensity and susceptibility effect along the margins of the right inferior frontal gyrus resection cavity. There is also unchanged surrounding confluent T2 hyperintensity. There is slight interval increase in size of the lesion at the grey-white matter interface with T1 hyperintensity and possibly contrast enhancement and susceptibility effect posterior medial to the treatment bed in the inferior right frontal gyrus, now measuring up to 3 mm, previously 2 mm. The punctate enhancing lesion in the left superior cerebellar hemisphere remains minimally conspicuous and there is no associated vasogenic edema. The punctate focus of susceptibility effect without associated enhancement in the right basal ganglia is unchanged. The ventricles and sulci are unchanged. There is no midline shift. There is no evidence of acute infarction. There is an unchanged subcentimeter posterior nasopharynx retention or Thornwaldt cyst. There is minimal mucosal thickening in the inferior aspect of the right maxillary sinus.

Output: 1.Post-treatment findings related to resection of a right frontal lobe metastasis with persistent nonspecific enhancement along the posterior margin of the treatment bed. 2. A lesion medial to the treatment bed appears to be slightly larger and may represent a metastasis. 3. The punctate lesion in the left superior cerebellar hemisphere remains minimally conspicuous.


Instruction: Generate impression based on findings.

Input: Female, 33 years old, with known Chiari malformation. The left cerebellar tonsil herniates approximately 8 mm below the level of the foramen magnum, and the right cerebellar tonsil herniates approximately 6 mm below. Both tonsils maintain a normal round configuration, and there is evidence of patent CSF space both anteriorly and posteriorly through the foramen magnum. On CSF flow imaging, robust biphasic CSF flow is seen anteriorly through the foramen magnum as well as posteriorly along the cerebellar tonsils.Slight reversal of the cervical lordosis is likely positional. Sagittal alignment is otherwise unremarkable. Vertebral body height and morphology are within normal limits. No evidence of concerning marrow replacement or marrow edema is seen.The visualized spinal cord demonstrates normal signal intensity and morphology. No focal lesions are seen. No epidural abnormalities are suspected.Minimal disc osteophyte formation is seen at C5-6. No significant spinal canal or foraminal stenosis is detected level.

Output: The cerebellar tonsils descend below the level of the foramen magnum meeting imaging criteria for a Chiari I malformation. However, the tonsils are round in contour, and there appears to be adequate CSF flow both anteriorly and posteriorly through the foramen magnum. No evidence of spinal cord syrinx or other cord abnormality is seen.


Instruction: Generate impression based on findings.

Input: Knee pain. Evaluate for meniscal tear. MENISCI: Extensive signal abnormality through the majority of the anterior horn of the lateral meniscus indicates severe degeneration and fragmentation. This tearing extends into the body of the lateral meniscus, with blunting of the free edge and degenerative tearing of the undersurface of the meniscus. There is irregularity of the free edge of the posterior horn of the medial meniscus, with poorly defined intrasubstance signal that extends to the free edge and tibial articular surface, suggesting degenerative tearing. There is also intrasubstance degeneration of the body of the medial meniscus. The anterior horn of the medial meniscus appears normal.ARTICULAR CARTILAGE AND BONE: There is severe degeneration of the articular cartilage of the lateral facet of the patella and lateral facet of the femoral trochlea. There is also full-thickness cartilage loss along the lateral tibial plateau, as well as along the lateral femoral condyle above the posterior horn of the meniscus. There are small subchondral cysts in the lateral tibial plateau and femoral trochlea. Mild cartilage degeneration affects the medial compartment.LIGAMENTS: The cruciate and collateral limits are intact.EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Tears of the lateral and medial meniscus, as described above.2. Osteoarthritis, synovitis, and Baker's cyst, as described above.


Instruction: Generate impression based on findings.

Input: Reason: fluid collection History: right hand erythema There is edema within the dorsal soft tissues of the wrist and hand, extending into the fingers, with a smaller amount of edema seen volarly in the palm, also extending into the fingers. More homogeneous fluid-signal intensity immediately dorsal to the extensor tendons is compatible with confluent edema, although it is impossible to exclude a developing abscess on this nonenhanced study.Aside from small foci of signal abnormality in the third metacarpal head, likely representing degenerative cysts, the bones are unremarkable, and we see no findings to suggest osteomyelitis. There is no fluid collection within the musculature of the hand.

Output: Findings compatible with cellulitis, particularly along the dorsum of the hand, as described above. More homogeneous fluid-signal intensity immediately dorsal to the extensor tendons is compatible with confluent edema, although it is impossible to exclude a developing abscess on this nonenhanced study. If further imaging is clinically warranted, repeat study following contrast or ultrasonography may be considered.


Instruction: Generate impression based on findings.

Input: 55 year old with history of pleomorphic LCIS status post excision in 2010. History of benign phyllodes tumor and multiple benign bilateral breast biopsies. Strong family history of malignancy; breast cancer in sister, paternal aunt and paternal first cousin, and several other types of cancer in multiple relatives. There is heterogeneous amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.Enhancing foci and a few masses are unchanged in both breasts.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: 17-year-old male with right elbow pain and lucent lesion in the capitellum seen on radiograph LIGAMENTS: No significant abnormality noted.TENDONS: No significant abnormality noted.ARTICULAR SURFACES AND BONE: Articular cartilage defect in the mid to anterior capitellum with underlying increased T2 marrow signal. Incidental note is made of a pseudodefect in the posterior aspect of the patella, normal variant.SURROUNDING STRUCTURES: No significant abnormality noted.ADDITIONAL

Output: Articular cartilage defect in the mid to anterior capitellum likely represents an osteochondral defect. Small joint effusion.


Instruction: Generate impression based on findings.

Input: Possible arachnoid cyst and abnormal vessel: right side headache, abnormal CT. MRI: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and brainstem appear unremarkable. There is focal prominence of cerebrospinal fluid spaces along the inferior aspect of the left cerebellar hemisphere, measuring 10 mm in width, 2 mm in height, and 10 mm anteroposteriorly. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.MRA: The vertebrobasilar system is tortuous, but there is no evidence of significant steno-occlusive lesions or cerebral aneurysms.

Output: 1. No evidence of arachnoid cyst in the premedullary space. However, a small area of focal prominence of the cerebrospinal fluid spaces along the inferior aspect of the left cerebellar hemisphere may be attributable to an arachnoid cyst.2. No evidence of cerebral aneurysms.


Instruction: Generate impression based on findings.

Input: Progression of metastatic lung lesions. The left cerebellar hemisphere enhancing lesion is no longer discernible. In addition, a left inferior sulcus lesion has decreased in size, measuring 6 x 8 mm in axial section, previously 9 x 11 mm. Otherwise, there is no significant interval change in size of the bilateral cerebral hemisphere peripherally enhancing tumors. For, example, a right superior frontal gyrus lesion measures 19 x 21 mm in axial section, previously 20 x 20 mm and a left middle frontal gyrus lesion measures 5 x 6 mm in axial section, previously 5 x 6 mm. There is a persistent mild degree of vasogenic edema associated with some of the lesions. Many of the lesions also display persistent susceptibility effect. There is no evidence of 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 a small left maxillary sinus retention cyst.

Output: The left cerebellar hemisphere enhancing lesion is no longer discernible and a left inferior sulcus lesion has decreased in size. Otherwise, no significant interval change in size of the bilateral cerebral hemisphere metastases.


Instruction: Generate impression based on findings.

Input: 41 year old with bilateral breast masses present for Alan Penn research study. There is heterogeneous amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.There is a slowly enhancing, circumscribed mass at anterior 12:00 position, measuring 11 x 21 x 17 mm (AP x LR x CC) in the left breast. No other abnormal enhancement is seen elsewhere in the left breast.No abnormal enhancement is seen in right breast. No abnormal lymph nodes are identified in either axillary region.

