Instruction: Generate impression based on findings.

Input: History of HIV. History of regional enteritis. Evaluate for active inflammation. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The bowel is adequately distended with oral contrast. The small bowel fold pattern is maintained.The terminal ileum is well visualized. The small bowel is normal in caliber wall thickness and without adjacent inflammatory changes. There is no abnormal T2-weighted signal intensity, restricted diffusion or postcontrast enhancement of the small bowel wall to suggest active inflammation.No fixed luminal narrowing or upstream dilatation to suggest a flow-limiting stricture.No evidence of sinus tract or fistula formation.No free fluid or loculated fluid collection.The colon is normal caliber, wall thickness and without adjacent inflammatory changes.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No evidence of active small bowel inflammation, flow-limiting stricture or sinus-fistulous disease.


Instruction: Generate impression based on findings.

Input: No diffusion restriction to suggest acute infarction. Periventricular and subcortical white matter T2/FLAIR signal abnormality consistent with chronic small vessel ischemic disease. Additionally, there is encephalomalacia with gliosis involving the anterior temporal lobes and bilateral paramedian frontal lobes including rectus gyri consistent with sequelae of remote trauma. Foci of scattered susceptibility consistent with prior remote microhemorrhages. Moderate prominence of the ventricles and sulci consistent with age-related diffuse volume loss. There are no masses, mass effect, or midline shift. There are no extraaxial fluid collections or subdural hematomas. There is no evidence of acute intracranial hemorrhage. The cerebellar tonsils are in normal position. The pituitary gland is normal in size. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear.

Output: 1.No findings to suggest acute ischemia.2.MRI evidence for sequelae of remote brain trauma.


Instruction: Generate impression based on findings.

Input: 30 year-old female with metastatic Ewing sarcoma. Evaluate for disease progression. CHEST:LUNGS AND PLEURA: Index right lower lobe pulmonary nodule measures 7-mm in diameter image number 46, series number 5. No other lung nodules. Subsegmental atelectasis in lung bases, more prominent on the right side.MEDIASTINUM AND HILA: Index right paratracheal node is slightly increased in size and now measures 15 x 8 mm image number 13, series number 3. Other mediastinal nodes are also stable to slightly increased in size.CHEST WALL: Heterogeneously changes in the right femoral head. These changes can better evaluated on a dedicated MRI.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: Pancreas is atrophic. Previously identified mass along the superior aspect of the pancreatic body is not visualized. Previously described small cystic lesion in the pancreas is also not well seen.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Lesion in the left midpole of the kidney is smaller measuring 9 x 11 mm image number 96, series number 3.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small fat containing periumbilical hernia.BONES, SOFT TISSUES: Round nodules in the anterior abdominal wall likely represent injection changes.OTHER: Small fat containing umbilical hernia.PELVIS:UTERUS, ADNEXA: Atrophic uterus.BLADDER: Significant wall thickening of the bladder persists without change and this may represent cystitis.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted. Normal appendix in the right lower quadrant.BONES, SOFT TISSUES: Laminectomy defect, stable.OTHER: No significant abnormality noted.

Output: Right lung nodule is stable.Mediastinal and lymph nodes have remained stable to minimally increased in size.Pancreatic lesions have resolved. Large left renal lesion has not changed in size. Smaller left renal lesions are larger. Diffuse wall thickening of the bladder suspicious for cystitis.Heterogeneous lytic changes in the right humerus, inadequately evaluated with this study.


Instruction: Generate impression based on findings.

Input: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are scattered punctate foci of T2 hyperintensity within the supratentorial and infratentorial white matter most compatible with mild chronic small vessel ischemic disease. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull and scalp soft tissues are unremarkable. There is minimal paranasal sinus mucosal thickening.

Output: Mild chronic small vessel ischemic disease. Otherwise unremarkable MRI of the brain.


Instruction: Generate impression based on findings.