Output: 1. Slowly enhancing mass in the left breast, likely benign. Percutaneous biopsy of this mass was performed later today.2. No MR evidence of malignancy in the right breast.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: The patient has undergone interval laminectomy with posterior fusion from C2 - C5. Artifact from surgical screws is noted along with postsurgical change in the paraspinal soft tissues, but no abnormal fluid collection is seen. There are diffuse osseous metastases in the vertebral bodies and pedicles which have increased from the prior examinations. The largest of these lesions is an expansile, enhancing metastasis in the C2 vertebral body measuring approximately 41 x 26 mm and causing compression of the pre-vertebral soft tissues. Additionally, there is abnormal marrow signal with loss of vertebral body height of C5. There is narrowing of the spinal canal between C5 and C7 with asymmetric, severe narrowing of the spinal canal on the right at C6/C7 and mildly increased cord signal. There is no abnormal dural or leptomeningeal enhancement. There is moderate stenosis of the C6/C7 left neural foramen and mild stenosis of the C7/T1 left neural foramen. There is severe stenosis of the C6/C7 and C7/T1 right neural foramina.

Output: 1.Progression of diffuse osseous metastases in the vertebral column.2.Severe, asymmetric narrowing of the spinal canal at C6/C7 with right hemicord compression.3.Since 1/2015, interval laminectomy with posterior fusion from C2 - C5, no evidence of post-surgical complication.4.New pathologic fracture with loss of vertebral body height of C5.


Instruction: Generate impression based on findings.

Input: 56 years Female (DOB:1/29/1960)Reason: r/o crypto History: MRI brain with lesionPROVIDER/ATTENDING NAME: SCOTT STERN SCOTT STERN There are patchy foci of T2 and FLAIR signal hyperintensity along the basal ganglia bilaterally more so on the right basal ganglia anteriorly compared to the left. There is some associated T1 signal hyperintensity but no significant susceptibility effect. On the postcontrast imaging there is no convincing evidence for contrast enhancement.There are patchy foci of T2 and FLAIR signal hyperintensity within the brainstem. The left pons is suspected more than the right pons. There are several punctate foci of T2 and FLAIR signal hyperintensity in the thalami and internal capsules.On susceptibility weighted imaging and postcontrast imaging there appears to be a developmental venous anomaly present in the right thalamus.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate some mucosal thickening in the right maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Lesions in the basal ganglia especially in the right side are suspicious for involvement with cryptococcus given the patient's clinical history. 2.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions as well as hyperintense patchy lesions in the brainstem and thalami present identified on the FLAIR and T2 images. Although they are nonspecific, most likely these are vascular related.


Instruction: Generate impression based on findings.

Input: Female, 56 years old, with lower back pain and radicular symptoms in the right lower extremity. Within the limitations of mild motion degradation, the following observations are made.A trace retrolisthesis of L5 relative to S1 is seen, new from prior. Sagittal alignment is otherwise unremarkable. Vertebral body morphology and signal characteristics are within normal limits.The visualized distal spinal cord, conus and nerve roots of the cauda equina are within normal limits. No epidural abnormality is suspected.T12-L1: Unremarkable. L1-2: Mild loss of disc height and T2 signal. Minimal disc bulging. No significant spinal canal or foraminal stenosis. L2-3: Mild facet arthropathy. No significant spinal canal or foraminal stenosis. L3-4: Mild facet arthropathy. No significant spinal canal or foraminal stenosis.L4-5: Moderate facet arthropathy. Mild loss of disc height and T2 signal. Mild bulging disc slightly asymmetric to the right, similar to prior. No significant spinal canal or foraminal stenosis. L5-S1: Moderate facet arthropathy and ligamentum flavum thickening, mildly progressed. Loss of disc T2 signal and mild disc bulging, slightly progressed. No significant spinal canal stenosis. Mild right foraminal narrowing.

Output: Mild interval progression of relatively mild degenerative findings is seen. No areas of high-grade spinal canal or neuroforaminal stenosis are detected.


Instruction: Generate impression based on findings.

Input: 28-year-old woman with history of large uterine fibroids and abnormal uterine bleeding. PELVIS:UTERUS, ADNEXA: There is a submucosal anterior fundal mass measuring approximately 127 x 97 x 80 mm (5/20 and 8/15). This mass is predominantly T2 hypointense and enhances avidly on postcontrast imaging (1102/33). This mass distorts the endometrial canal, but there is no significant intraluminal abnormality.The ovaries appear unremarkable with normal follicles.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: Large enhancing submucosal fibroid in the uterine fundus.


Instruction: Generate impression based on findings.

Input: There are multiple nonspecific T2/FLAIR hyperintensities in the subcortical and periventricular white matter and the centrum semiovale due to chronic small vessel ischemic changes. There is encephalomalacia seen in the right parieto-occipital lobe. There is volume loss with prominence of the ventricles and sulci. There is no midline shift. There is no evidence of hemorrhage or mass effect. There is no diffusion or susceptibility abnormalities. There is no abnormal enhancement. There is dolichoectasia of intracranial arterial system indicating atherosclerotic changes.

Output: 1. No evidence for acute intracranial hemorrhage, mass effect, or edema. 2. Periventricular and subcortical white matter chronic ischemic changes.3. Encephalomalacia in the right parieto-occipital lobe.4. Atherosclerotic changes of intracranial arterial system.


Instruction: Generate impression based on findings.

Input: TIA: Right hand weakness, dysarthria. MRI: There are several punctate foci of restricted diffusion and high T2 signal in the bilateral cerebral hemispheres, including in the left precentral gyrus hand region and right posterior temporal and occipital lobes. There is diffuse cerebral white matter T2 hyperintensity, predominantly in a periventricular distribution. There is also a punctate area of encephalomalacia in the right corpus callosum body. There is no evidence of intracranial hemorrhage or mass. There is diffuse cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull is grossly unremarkable. There are bilateral lens implants. There is a right scalp lipoma that measures up to 12 mm in thickness.MRA: There is no evidence of significant steno-occlusive lesions in the head and neck arteries. The right vertebral artery is hypoplastic. There is no evidence of cerebral aneurysm.

Output: 1. Acute punctate infarcts in the bilateral cerebral hemispheres, including the left precentral gyrus hand region. Diffuse cerebral white matter T2 hyperintensity, predominantly in a periventricular distribution may represent chronic small vessel ischemic disease and probable chronic infarct in the right corpus callosum.2. No evidence of significant steno-occlusive lesions in the head and neck arteries.


Instruction: Generate impression based on findings.

Input: Wrist mass There is abnormal increased T2 signal within the radial and volar soft tissues of the wrist. There is no discrete soft tissue mass identified. There is enlargement and fluid signal surrounding the flexor pollicis longus tendon suggesting tenosynovitis. Following contrast administration, there is mild contrast enhancement of the soft tissues of the wrist particularly along the volar and radial aspect however again, no discrete enhancing mass is appreciated.The marrow signal of the distal radius and ulna and carpal bones is normal. There is a mild amount of fluid in the distal radioulnar joint.

Output: No evidence of discrete enhancing mass. Findings suggestive of tenosynovitis of the flexor pollicis longus tendon with associated soft tissue inflammation.


Instruction: Generate impression based on findings.

Input: Image quality has decreased due to motion artifacts.There are moderate to severe spinal canal stenosis from C45 to C56. Increased T2/STIR signal intensity of spinal cord is seen at the level of C56 which suggest possible compressive myelopathy.No evidence of abnormal enhancement.Normal cervical lordosis is seen with preservation of vertebral body heights. No fracture or infiltrative marrow process. Degenerative findings include: C2-3: No evidence of neuroforaminal or spinal canal stenosis.C3-4: Minimal to mild left side neuroforaminal narrowing, no evidence of spinal canal stenosis.C4-5: Diffuse bulging of disc results minimal spinal canal stenosis.C5-6: Diffuse bulging of disc with broad based central disc protrusion (best seen on post contrast enhanced sagittal scan; series 1301, image 6) with bilateral ligamentum flavum thickening results moderate to severe spinal canal stenosis.C6-7: Broad based disc bulging with focal central disc protrusion which indents thecal sac. Otherwise unremarkable. C7-T1: No evidence of neuroforaminal or spinal canal stenosis.

Output: 1. Moderate to severe spinal canal stenosis with broad based central disc protrusion at the level of C56 with possible myelopathy.2. Multilevel various degree cervical spine degenerative changes.


Instruction: Generate impression based on findings.

Input: Postsurgical changes of right L5 and S1 hemilaminotomies are seen for resection of osseous lesion at the S1 level on the right. There appears to be resection of at least majority of the lesion including component extending medially extradurally in the lateral aspect of the spinal canal at S1. Rind of bone at the S1 level is seen projecting into the spinal canal which may represent normal/reactive residual bone or possibly small residual medial component of the lesion. Edema within the right S1 pedicle has not significantly changed from the prior study and is likely postprocedural and/or related to previously noted S1 lesion. Alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign. No areas of abnormal enhancement are present. The conus is normal in signal and morphology and terminates at an appropriate level. The visualized intra-abdominal and paraspinal contents are unremarkable. No spinal canal or neural foraminal narrowing.

Output: Postsurgical changes at the right L5-S1 level for resection of right S1 lesion. There appears to be resection of at least majority of the lesion. Consider CT for better evaluation for residual bony lesion lesion.


Instruction: Generate impression based on findings.

Input: Evaluate pineal gland cyst for growth: large head size and seizures. There is an unchanged cystic pineal gland, which measures up to approximately 15 mm, without evidence of abnormal enhancement. There is no evidence of intracranial hemorrhage or acute infarct. The left hippocampus appears to be slightly malrotated. The brain parenchyma otherwise appears unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There are small retention cysts in the maxillary sinuses.

Output: 1. Unchanged cystic pineal gland.2. The left hippocampus appears to be slightly malrotated. Follow up via dedicated seizure protocol MRI may be useful.


Instruction: Generate impression based on findings.

Input: 61-year-old female. Status post distal pancreatectomy/splenectomy for pancreatic endocrine tumor. Evaluate for any abnormalities or recurrence. ABDOMEN:LUNG BASES: Nonspecific right basilar opacity.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Status post splenectomy.PANCREAS: Postsurgical findings of distal pancreatectomy without evidence of local recurrence. 3.5 x 2.7 cm cm well-circumscribed T1/T2 hyperintense lesion immediately adjacent to the distal end of the residual pancreas without internal enhancement, consistent with a pseudocyst. The pancreatic duct approaches this pseudocyst but without a definite communication. 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: Post-surgical findings of distal pancreatectomy without evidence of local recurrence. A well-demarcated collection at the distal end of the residual pancreas is most consistent with a pseudocyst.


Instruction: Generate impression based on findings.

Input: Diagnosis: Anesthesia of skinClinical question: evaluate for demyelinating or other lesionSigns and Symptoms: ascending numbness MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a punctate T2 and FLAIR signal hyperintense lesion present in the left superior frontal gyrus. There are no foci of diffusion restriction appreciated. Additionally there are a couple periventricular white matter lesions which are hyperintense on T2 and FLAIR imaging.No abnormal mass lesions are appreciated within the brain parenchyma. 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.MRI orbits:The eyeballs are intact. No intraconal or extraconal space mass is identified. The extraocular muscles are intact. The lacrimal glands are symmetric and within normal limits in size and configuration. The suprasellar cistern is intact .Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. There is a focus of T2 signal hyperintensity centered in the spinal cord at the C2 vertebral body level centered along the posterior aspect and right paramedian aspect of the spinal cord. This associated with mild cord enlargement.There is a T2 hyperintense lesion along the periphery of the the left hemicord at the C6 vertebral body level. This is not associated with cord enlargement.There is a punctate T2 hyperintense lesion present along the cervical spinal cord at the C3-4 disc space level at the right posterior lateral aspect of the spinal cord which is rather subtle.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.MRI thoracic spine:The thoracic vertebral bodies are appropriate in the overall alignment and height. There is no compromise of thoracic spinal canal or exiting nerve roots. There is a subtle focus of T2 hyperintensity within the spinal cord at the T12 vertebral body level. This is best seen on the lumbar spine MRI.The assessment of the thoracic spinal cord on T2-weighted imaging is somewhat degraded due to phase encoding artifacts.Lumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. There is disc desiccation present at L3-4 and L4-5. There is a subtle focus of T2 hyperintensity within the spinal cord at the T12 vertebral body level. This is best seen on the lumbar spine MRI.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. There is disc desiccation and a mild disc bulge at this level. A small focus of T2 hyperintensity is present along the posterior aspect of the annulus of the L4-5 disc. There is mild loss of disc space height at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is disc desiccation and a mild disc bulge at this level.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 patient was unable to complete the exam. No post gadolinium imaging was performed.2.There are multiple lesions present in the cervical spinal cord as well as in the distal thoracic spinal cord which are suspicious but not specific for demyelination. Please note that the thoracic spinal cord is a somewhat degraded by phase and coding artifact. Perhaps repetition of the T2-weighted imaging of the thoracic spine with a saturation bands would be helpful in reducing the artifact when and if the patient comes back for post gadolinium imaging.3.Although no orbital lesion is identified postcontrast imaging may be helpful in identifying optic neuritis if present.4.There are several subcortical and periventricular white matter lesions identified which are too few to create a pattern since this is not an uncommon finding. It is possible that these are related to demyelination, however, they are nonspecific.


Instruction: Generate impression based on findings.

Input: Reason: re-evaluate suspected ischemic changes: migraine. There is a non-enhancing T2 hyperintense cortical and subcortical lesion in the right superior parietal lobule that measures up to 7 mm, which is not significantly changed. There is no evidence of intracranial hemorrhage, mass-effect, or acute infarct. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: A non-enhancing T2 hyperintense cortical and subcortical lesion in the right superior parietal lobule that measures up to 7 mm, which is not significantly changed, may represent a prior ischemic event, but is otherwise nonspecific. Otherwise, no evidence of intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: 62 years Male Reason: abdominal pain, ? constipation, obstruction, perf History: abdominal pain Large stool burden in the colon. Correlate for constipation. Nonobstructive bowel gas pattern.Osseous changes of discitis osteomyelitis at T8-9-10 again seen, better evaluated on recent MRI spine. Dense arterial calcifications in the pelvis.

Output: Large stool burden in the colon. Correlate for constipation.


Instruction: Generate impression based on findings.

Input: Clinical question: Smoldering versus symptomatic symptomatic multiple myeloma, follow up on prior vertebral lesions. Signs and symptoms: No focal pain in these area. Pre-and enhanced cervical MRI:There is a well demarcated round mildly enhancing focus in the vertebral body of C6 measuring approximately 6 mm in size. The lesion demonstrate no appreciable change since prior exam in its signal intensity, size or pattern of enhancement.There is no evidence of an additional foci of marrow signal replacement or enhancement. This is a similar observations prior study. Moderate disk disease at C5 -- C6 and mild disk disease at other levels similar to prior exam. No spinal stenosis at any level. Degenerative changes however results in mild left neural foraminal compromise at C3-C4, mild bilateral neural foraminal compromise at C4 -- C5 and moderate right and mild left C5 -- C6 levels without significant change.There is normal signal intensity and caliber of cervical cord and without abnormal enhancement.Pre-and post-enhanced thoracic MRI:There is normal anatomical alignment of the vertebral column.There is normal signal intensity of which column.There is no detectable abnormal enhancement of vertebral column.There is no evidence of spinal canal or neural foraminal compromise at any level.There is normal signal intensity and caliber of cord and without evidence of enhancement.Pre-and post-enhanced lumbar MRI:Examination demonstrates an approximately 9 mm focus of T2 stir hyperintensity in the vertebral body of L1 with mild uniform enhancement without appreciable interval change since prior exam. There is no detectable additional foci of marrow signal change or abnormal enhancement of the vertebral column. This is a similar observations as the prior MRI exam.There is normal signal intensity and alignment the vertebral column.There is no evidence of spinal canal or neural foraminal compromise at any level.

Output: 1.MRI examination of cervical spine demonstrate stable 6-mm focus of marrow signal change and enhancement in C6 vertebral body without change since prior exam. No additional suspected lesions. No evidence of central spinal stenosis. Mild multilevel neural foraminal compromise as detailed per level. Normal signal intensity and caliber of cervical cord without abnormal enhancement.2.Pre-and post-enhanced MRI of thoracic spine is unremarkable and stable since prior study.3.Pre-and post-enhanced lumbar MRI demonstrates a single stable 8mm focus of marrow signal change with enhancement in the vertebral body of L1. Unremarkable and stable pre-and post enhanced lumbar MRI exam otherwise.