Input: 58-year-old male with alcoholic cirrhosis who presents for hepatocellular carcinoma screening. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology and evidence of hepatic steatosis. There are multiple T2 hyperintense subcentimeter foci without evidence of contrast enhancement, compatible with simple cysts. On the arterial phase, there are scattered vague subcentimeter enhancing lesions without definite corresponding washout, which may be perfusional in etiology.Sequela of portal hypertension including gastroesophageal varices noted.No intra or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple bilateral T2 hyperintense, T1 hypointense, nonenhancing lesions compatible with cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is thickening of the ascending colon compatible with portal colopathy. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Cirrhotic hepatic morphology without evidence of hepatocellular carcinoma. Scattered vague subcentimeter lesions noted on the arterial phase without washout may be perfusional in etiology.2.Multiple subcentimeter hepatic cysts.3.Bilateral renal cysts.


Instruction: Generate impression based on findings.

Input: Examination is of the thoracic spine, and the cervical spine is partially imaged on the sagittal T2 counting sequence.There are postoperative findings related to Chiari decompression surgery. The cerebellar tonsils display a grossly unchanged configuration and position based on the limited sequence. Again seen is a thin, long-segment cervicothoracic syrinx. Cervical portion of the syrinx is not well evaluated. The thoracic component extends throughout the thoracic cord terminating inferiorly at the T11 level. Syrinx is relatively largest at the T4-T5 level where it measures 2 x 4 mm in the AP and transverse dimensions and unchanged.There is unchanged loss of the usual cervical lordosis and a small posterior disc-osteophyte complex at C5-6 without significant spinal canal stenosis. Vertebral body heights and alignment in the thoracic spine are normal. There is no significant spinal canal or neural foraminal stenosis in the thoracic spine. Bone marrow signal is benign.

Output: No significant change in size of the thoracic syrinx compared to 9/10/2015. Note the cervical portion of the syrinx is not well assessed.


Instruction: Generate impression based on findings.

Input: Clinical question: Please evaluate patient with malignancy and recent increase intracranial pressure/hydrocephalus. Signs and symptoms: As above. Nonenhanced head CT:Diffuse low-attenuation of bilateral cerebellar hemispheres is consistent with extensive edema. There is near complete effacement of cerebellar and vermian for your, complete effacement of bilateral cerebellopontine cisterns, compressed fourth ventricle and crowding of the fragment magnum as well as effacement of the quadrigeminal plate cistern are all results of intracranial increased pressure in the posterior fossa. This appearance is not significantly different than prior head CT from 8 -- 22 -- 11. Prior MRI is suggestive of cerebellitis.Images through the supratentorial space demonstrate shunted lateral ventricles with significant interval decrease in their size since prior study. Minimal amount of blood in the dependent portion of right occipital horn is minimally larger than prior study and likely result of precipitation. There is better visualization of supratentorial cortical sulci due to reduction in the size of ventricles. No evidence of parenchymal hemorrhage with edema. No evidence of midline shift.

Output: 1.Significant interval decrease in the size of supratentorial ventricular system. Minimal blood in the dependent right occipital horn.2.Extensive cerebellar edema and resultant mass effect similar to prior study.3.No evidence of acute new findings.


Instruction: Generate impression based on findings.

Input: 76-year-old male with history of kidney cancer. ABDOMEN:LIVER, BILIARY TRACT: Stable segment 8 benign cyst. Scattered benign subcentimeter cysts. No intrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Postoperative changes of right nephrectomy. No evidence of disease recurrence. Unchanged nonenhancing left renal 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: Postoperative changes as above with no evidence of recurrence or metastatic disease.


Instruction: Generate impression based on findings.

Input: Female 27 years old Reason: evaluate for possible pleural infection/empyema History: sob, malabsorption of csf in pleural space LUNGS AND PLEURA: There is right basal atelectasis and a small right pleural effusion with minimal loculation. The lung parenchyma is suboptimally evaluated on MRI. MEDIASTINUM AND HILA: Left sided central venous catheter with tip in the distal SVC.CHEST WALL: A ventriculopleural shunt tracks within the right anterior chest wall subcutaneous tissues, and traverses the right pleura terminating in the right lower pleural space.UPPER ABDOMEN: Incidental note is made of a small splenule.