Instruction: Generate impression based on findings.

Input: MRI OF THE BRAIN:A focus of intensely restricted diffusion is seen is seen in the left thalamus. Foci of more moderately restricted diffusion are also seen in the anterior left putamen, and in the left corona radiata. In the same distribution there is corresponding T2 and FLAIR high signal. Extensive nearly confluent periventricular white matter T2 hyperintensity is seen in the bilateral cerebral hemispheres, left side more than right. Small areas of encephalomalacia with corresponding susceptibility are evident in the right frontal and parietal operculum.Ventricular size is normal. No midline shift. No mass effect or edema. No evidence of herniation.MRA OF THE BRAIN:Within the limitations of a slightly degraded examination, no high-grade vascular stenosis or occlusion is suspected intracranially. A moderate left PCOM artery is seen. The right PCOM artery is not clearly identified.

Output: 1. A small focus of early acute ischemia is seen within the left thalamus. Small foci of slightly older, acute subacute ischemia are seen in the left anterior putamen and left corona radiata.2. The background brain shows evidence of prior cortical ischemia involving the right operculum, and extensive chronic microvascular ischemic disease.3. MRA demonstrates no evidence of high-grade stenosis.


Instruction: Generate impression based on findings.

Input: History of metastatic prostate cancer. ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in signal and morphology. Status post cholecystectomy. No intrahepatic or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: There is a subcentimeter T2 bright focus in the tail the pancreas that may represent a small sidebranch IPMN). The pancreas is otherwise unremarkable. The pancreatic duct is normal in diameter.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple renal cysts bilaterally measuring up to 13 mm in diameter. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postoperative changes from ileal conduit formation.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: Status post cystoprostatectomy. Stable simple cystic collection in the resection cavity. No evidence of local recurrence.BLADDER: Status post cystoprostatectomy. Ileal conduit. Patient with a right lower quadrant ostomy. LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Post surgical changes from ileal conduit formation.BONES, SOFT TISSUES: Small T2 bright cystic focus adjacent to the left acetabulum may represent a para labral cyst.OTHER: No significant abnormality noted.

Output: 1.Stable post treatment findings without evidence of metastatic disease.


Instruction: Generate impression based on findings.

Input: Male, 52 years old, with hyponatremia. Assess for causes of SIADH, pituitary lesion. A few scattered T2 hyperintense lesions are seen within the periventricular white matter without mass effect or edema. No restricted diffusion is seen. The cerebral sulci and the cerebellar fissures are prominent compatible with parenchymal volume loss.No evidence of intracranial hemorrhage or any abnormal extra axial fluid collection is seen. The ventricles are slightly prominent related to volume loss but are otherwise unremarkable. Postcontrast images are degraded by motion, but within this limitation, no pathologic parenchymal or extra-axial enhancement is observed.Although this is not a dedicated pituitary examination, no gross or large pituitary lesions are suspected. Please note, however, that this examination is not adequate for the detection of small pituitary lesions.

Output: 1.Scattered nonspecific small white matter lesions are seen.2.Volume loss of the brain and cerebellum is seen, greater than expected for age.3.No acute intracranial abnormalities are noted.4.No gross or large pituitary lesions are seen, though please note that this nondedicated examination is not adequate for the assessment of small pituitary lesions.


Instruction: Generate impression based on findings.

Input: Female, 50 years old, with pain in the right arm. Evaluate for pinched nerve. Alignment is anatomic. Vertebral body heights are preserved. No marrow replacement or edema is seen. No pathologic marrow enhancement is detected.The visualized spinal cord demonstrates normal signal intensity and is free of pathologic enhancement. No epidural abnormalities are suspected.C2-3: No significant spinal canal or foraminal stenosis. C3-4: Mild right uncovertebral hypertrophy. No significant spinal canal stenosis. Mild narrowing of the right neural foramen. C4-5: Facet arthropathy. Minimal posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Mild bilateral foraminal narrowing. C5-6: Facet arthropathy. Posterior disc-osteophyte complex formation, particularly towards the right. Severe right and moderate left foraminal narrowing. C6-7: No significant spinal canal or foraminal stenosis. C7-T1: No significant spinal canal or foraminal stenosis.

Output: 1.A combination of disc osteophyte formation and facet arthropathy results in severe right and moderate left foraminal narrowing at the C5-6 level.2.No other areas of high-grade foraminal or spinal canal compromise are seen.


Instruction: Generate impression based on findings.

Input: 66 year-old male history of HCV cirrhosis. Evaluate for HCC. ABDOMEN:LIVER, BILIARY TRACT: Previously seen segment 8 hyperenhancing lesion has been replaced by a large ablation cavity measuring 2.2 x 3.7 cm. Focus of enhancement along the right lateral cavity wall is felt to represent a tortuous vessel. No convincing abnormal enhancement to suggest residual disease is present. No intra or extrahepatic biliary ductal dilatation. Hepatic steatosis.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: Status post chemoembolization and thermal ablation of segment 8 HCC with no evidence of residual or recurrent disease.


Instruction: Generate impression based on findings.

Input: 77-year-old male with history of stroke. Now with mental status changes. Evaluate for bleed/mass Large low attenuation area involving the left cortical and subcortical temporoparietal lobe in the territory of the left MCA consistent with encephalomalacia. MRI recommended for further evaluation if clinical concern remains for acute stroke. There is no evidence for mass or hemorrhage. There is associated ex vacuo dilatation of the left lateral ventricle.The basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Chronic left MCA infarct. MRI recommended for further evaluation if clinical concern remains for acute stroke.


Instruction: Generate impression based on findings.

Input: Diagnosis: Multiple myeloma, without mention of having achieved remission Closed fracture of unspecified boneClinical question: acuity of compression fractureSigns and Symptoms: back pain MRI thoracic spine:The thoracic vertebral bodies are appropriate in the overall alignment and height. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots. There is redemonstration of compression fractures at T5 (40%), T8 (60%), T11 (30%), T12 (20%) and L1 (60%). The patient is status post kyphoplasty at T11, T12 and L1. Compared to the prior exam there is no interval progression.There is a focus of enhancement identified along the T10 spinous process which was also present on the prior exam and is unchanged. Another focus of enhancement is present along the right posterior elements of T9. It currently measures 16 x 11 mm and previously measured 18 x 11 mm.There is predominantly low marrow signal on T1-weighted images throughout the thoracic spineLumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment. The conus medullaris on sagittal imaging is grossly intact. There is approximately 30% compression of the L5 vertebral body which is new since the prior exam. There is associated contrast enhancement within the L5 vertebral body which appears to be new compared to prior exam.There are multiple marrow replacing foci identified in the lumbar spine. One along the left posterior elements of L3 was also present on the prior exam and is changed character but appears a little bit smaller. It previously measured 29 x 20 mm sagittal dimensions and now measures 20 mm x 14 mm sagittal dimensions.. Similarly 1 along the posterior aspect of the L2 vertebral body appears to be old but smaller. In general the marrow signal is heterogeneous in appearance.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is mild ligamentum flavum hypertrophy present at this level there is mild encroachment of the left-sided exiting nerve roots at this level.At L4-5 there is diffuse disc bulge associated bilateral facet and ligamentum flavum hypertrophy. Overall there is a moderate degree of spinal stenosis present at this level. There is also narrowing of the neural foramina with mild encroachment of the exiting nerve roots which is worse on the right side compared to the left. There is some mild encroachment of the right-sided exiting nerve root at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is a disc bulge present at this level. There is disc desiccation present at this level.At L2-3 there is no significant compromise to spinal canal or neural foramina. There is a disc bulge present at this level. There is disc desiccation present at this level.At L1-2 there is no significant compromise to spinal canal or neural foramina.The uterus is enlarged but incompletely imaged.