Output: A ventriculopleural shunt tracks within the right anterior chest wall subcutaneous tissues and terminates in the right lower pleural space within small adjacent atelectasis/minimally loculated right pleural effusion.


Instruction: Generate impression based on findings.

Input: 12 years Male (DOB:3/30/2004)Reason: migraines, questionable seizure History: as abovePROVIDER/ATTENDING NAME: CHARLES J MARCUCCILLI CHARLES J MARCUCCILLI The CSF spaces are appropriate for the patient's stated age with no midline shift. The previously noted lesion along the right inferior colliculus is barely identified on this exam.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate a mucous retention cyst in the left maxillary sinus.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: The previously noted lesion in the inferior colliculus is not readily identified on this exam. No intracranial mass lesions are appreciated.


Instruction: Generate impression based on findings.

Input: Diagnosis: Displacement of lumbar intervertebral disc without myelopathy. Thoracic or lumbosacral neuritis or radiculitis, unspecifiedClinical question: hx lumbar disc herniation. Eval for new abnormality or reherniationSigns and Symptoms: back pain, Left leg pain, left big toe numbness Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. There is a high T1 signal lesion present within the L4 vertebral body which is a on the right half of the vertebral body and measures 13 x 12 mm sagittal dimensions and most likely represents a vertebral body hemangioma.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is a left lateral disc protrusion present which extends into the left neural foramen and encroaches on the left-sided exiting nerve root. Additionally there is a sequestered fragment present at the left lateral recess behind the L4 vertebral body. This sequestered fragment was not present on the prior exam. The lateral disc protrusion was present on the prior exam and has mildly progressed. There is redemonstration of loss of disc space height and disc desiccation at this level. High signal foci on T2 imaging are present within the disc protrusion.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.There are small Schmorl's nodes present at T12-L1 and T11-T12 along the corresponding superior endplates.

Output: Since the prior exam in addition to the left lateral disc protrusion encroaching the exiting nerve roots on the left-side at L4-5 which has progressed, the patient has developed a disc fragment which is at the left lateral recess behind the L4 vertebral body affecting the nerve roots at the left lateral recess.


Instruction: Generate impression based on findings.

Input: Right parietal ischemic stroke and a 60-year-old female. Images through posterior fossa demonstrates a focal area of low attenuation in the right aspect of pons with a small calcification. This is believed to represent an old lacunar infarct and dystrophic calcification. This finding was present on the prior exam and demonstrates no definitive interval change. To exclude other pathologies at this location an MRI exam is recommended.Images through the supratentorial brain parenchyma demonstrate no definitive evidence of stroke, hemorrhage, mass-effect or midline shift. A very subtle questionable lucency however overlapping the cortex of the operculum of the right parietal lobe is suspected on axial image 14 which was not present on the prior study. Further dilation with an MRI is recommended. This finding may represent a very small area of new cortical stroke.

Output: 1.Likely old lacunar infarct of the pons with calcification.2.Only suspect small lucency involving the cortex of the proximal right frontal lobe.3.Both these findings can be better evaluated with an MRI exam.


Instruction: Generate impression based on findings.

Input: 3-year-old female in status epilepticus There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Normal brain CT.


Instruction: Generate impression based on findings.

Input: 80 year old female patient with CNS lymphoma, follow up examination. There are post-surgical findings related to a prior transphenoidal pituitary surgery with enhancing tissue within the sella and the right cavernous sinus, appearing similar to the prior study. There is subcortical and periventricular white matter abnormal T2 signal which is non-specific but likely represents chronic small vessel ischemic disease. There are scattered foci of susceptibility artifact within the left parietal, bilateral basal ganglia, and temporal lobes, which likely represents chronic blood products. There is an increased degree of T2 hyperintensity just anterolateral to the right cerebral peduncle, best seen on series 501, image 17, which does not demonstrate enhancement.The ventricles and basal cisterns are stable in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The right maxillary sinus is atelectatic. There is a right frontal burr hole. An ovoid nodule within the right parotid gland is not significantly changed. The orbits and scalp soft tissues are grossly unremarkable.