Output: 1.There is a moderate degree of spinal stenosis present at L4-5. This was also present on the prior exam and has not changed substantially.2.Since the prior exam from 2/15 a compression fracture has developed a new compression fracture at L5 which is subacute.3.There are multiple compression fractures present in the thoracic spine and at L1 which are stable since the prior exam from 8/15.4.The patient status post kyphoplasty is at T11, T12 and L1.5.There are multiple enhancing lesions throughout the lumbar spine and thoracic spine which are compatible with patient's diagnosis of multiple myeloma. Some of these appear smaller on the current exam compared to the prior exams.6.The uterus is large but not completely included on this exam. Please correlate with patient's clinical history and findings


Instruction: Generate impression based on findings.

Input: Female 59 years old with pelvic spread of colorectal cancer with invasion of bladder in area of trigone seen intraoperatively. Please evaluate extent of disease for consideration of pelvic radiation therapy. Overall image quality: GoodPELVIS:UTERUS, ADNEXA: The uterus and ovaries are surgically absent. BLADDER: The bladder is incompletely distended. There is an poorly defined 1.5 x 1.0 cm (series 1201, image 37) enhancing soft tissue mass along the right aspect of the vaginal cuff and bladder trigone which has decreased in size since the CT in March 2016 but remains stable when compared to the CT from September 2016. LYMPH NODES: Lymph nodes in the perirectal space, within the mesorectal fascia: NoneLymph nodes outside the mesorectal fascia: 1.0 x 0.8 cm left internal iliac lymph node measured 1.1 x 1.1 cm on the most recent prior CT.BOWEL, MESENTERY: Status post right hemicolectomy.Rectal Tumor: N/ABONES, SOFT TISSUES: An irregular, enhancing lesion along the right pelvic sidewall measures 1.9 x 1.3 cm (series 1104, image 409) is suspicious for residual or partially treated disease versus postsurgical change. The lesion involves the adjacent right acetabular wall which appears slightly eroded.OTHER: No significant abnormality noted.

Output: 1.A small foci of abnormal soft tissue enhancement in the right pelvis involving the bladder trigone and vaginal cuff and and additional focus along the right pelvic sidewall are suspicious for residual or partially treated disease versus postsurgical change.2.Left internal iliac lymph node has decreased in size. There is no new lymphadenopathy.INDEX LESION MEASUREMENTS (Current exam date/time: 11/18/2016 17:30:00)LEFT INTERNAL ILIAC LYMPH NODE: 1.0 x 0.8 cm (Image 48, Series 501); 1.0 x 1.0 cm on prior (9/3/2016) (Image 122, Series 3).BLADDER TRIGONE MASS: 1.5 x 1.0 cm (Image 37, Series 1201).RIGHT PELVIC SIDE WALL MASS: 1.9 x 1.3 cm (Image 409, Series 1104).


Instruction: Generate impression based on findings.

Input: 83 year old man with history of bradycardia with dual chamber pacemaker, PVC s/p recent ablation, referred for cardiac MR to evaluate scar. Left VentricleThe left ventricle is normal in size with mildly reduced systolic function. The overall LV ejection fraction is 48%, the LV end diastolic volume index is 76 ml/m2 (normal range: 74+/-15), the LVEDV is 167 ml (normal range 142+/-34), the LV end systolic volume index is 39 ml/m2 (normal range 25+/-9), the LVESV is 86 ml (normal range 47+/-19), the LV mass index is 72 g/m2 (normal range 85+/-15), and the LV mass is 159 g (normal range 164+/-36). There is abnormal septal motion and apical hypokinesis. There is a small, focus of subendocardial late gadolinium enhancement in the basal lateral wall which is not transmural but extends to 2/3 of the wall thickness. Although the late gadolinium enhancement involves the endocardium, it is associated with normal wall thickness and is not likely to be secondary to a small focal myocardial infarction. It suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process.There is [no]myocardial iron overload. There is no LV thrombus. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 48%, the RV end diastolic volume index is 90 ml/m2 (normal range 82+/-16), the RVEDV is 197 ml (normal range 142+/-31), the RV end systolic volume index is 47 ml/m2 (normal range 31+/-9), and the RVESV is 103 ml (normal range 54+/-17). A pacemaker lead terminates in the right ventricular apex. Right AtriumThe right atrium is normal in size. A pacemaker lead terminates within the right atrial appendage. Aortic ValveThe aortic valve opens widely. Qualitatively there is mild aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is mildly dilated (44 mm at the sinus of Valsalva; 39 x 39mm ascending aorta.)Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is mildly dilated (34mm). Venous AnatomyThe SVC and IVC drain normally into the right atrium. Pacemaker leads traverse the innominate and SVC into the right heart.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsA pacemaker is present in the right upper chest wall. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Normal LV size with mildly reduced systolic function (EF 48%). There is a small focus of late gadolinium enhancement as described above which suggests the presence of a fibrosing, infiltrative, or inflammatory process. 2. Normal RV size with mildly reduced systolic function (EF 48%).3. Pacemaker leads within the SVC and right heart.4. Mild aortic regurgitation. 5. Mildly dilated aortic root. 6. Mildly dilated main pulmonary artery. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Reason: evaluate liver lesions History: newly diagnosed prostate cancer, Hepatitis hx ABDOMEN:LIVER, BILIARY TRACT: 2.8 cm T2 hyperintense lesion in the posterior right hepatic lobe with peripheral nodular enhancement and gradual fill-in on subsequent delayed images, compatible with a hemangioma. Another similar appearing lesion is seen more inferiorly in the posterior right hepatic lobe measuring 4.3 cm, and also compatible with a hemangioma. A less than 5 mm T2 hyperintensity in the lateral left hepatic lobe (3:13) is too small accurately characterize, but likely a cyst or hemangioma.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: 2.2 cm left adrenal lesion previously seen on CT has increased signal within it on that only images and foci of drop out on out of phase imaging, most compatible with an adenoma.KIDNEYS, URETERS: Scattered T2 hyperintense bilateral 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.Hepatic hemangiomas as above.2.Left adrenal lesion most compatible with an adenoma.3.Bilateral renal cysts.


Instruction: Generate impression based on findings.

Input: The 62-year-old male with seizures. Minimal small vessel disease of indeterminate age is noted.High density tissue prominence along the medial aspect of left temporal lobe which obscures the left perimesencephalic cistern is noted. This lesion may contain calcification and it overlaps the edge of the tentorium. The finding may represent a small meningioma with a small amount of vasogenic edema within the left temporal lobe. Possibly tilt primary tumor of the brain parenchyma cannot be entirely however ruled out. Further evaluation with an infused MRI examination is highly recommended. This finding is best appreciated on axial image 5 through 7. No evidence of hemorrhage, mass-effect, midline shift or hydrocephalus.

Output: 1.Minimal small vessel disease.2.Mass along the medial aspect left temporal lobe or along the edge of the tentorium with minimal vasogenic edema as detailed above.3.Follow-up with a dedicated posterior diffuse MRI of brain is recommended.


Instruction: Generate impression based on findings.

Input: 41-year-old female intravenous drug user with left hip fracture, febrile despite antibiotics. There is enhancement of the left hip joint indicating synovitis with small nonenhancing pockets representing small collections of fluid. There is a 2.0 x 2.0 x 0.8 cm collection of fluid along the anterosuperior aspect of the hip joint capsule, which possibly communicates with the underlying joint. There is edema and enhancement of the surrounding soft tissues of the hip extending into the proximal thigh musculature and off the field of view of this study. There is also edema and enhancement of the acetabulum and femoral head. There is loss of hip joint cartilage superiorly. There is flattening and fragmentation of the superior aspect of the femoral head, which is better seen on the recent CT scan. These findings are compatible with septic arthritis and adjacent osteomyelitis of the femoral head and acetabulum. Intramedullary edema and enhancement also extends to the femoral neck and intertrochanteric region to a lesser degree. The right hip, sacroiliac joints and pubic symphysis appear normal. Degenerative disc disease affects the lower lumbar spine. There is minimal peritrochanteric edema and enhancement on the right and mild enhancement of the obturator internus on the right, which is nonspecific. There is a Foley catheter within the bladder.

Output: 1.Synovitis of the left hip with small pockets of fluid compatible with septic arthritis.2.Extensive inflammatory changes in the soft tissues with a small collection of fluid along the anterosuperior aspect of the hip joint, which may represent a small abscess.3.Abnormal signal in the femoral head and acetabulum compatible with osteomyelitis.


Instruction: Generate impression based on findings.

Input: Following a discussion of the procedure with the patient and/or family, including its risks, benefits, alternatives and steps to prevent infection, informed written consent was obtained and documented in the patient's chart. The time-out form was completed to confirm patient identity and side/type of procedure. All operators present for the case performed standard preprocedural prep including hand washing, sterile gloves, mask and cap. The patient was prepped and draped in the usual aseptic fashion. Local anesthesia over the target area was obtained by 1% lidocaine. Midazolam and fentanyl were administered IV by the nurses during continuous hemodynamic monitoring. A localizing CT demonstrates a sclerotic focus within the left iliac bone corresponding to the findings seen on recent MRI examination. An OnControl core biopsy needle was advanced into the lesion using CT guidance. Two 13-gauge biopsy specimens were obtained.The core biopsy specimens were hand carried to the Surgical Pathology lab. The patient tolerated the procedure well without immediate complication. Routine post procedure instructions were communicated to the patient.ESTIMATED BLOOD LOSS: Less than 5cc. An adhesive bandage was placed on the patient’s skin.

Output: CT guided biopsy of a sclerotic lesion within the left iliac bone.


Instruction: Generate impression based on findings.

Input: Female, 36 years old, 36 weeks gestational age, with enlarged fetal ventricles and cisterna magna on ultrasound. The right lateral ventricle is enlarged measuring up to 13 mm in diameter at the level of the atrium. The left lateral ventricle is within normal limits measuring up to 8 mm at the level of the atrium. The third ventricle is within normal limits. The cerebral aqueduct is patent. The fourth ventricle is within normal limits.The cisterna magna measures up to 12 mm. However, the posterior fossa structures including the brainstem, cerebellar vermis and cerebellar hemispheres are otherwise normally formed and unremarkable.The corpus callosum is fully formed and intact. The pituitary region is unremarkable. The degree of cerebral gyration is appropriate for gestational age. No areas of parenchymal signal abnormality are suspected. No findings to suggest intracranial hemorrhage or any abnormal extra-axial fluid collection are identified.

Output: 1.Enlargement of the right lateral ventricle.2.Prominence of the cisterna magna.3.The remainder of the examination is within normal limits.


Instruction: Generate impression based on findings.

Input: 44-year-old male with pancreatitis. Rule out pancreatic duct obstruction. Motion artifact limits evaluation on multiple sequences. Within this limitation, the following observations are made.ABDOMEN:LIVER, BILIARY TRACT: No suspicious hepatic lesions. Distention of the gallbladder and prominence of the central intrahepatic bile ducts and common bile duct without evidence of distal obstructing stone; these findings may be due to fasting state or pancreatitis (see below).SPLEEN: No significant abnormality noted.PANCREAS: Mild atrophy of the pancreas diffusely with loss of normal high T1 signal. Main pancreatic ductal dilation measuring up to 11 mm with multiple side branches visualized. Low T1 and T2 signal material measuring about 7 mm without enhancement is seen within the main pancreatic duct in the head, most compatible with impacted debris and/or stone (series 4/15). Mild-to-moderate peripancreatic edema predominantly around the head with a small amount of free fluid is also seen extending down the right paracolic gutter. Overall, the findings are most compatible with acute on chronic pancreatitis due to obstructing pancreatic duct stone. There is increased wall thickening with enhancement of the adjacent descending duodenum, most likely reactive. 2.1 x 1.1 cm loculated fluid collection posterior to the descending duodenum (series 501/12), most likely a pancreatic pseudocyst. A subcentimeter T2 hyperintense cystic lesion within the uncinate is also likely due to a small pseudocyst. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Prominent peripancreatic lymph nodes are most likely reactive.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Trace left pleural effusion partially visualized.

Output: 1. Findings most compatible with acute on chronic pancreatitis due to obstructing pancreatic duct stone, as detailed above.2. Small probable pseudocyst posterior to the descending duodenum with additional smaller probable pseudocyst in the uncinate process.3. Findings suggestive of reactive duodenitis.


Instruction: Generate impression based on findings.

Input: Right temporal lobe epilepsy: complex partial seizures. The brain parenchyma, including the hippocampi appears unremarkable. There is no evidence of intracranial hemorrhage, mass, 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 paranasal sinuses are grossly unremarkable. There is a small amount of fluid in the right mastoid air cells. There is a nonspecific low T1 and T2 signal subcentimeter apical scalp nodule.

Output: No evidence of gross seizure foci.


Instruction: Generate impression based on findings.

Input: Clinical question: Orbital cellulitis?. Signs and symptoms: Right eye pain with movement. Enhanced MRI of orbits:120 cc of Omnipaque 350 was administered.The retro-orbital fat is well preserved and with no evidence of stranding or abnormal enhancement. The extraocular musculature has normal morphology and size and no abnormal enhancement.The optic nerves are well visualized and with no abnormal enhancement.There is normal morphology and density of bilateral globes and with no abnormal enhancement.The adjacent paranasal sinuses demonstrate minimal sinus disease of the ethmoids and otherwise unremarkable.Cavernous sinuses and sella are normal and no abnormal enhancement. No evidence of preseptal soft tissue swelling or abnormal enhancement.

Output: Negative enhanced CT of orbits.


Instruction: Generate impression based on findings.

Input: Male; 71 years old. Reason: assess for HCC recurrence. History: HCC s/p treatment. ABDOMEN:LIVER, BILIARY TRACT: Nodular liver contour and caudate lobe hypertrophy are again noted and compatible with cirrhosis. Patent hepatic vasculature. Perigastric varices indicative of portal hypertension. Cholelithiasis. No biliary ductal dilatation. There has not been significant interval change in size of the treatment cavities s/p ablation, with both cavities demonstrating high intrinsic T1 signal compatible with residual blood products. Subcapsular segment 6 cavity measures 5.8 x 4.8 cm, previously 5.7 x 4.6 cm (series 9, image 38), and the segment 5 treatment cavity measures 3.6 x 2.5 cm, previously 3.5 x 2.3 cm (series 9, image 39). No definite enhancing areas of soft tissue are noted in either cavity to indicate residual/recurrent tumor. No suspicious arterially enhancing lesions seen elsewhere in the liver. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Scattered bilateral renal cysts. No hydronephrosis. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small anterior wall hernia (Spigelian versus incisional) in the right lower quadrant containing mesenteric fat and nonobstructive loops of small bowel, unchanged.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Cirrhotic liver morphology without significant interval change in size and appearance of ablation cavities as described above. 2.No new suspicious lesions or definite evidence of residual enhancing tumor. 3.Cholelithiasis.


Instruction: Generate impression based on findings.

Input: Female, 62 years old, with back pain after lumbar puncture radiating to the right lower extremity. Alignment is anatomic. Vertebral body morphology is within normal limits. Marrow signal characteristics are normal with no evidence of marrow infiltration or marrow edema.The visualized spinal cord, conus and cauda equina demonstrate normal signal intensity and mor phology. No pathologic epidural fluid or tissue is seen.L1-2: Left paracentral disk protrusion without significant spinal canal stenosis or obvious nerve root impingement. The neural foramina are patent. L2-3: Minimal right paracentral disk protrusion without significant canal stenosis or nerve root impingement. The neural foramina are patent. L3-4: Mild facet hypertrophy and ligamentum flavum thickening. Minimal left foraminal protrusion. No significant spinal canal or neuroforaminal narrowing. L4-5: Mild facet hypertrophy and ligamentum flavum thickening. Minimal left foraminal protrusion/annular fissure. No significant spinal canal or neuroforaminal narrowing. L5-S1: Mild facet hypertrophy. No significant spinal canal or neuroforaminal narrowing. Perineural root sleeve cysts are seen scattered through the sacral foramina.

Output: 1. Left paracentral disk protrusion at L1-2 without significant spinal canal or neuroforaminal stenosis and no evidence of nerve root impingement.2. Very mild degenerative findings at other levels as discussed above.3. No complications of lumbar puncture are seen including no evidence of any epidural blood or other fluid collections.


Instruction: Generate impression based on findings.