Output: 1.No abnormal enhancement to suggest recurrent primary CNS lymphoma.2.Increased T2 hyperintensity anterolateral to the right cerebral peduncle is non-specific and is of uncertain significance, but should be followed on subsequent imaging. 3.Stable appearance of the post-operative sella.4.Unchanged non-specific right parotid nodule.


Instruction: Generate impression based on findings.

Input: Male; 24 years old. Reason: history of Crohn's disease s/p ileocecectomy. assess for stricture at anastomosis and active disease History: abdominal pain ABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy.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: Status post ileocecectomy with patent anastomosis. Minimal bowel wall thickening and enhancement of the neoterminal ileum, equivocal for active inflammatory bowel disease.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Patent ileocecostomy anastomosis with findings equivocal for active inflammatory bowel disease of the neoterminal ileum.


Instruction: Generate impression based on findings.

Input: 67-year-old male with a history of foreign body between the third and fourth metatarsals, on prior MRI dated 5/2013, which was not removed. Now with recent onset of increasing pain and edema. Again seen is a 1.6 cm linear focus of low signal abnormality along the dorsal aspect of the interspace between the third and fourth metatarsal heads, best seen on the sagittal STIR images (image 11; series 8), consistent with the patient's history of a retained foreign body. There is interval increase in size of the surrounding enhancing increased signal abnormality in the surrounding area along the dorsal aspect of the foot which extends into the web space between the third and fourth metatarsal, which may represent granulation tissue, measuring approximately 2.2 x 1.5 x 2.9 cm (image 27; series 4). There is a central focus of fluid signal intensity which does not enhance on post contrast sequences which may represent fluid/debris within a subcentimeter abscess (image 27; series 10). There is extensive subcutaneous edema in the surrounding area along the dorsal aspect of the second through fifth metatarsals.There is increased T2 signal abnormality in the bone marrow of the proximal phalanx of the fourth digit of the left foot without associated decreased T1 signal abnormality likely representing reactive osteitis. Osteomyelitis is considered less likely. There is also fluid along the tendon sheath of the extensor digitorum tendon of the fourth digit of the left foot which is suspicious for tenosynovitis.

Output: Retained foreign body along the dorsal aspect of the third and fourth metatarsals with interval increase in the previously described surrounding inflammatory change and equivocal subcentimeter abscess formation.


Instruction: Generate impression based on findings.

Input: History of left-sided testicular cancer. Evaluate for metastatic disease. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No enlarged retroperitoneal lymph nodes. The largest lymph node is a left periaortic node measuring 4 mm in short axis.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No enlarged pelvic lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Postsurgical changes from left orchiectomy.OTHER: No significant abnormality noted.

Output: No enlarged retroperitoneal lymphadenopathy.


Instruction: Generate impression based on findings.

Input: 17-year-old male with left knee pain. Evaluate for lateral meniscal tear. MENISCI: The lateral meniscus is discoid. There is increased signal in the anterior and posterior horns of the lateral meniscus with signal in the posterior horn extending to the inferior articular surface; findings compatible horizontal cleavage tear. No evidence of abnormal signal in the medial meniscus.ARTICULAR CARTILAGE AND BONE: No significant abnormality noted.LIGAMENTS: The anterior cruciate, posterior cruciate, medial collateral, and lateral collateral ligaments are intact.EXTENSOR MECHANISM: Patellar tendon and quadriceps tendon are intact.ADDITIONAL

Output: Findings compatible with a horizontal cleavage tear of the lateral, discoid meniscus.


Instruction: Generate impression based on findings.

Input: 25 years old female with history of narcolepsy came with chief complaint of word finding difficulty and bilateral hand numbness. Patient found to be hyperreflexic on neuro-exam. Rule out multiple sclerosis. Brain:The brain shows no focal lesion. Dilated perivascular spaces are present in the frontal white matter. There is also an incidental right frontal developmental venous anomaly which is a normal variant, of no clinical significance. The dural venous sinuses and the major intracranial arteries are patent. The ventricles and the other CSF-containing spaces are also normal in size. There is no abnormal enhancement.There is left more than right temporomandibular joint osteoarthrosis associated with synovial contrast enhancement and thickening. This is also associated with erosions and joint space loss.Cervical Spine:Cervical spinal alignment is notable for straightening which may reflect patient position. The vertebral bodies are preserved in height. The marrow signal is normal. There is minimal disc T2 signal loss from C2-C3 through C5-C6. The disc heights are fairly preserved. The spinal canal is not significantly narrowed. The spinal cord has normal morphology and signal. There is no abnormal spinal cord, leptomeningeal or nerve root contrast enhancement.C2-C3 and C3-C4: There is no spinal canal or neural foraminal narrowing.C4-C5, C5-C6 and C6-C7: There are shallow, insignificant anterior indentations of the thecal sac by degenerative dense. There is no neural foraminal narrowing. C7-T1: There is no spinal canal or foraminal stenosis.

Output: 1.Normal brain examination.2.Normal cervical spinal cord.3.Minimal cervical spondylosis without nerve or spinal cord compression.4.Left more than right temporomandibular joint osteoarthrosis, significantly advanced for age. Please correlate clinically.


Instruction: Generate impression based on findings.

Input: 29 year-old female with right lower quadrant pain. Evaluate for appendicitis versus kidney stone. This examination is limited by the absence of oral and intravenous contrast.ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Cholelithiasis without evidence of cholecystitis.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: There is a very large right parapelvic cyst vs. dilated extra-renal pelvis which measures 5.6 x 7.4 cm in axial image 61/160 of series 4. In a right lower pole calix there is a 1 cm diameter calcification. No definite hydroureter. The right upper pole renal collecting system is moderately dilated compatible with mild hydronephrosis. To further evaluate the renal collecting system, a dedicated renal CT or MRI examination may be helpful, if clinically indicated.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted. A normal appendix is present in the right lower quadrant.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: 1 cm nonobstructing right lower pole renal calculus. Large right parapelvic cyst, and less likely dilated extrarenal pelvis with associated mild right upper pole hydronephrosis. Findings may be further evaluated with a dedicated renal CT or MRI examination, if indicated. Normal appendix. Cholelithiasis.


Instruction: Generate impression based on findings.

Input: 75-year-old woman with history of osteoarthritis and intra-articular pain. MENISCI: The medial and lateral menisci are intact without evidence of tear.ARTICULAR CARTILAGE AND BONE: There is thinning of the articular cartilage over the medial femoral trochlea with with an approximately 12 mm bare area, underlying reactive marrow change, and a 5 x 5 mm subchondral cyst (series 7, image 14). There is significant thinning of the articular cartilage over the medial patellar facet with underlying reactive marrow changes. Additionally, there is fissuring of the articular cartilage over the lateral patellar facet with underlying marrow change. The articular cartilage of the tibial femoral compartment is thinned without full-thickness loss.LIGAMENTS: The ACL, PCL, MCL, and LCL complex are intact. The popliteus muscle and tendon are intact. EXTENSOR MECHANISM: The patella and extensor mechanism are intact.ADDITIONAL

Output: 1. Articular cartilage loss predominantly over the medial patellofemoral compartment with underlying reactive marrow change and subchondral cysts.2. Findings compatible with prepatellar bursitis.


Instruction: Generate impression based on findings.

Input: Reason: left knee pain History: left knee pain As seen on prior MRI examination, there is a mildly displaced ACL avulsion fracture of the anterior aspect of the intercondylar eminence of the proximal tibia. We see no joint effusion.

Output: Mildly displaced ACL avulsion fracture of the anterior aspect of the intercondylar eminence of the proximal tibia.


Instruction: Generate impression based on findings.

Input: 20-year-old female patient with pain, dislocation. Question of patella ligament tear, loose body. MENISCI: The medial and lateral menisci are intact.ARTICULAR CARTILAGE AND BONE: The articular cartilage of all three compartments is intact. Bone marrow signal is within normal limits.LIGAMENTS: The collateral and cruciate ligaments are intact. EXTENSOR MECHANISM: The patellar and quadriceps tendons are intact. There is subtle edema in the superolateral aspect of Hoffa's fat pad which may suggest patellofemoral instability, similar to the prior study. ADDITIONAL

Output: 1. Subtle edema in the superolateral aspect of Hoffa's fat pad may suggest patellofemoral instability.2. Intact extensor mechanism.