Input: Chiari and syrinx, follow up evaluation in 3 months, sp decompression. There are postoperative findings related to Chiari decompression. There is a persistent extra-axial fluid collection in the surgical bed that measures 25 AP x 33 RL x 32 SI mm. The inferior cerebellar demonstrates an unchanged configuration. There is no significant interval change in the mild cervicothoracic syringohydromyelia. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis.

Output: Postoperative findings related to Chiari decompression with a persistent pseudomeningocele, but no significant interval change in the mild cervicothoracic syringohydromyelia.


Instruction: Generate impression based on findings.

Input: Ms. Sherri Downs is a 58 years old female with MRI detected enhancing mass in the right breast presents for MRI directed ultrasound. A targeted right ultrasound was performed for the MRI area of concern. There is no solid or cystic mass identified to definitively correlate with the MRI.

Output: No sonographic correlate for the enhancing right breast lesion detected on the MRI breast. MRI guided biopsy of this right breast breast mass is recommended. Results and recommendations were discussed with the patient.BIRADS: 1 - Negative.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration.


Instruction: Generate impression based on findings.

Input: 26 years, Male, Reason: H/o PSC, elevated alk phos, eval for disease progression History: see above. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Peripheral regions arterial enhancement which do not persist on subsequent phases likely represent transient hepatic intensity differences. No suspicious hepatic lesions are evident.The common bile duct is dilated to 1 cm, proximal to an approximately 2 cm segment of narrowing and irregularity of the distal common bile duct, new from the prior exam. There are multiple regions of narrowing and dilatation involving the intrahepatic bile ducts giving a beaded appearance, increased from the prior exam. The right common bile duct is particularly narrowed at its confluence.SPLEEN: Multiple splenic cysts are overall similar in appearance to the prior exam. A large T2 hyperintense complex cystic lesion in the anterior spleen with multiple enhancing septations and progressive centripetal enhancement is unchanged in size measuring 3.5 x 2.8 cm (501/34), previously 3.4 x 2.8 cm.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: There is mild diffusion restriction, thickening and minimal enhancement within the relatively ahaustral colon and terminal ileum.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Multiple foci of intrahepatic and extrahepatic stricturing, increased from the prior exam, suggestive of primary sclerosing cholangitis.2.Diffusion restriction, enhancement and ahaustral colon is suggestive of inflammatory bowel disease with terminal ileitis.3.Multiple splenic cysts, including a larger nonspecific enhancing complex cystic lesion, are stable.


Instruction: Generate impression based on findings.

Input: Amenorrhea. The pituitary gland is not enlarged and enhances homogeneously. There is no evidence of mass lesions. The infundibulum is intact and situated in the midline. The adjacent optic apparatus, cavernous sinuses and internal carotid artery flow voids are intact. There are bilateral maxillary sinus retention cysts.

Output: No evidence of pituitary lesions.


Instruction: Generate impression based on findings.

Input: 68 year old female with newly diagnosed right breast cancer at upper outer quadrant (2 sites) and with a proven benign lesion in the right breast, presents for breast MRI study. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.In the right breast, there are three abnormally enhancing masses in the posterior 11:00 position. Most superior mass (#1) measures 19 x 19 x 12 mm (AP x LR x CC), and this is a proven IDC with a venus clip. Second mass is located between #1 and #3 masses, measuring 29 x 12 x 19 mm, with a ribbon clip, and this is another biopsy proven IDC. #3 mass is located most inferiorly, measuring 13 x 11 x 10 mm. Overall measurement of these three masses is 34 x 29 x 38 mm.There is a small clip artifact from recent benign biopsy at anterior 10:00 position in the right breast.There is a non enhancing benign mass in the central right breast.No abnormal enhancement is seen in left breast. No abnormal lymph nodes are identified in either axillary region.

Output: 1. Two biopsy proven cancers and one suspicious mass in the right breast at posterior 11:00 position. If conservation surgery is planned, bracketed wire localization for the most superior mass (#1 with venus clip) and most inferior mass (#3: non-biopsied) is recommended. #3 mass corresponds to the mass annotated as #3 in the ultrasound study performed on Sep 21, 2016. This mass is also seen on mammogram.2. No abnormal enhancement in left breast. 3. No abnormal lymph nodes in either axillary regionBIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: 57-year-old female with history of HCV and HCC. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology. Increased T2 reticulation within the liver parenchyma compatible with fibrosis. Large volume ascites.In segment 7 there is a heterogeneous mass with a low signal intensity capsule as well as internal foci of high T1/T2 measuring 5.5 x 4.6 cm (image 34 of series 41). There is no arterial enhancement, however there is diffuse washout extending outside of the boundaries of the capsule likely representing diffusely infiltrative disease.In segment 6, there is a round T2 hypointense lesion with arterial enhancement and washout measuring 2.3 x 2.6 cm (image 24 of series 401).In the lateral segment of the left hepatic lobe there is an ill defined area of signal abnormality with washout.There is a large thrombus within the right portal vein extending into the main portal vein. This thrombus demonstrates foci of enhancement compatible tumor thrombus.Hydropic gallbladder wall thickening likely secondary to hypoproteinemia.Numerous enlarged portal lymph nodes.SPLEEN: Splenomegaly measuring 18 cm.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: Gastric and esophageal varices.

Output: 1.Diffuse multifocal HCC as above with tumor thrombus in the right portal vein extending into the distal main portal vein.2.Portal hypertension with gastric and esophageal varices. Splenomegaly.3.Hydropic gallbladder wall thickening likely secondary to hypoproteinemia.


Instruction: Generate impression based on findings.

Input: There is straightening of the cervical lordosis. The vertebral body heights are preserved. There is mild loss of disc height at C5-6, C6-7 and C6-7. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.C2-C3: No significant disc bulge, herniation, spinal canal or foraminal stenosis.C3-C4: No significant disc bulge, herniation, spinal canal or foraminal stenosis.C4-C5: No significant disc bulge, herniation, spinal canal or foraminal stenosis.C5-C6: Posterior disc-osteophyte complex with superimposed small central disc protrusion, contributing to mild bilateral foraminal narrowing. No significant spinal canal stenosis.C6-C7: Posterior disc-osteophyte complex, contributing to moderate bilateral foraminal stenosis. No significant spinal canal stenosis.C7-T1: No significant disc bulge, herniation, spinal canal or foraminal stenosis.

Output: Mild degenerative cervical spondylosis that is most prominent at C6-C7 with moderate bilateral foraminal stenosis, but no significant spinal canal stenosis. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 4-year-old male with deep sacral dimple. Determine if tethered cord with comparison with previous lumbar spine. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign. There is no pathological enhancement. The distal spinal cord and the conus are within normal limits. The conus terminates at the L1-L2 level. There is no abnormal intrinsic T1 hyperintensity within the distal thecal sac to suggest fatty filum. On prone imaging, there is clear anterior displacement of the cord. There is no significant disc bulge, herniation, spinal canal or foraminal stenosis in the lumbar spine.Paraspinous soft tissues are within normal limits.

Output: Unremarkable evaluation with no evidence of tethered cord.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Reason: 60F with unexplained elevated Alk Phos (500s) > AST/ALT (300-400s), MGM died of non-EtOH cirrhosis of unclear etiology, ultrasound unremarkable, asymptomatic, ?stone, ?biliary pathology History: 60F with unexplained elevated Alk Phos (500s) > AST/ALT (300-400s), MGM died of non-EtOH cirrhosis of unclear etiology, ultrasound unremarkable, asymptomatic, ?stone, ?biliary pathology ABDOMEN:LIVER, BILIARY TRACT: Noncirrhotic liver morphology. No focal hepatic lesions. Common bile duct appears normal.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal T2 hyperintensities, likely cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Ill-defined T2 hypointense lesions within the pelvis seen on the coronal view may represent uterine fibroids or adenomyomas

Output: Normal appearing liver and biliary system without findings to account for patients elevated alkaline phosphatase.


Instruction: Generate impression based on findings.