Instruction: Generate impression based on findings.

Input: History of single Gleason 8 prostate cancer that was ablated with cryosurgery now with increasing PSA. PELVIS:PROSTATE:Prostate Size: 3.1 x 2.7 x 3.0 cm. Peripheral Zone: There is contour irregularity (concavity) with associated signal changes involving the left mid peripheral zone presumably corresponding to posttreatment changes from prior cryoablation. No suspicious foci of signal abnormality are identified.Central Gland: No significant abnormality.Seminal Vesicles: No significant abnormality.Extracapsular Extension: No significant abnormality.BLADDER: No significant abnormality noted.LYMPH NODES: There is a single nonspecific 5 mm right obturator lymph node (series 1801, image 75).BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Presumed posttreatment changes involving left mid peripheral zone without suspicious prostatic lesions identified.2.Single nonspecific 5 mm right obturator lymph node.


Instruction: Generate impression based on findings.

Input: 65 year old man with prior myocardial infarction referred to evaluate for ischemia and viability.MEDICATIONS: simvastatin, atenolol, aspirin, enalapril, omega 3 supplements. First Pass PerfusionDuring hyperemia, perfusion defects corresponding to the below described transmural myocardial infarctions were noted in the basal anterior and anteroseptal walls, mid anterior and anteroseptal walls, and the apical inferior, anterior, and septal walls (i.e LAD territory). Additionally, perfusion defects independent of scar representing mild residual ischemia were seen in the mid anterolateral walls and the apical lateral wall (i.e. LCx territory). Viability/ Myocardial ScarThere is a large transmural myocardial infarction (i.e. late gadolinium enhancement) with associated fatty replacement involving the basal anterior and anteroseptal walls, the mid anterior and anteroseptal walls, and the apical anterior, septal, and inferior walls). These segments (LAD territory) are unlikely to be viable. The remainder of the myocardium (i.e. LCx and RCA territory) is free of myocardial infarction and is likely to be viable. Left VentricleThe left ventricle is normal in size with normal systolic function with regional wall motion abnormalities as described below. The overall LV ejection fraction is 64%, the LV end diastolic volume index is 77 ml/m2 (normal range: 74+/-15), the LVEDV is 151 ml (normal range 142+/-34), the LV end systolic volume index is 28 ml/m2 (normal range 25+/-9), the LVESV is 55 ml (normal range 47+/-19), the LV mass index is 57 g/m2, and the LV mass is 110 g. There is hypokinesis of the entire anterior wall and the anteroseptal wall. There is also hypokinesis of the apical inferior wall.Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 76%, the RV end diastolic volume index is 74 ml/m2 (normal range 82+/-16), the RVEDV is 143 ml (normal range 142+/-31), the RV end systolic volume index is 18 ml/m2 (normal range 31+/-9), and the RVESV is 34 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. There is a transmural infarction involving much of the LAD territory and it is unlikely to be viable.2. There is mild ischemia in the LCx territory and is likely to be viable.3. Normal LV size and systolic function (LVEF 64%). There is hypokinesis of the the entire anterior and anteroseptal walls and the apical inferior wall.4. Normal RV size and systolic function (RVEF 76%).5. Mild dilation of the left atrium.


Instruction: Generate impression based on findings.