Input: 63 years Male (DOB:7/30/1952)Reason: mets lung cancer, brain mets, s/p WBRT, on immunotherapy now, pls c/w previous study and evaluate tx response. History: brain metsPROVIDER/ATTENDING NAME: BRITTANY L BEACH JYOTI D PATEL The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a T2, FLAIR and T1 hypointense lesion associated with susceptibility effect located along the right choroid fissure.There are multiple heterogeneous lesions within the brain parenchyma associated with susceptibility effect and heterogeneous signal on T2 and T1-weighted imaging. One is located in the right inferior parietal lobule measuring 8 mm in size involving cortex and underlying white matter. Another is present along the right temporal lobe superior temporal gyrus measuring 5 mm in size. Another is located in the right occipital lobe along the cuneus and measures 4 mm in size. Another one is located in the left cerebellar hemisphere measuring 4 mm in size, another is located in the left posterior temporal lobe and measures 4 mm in diameter. Several smaller lesions are only detected on susceptibility weighted imaging in particular in the left superior frontal gyrus and the left precentral gyrus just medial to the hand motor area and another in the right inferior parietal lobule. A punctate one is located in the left uncus.A focus of susceptibility effect is present within the velum interpositumThere is redemonstration of a sessile extra-axial mass adjacent to the right temporal lobe measuring 14 x 6 mm sagittal dimensions on 2/21/2014 measured 4 x 9 mm sagittal dimensions.There is a mild degree of periventricular and subcortical confluent hyperintense white matter lesions present identified on the FLAIR and T2 images.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.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.Initial note is made of partial empty sella.

Output: 1.There are multiple hemorrhagic lesions scattered in both hemispheres of the brain as well as in the left cerebellar hemisphere. Additional lesions are identified in the right choroid fissure and the velum interpositum. These are known to represent treated metastases. No new metastatic foci are appreciated.2.There are periventricular white matter lesions present which are rather confluent and most likely treatment related.3.There is a small extra-axial mass adjacent right temporal lobe one possibility is that this represents a meningioma though metastatic disease cannot be entirely excluded. It has not changed substantially since 2/15/2016. It is slightly larger when compared to the 2/21/2014 exam.


Instruction: Generate impression based on findings.

Input: Reason: Persistent right knee pain - assess for possible cause: chondral defect, meniscal tear, etc History: Persistent right knee pain (medial) and patellofemoral pain Due to the technologist error, axial images were not obtained. We will attempt to have the patient return for additional imaging at which time an addendum will be logged. Furthermore, due to the patient's body habitus, a dedicated knee coil could not be utilized, resulting in suboptimal image quality.MENISCI: There is perhaps mild fraying of the undersurface of the anterior horn of the medial meniscus, but we see no discrete tear. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is near full-thickness to full-thickness cartilage loss along the medial facet of the patella, appearing similar to the prior study when accounting for the aforementioned technical differences. Relatively mild cartilage degeneration affects the lateral facet of the patella. There is subchondral cyst formation appearing similar to the prior study, when accounting for differences in technique. There is subchondral cyst formation within the posterior aspect of the medial tibial plateau that appears larger than on the prior study with increased signal intensity within the overlying articular cartilage likely representing focal degeneration. We see no discrete cartilage defects involving the lateral compartment cartilage. There is patchy intermediate signal intensity within the distal femoral metadiaphysis likely representing residual red marrow, unchanged.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact. There is mild intermediate signal intensity within the proximal fibers of the patellar tendon which may represent mild tendinosis, but is of questionable clinical significance.ADDITIONAL

Output: Osteoarthritis particularly affecting the patellofemoral joint and other findings as described above. Due to the technologist error, axial images were not obtained. We will attempt to have the patient return for additional imaging at which time an addendum will be logged. Furthermore, due to the patient's body habitus, the routine knee coil could not be utilized, resulting in suboptimal image quality.


Instruction: Generate impression based on findings.

Input: Known right triple negative cancer. Biopsy proven axillary metastasis. There is heterogeneous amount of fibroglandular tissue in both breasts. Mild background parenchymal enhancement is noted bilaterally.RIGHT BREAST:In the right upper outer breast, there is an irregular enhancing mass identified measuring 3.0 x 2.5 x 2.3 cm (AP x ML x SI). Susceptibility artifact from biopsy marker clip is seen within this proven malignancy.Again seen extending postero-inferiorly from the index malignancy are multiple additional enhancing masses. The largest extent of the index and satellite masses in an AP oblique projection is 6.3 cm. A hydromark clip is seen inferior and lateral to the index mass, from the prior benign biopsy. In the right axilla, there at least three abnormal morphology lymph nodes with eccentric cortical thickening , the largest of which measures approximately 1.7 cm. One hydromark clip is present within this largest node, and another clip is adjacent to the node.LEFT BREAST:In the left retroareolar region, an oval circumscribed mass with adjacent hydromark biopsy clip artifact and post biopsy changes is present. This area was benign at the outside hospital biopsy.No abnormal axillary lymph nodes are identified in the left axillary region.

Output: Proven malignancy in the right breast and axilla with measurements given above. Numerous satellite lesions are again noted extending inferior and posterior to the index lesion and ultrasound guided biopsy of one of satellites furthest from the index can be performed if clinically indicated. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Chiari decompression with syrinx spine, yearly follow up: Back, shoulder, and neck pain, and headache. Brain: There are postoperative findings related to Chiari decompression and right tonsillar reduction. There is now encephalomalacia within the remaining right cerebellar tonsil and right biventral lobule. There is no evidence of pseudomeningocele. There is biphasic cerebrospinal fluid flow anteriorly and posteriorly across the neo-foramen magnum. The cerebellum extends to the level of the superior aspect of the odontoid. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There is no evidence of acute infarction of hemorrhage.Spine: There has been interval decrease in caliber of the cervical and thoracic syringohydromyelia, which measures up to 5 mm in width, previously 7 mm. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis.

Output: 1. Expected postoperative findings in the posterior fossa related to prior Chiari malformation surgery. 2. Interval decrease in caliber of the cervical and thoracic syringohydromyelia


Instruction: Generate impression based on findings.

Input: Metastatic NSCLC to the brain. Status post stereotactic radiosurgery to the left frontal and left occipital regions and subsequently to right frontal and left occipital lesions.Additional clinical history from electronic medical records:L frontal and L occipital regions SRS 20 Gy x 1 on 7/8/15R frontal and L occipital regions SRS 20 Gy x 1 on 11/18/15 The ringlike contrast enhancing lesion in the left occipital lobe has increased in size, now measures up to 15 mm transaxially, compared to 5 mm previously. The contrast-enhancing rim is associated with susceptibility effect. There is also surrounding confluent T2-hyperintensity, consistent with edema.The small left frontal lesion with associated susceptibility effect is not significantly changed in size but shows more pronounced peripheral contrast enhancement, especially posteriorly, on axial imaging. However, the axial imaging on today's examination was obtained in a slightly more delayed fashion compared to on the previous examination, which may account for the apparent increase in contrast enhancement. The surrounding confluent T2-hyperintensity is unchanged to very minimally increased.The tiny right frontal lesion with associated susceptibility effect remains unchanged, without associated contrast enhancement or surrounding edema. Other similar small lesions in the deep posterior left parietal lobe and the superficial right middle frontal gyrus remain unchanged, also without associated contrast enhancement or surrounding edema.There is no acute infarct or acute intracranial hemorrhage. Tiny CSF intensity focus in the left midbrain is unchanged, and may represent a tiny chronic lacunar infarct or atypical dilated perivascular space. The left frontal developmental venous anomaly is unchanged. Major intracranial vascular flow voids are preserved. There is incidental finding of a small defect involving the anterior aspect of the falx.Orbits show findings of previous bilateral lens replacement. The mastoid air cells are clear. There is trace mucosal thickening in the ethmoid sinuses.

Output: 1.Since February 9, 2016, there has been increase in the size of the ring-enhancing lesion in the left occipital lobe with increased associated edema, which may reflect evolving post stereotactic radiosurgery change. However, progression of the metastasis can also appear similar. Continued follow-up is recommended.2.The small left frontal lesion shows apparent minimal increase in the peripheral contrast enhancement but this might be artifactual, from differences in technique as described above. The associated surrounding T2-hyperintensity is unchanged or very minimally increased.3.The other 2 right frontal and 1 left parietal lesions remain unchanged, without associated contrast enhancement or surrounding edema.