Input: The risks (including, but not limited to, those of bleeding, infection, allergic reaction, temporary nerve block, pain, and inability to access the joint) and benefits of the procedure were explained to the patient, and informed written consent was obtained. A pre-procedural “time-out” form was completed.he patient was placed supine on the fluoroscopy table. The right hip was localized fluoroscopically, and a spot radiograph was obtained. The course of the femoral artery was noted. The skin was cleansed and covered with a sterile drape. The skin and subcutaneous tissues were anesthetized with 1% lidocaine using 25-gauge and 22-gauge needles.Under fluoroscopic guidance, a 20-gauge spinal needle was advanced into the joint. Attempted aspiration yielded no fluid. Next, 15 ml of a 50/50 mixture of Omnipaque 240 (to confirm the intra-articular position of the needle) and dilute Multihance (0.1 cc in a 10 cc vial of saline, for subsequent MR imaging) were injected into the joint. Contrast opacified the joint in the expected manner. A spot radiograph was obtained for documentation. The needle was withdrawn. Blood loss was negligible (<1cc), and patient tolerated the procedure well without immediate complication. An adhesive bandage was placed on the patient’s skin. Routine post procedure instructions were communicated to the patient. The patient was escorted to the MRI suite for further imaging in stable condition. Please refer to the subsequent MRI report for further information.Exposure time: 01:28 mm:ss

Output: Successful right hip injection without immediate complication. MR arthrogram to follow.


Instruction: Generate impression based on findings.

Input: 44 year old with history of biopsy proven right breast cancer. Calcifications seen extending anterior to the proven malignancy were noted on mammography. The patient is part of the fast research protocol. There is heterogeneous amount of fibroglandular tissue in both breasts.Marked parenchymal enhancement is noted bilaterally. The ultrafast images show less background enhancement. There are multiple abnormal enhancing masses the right breast. This includes the biopsy proven index cancer in the right inner breast that measures 1.6 x 2.1 x 1.6 cm. Extending predominately in a segmental distribution towards the nipple are multiple subcentimeter enhancing masses which are suspicious for satellite lesions. The largest of these measures 9 mm. An additional round enhancing mass just lateral to the right nipple measures 5 mm. This may represent an additional site of malignancy or potentially a benign lesion such as a papilloma. The distance between the index lesion and the largest satellite lesion is 5.8 cm. The distance between the index lesion and the lateral anterior mass is 7.7-cm. There is extensive fluid filling dilated ducts in the right outer breast. However, there is no distinct suspicious enhancement around these ducts. The appearance may relate to a prior ductogram. No abnormal enhancement is seen in the left breast. No abnormal lymph nodes are identified in either axillary region.

Output: 1. Multiple enhancing right breast masses masses, predominantly in the right inner breast, including the biopsy proven malignancy. If breast conservation is being considered, then MRI directed ultrasound to assess the additional masses is recommended.2. No MRI evidence for malignancy in the left breast. 3. No suspicious axillary lymph node. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Male 28 years old Reason: Assess for active Ileal Crohn's History: abdominal pain, hx of ileal-colonic Crohn's ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. No suspicious hepatic lesions. Hepatic and portal veins are patent.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: There is bowel wall thickening with hyperenhancement of the mucosa involving the terminal ileum. The segment of bowel involved measures at least 12 cm. There is a skip segment of bowel in the distal ileum with similar imaging features in the right lower abdomen measuring at least 11cm. There is mild narrowing of this bowel segment in its distal aspect causing proximal bowel dilatation.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Active disease involving the terminal ileum and a segment of distal ileum. There is an area of narrowing involving the ileum causing proximal bowel distention.


Instruction: Generate impression based on findings.

Input: History of cirrhosis with chronic rejection, presenting for HCC screening. ABDOMEN:LIVER, BILIARY TRACT: Postsurgical changes from liver transplant with fibrosis of the right hepatic lobe and posterior segment atrophy with compensatory hypertrophy of the left lobe. Since the 2013 study there has been mild interval increase in multiple sites of intrahepatic duct stricturing and dilatation in both lobes. The common hepatic duct is diffusely narrowed, similar to prior. No suspicious arterial enhancing lesion.The portal vein is patent. The hepatic artery is patent.SPLEEN: Mild splenomegaly, measuring 16.5 cm in craniocaudal dimension.PANCREAS: Stable mild narrowing of the mid-body main pancreatic duct without a focal lesion, similar to prior.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Cirrhotic liver morphology with right hepatic lobe fibrosis and posterior segment atrophy without a suspicious arterial enhancing lesion.2.Mild worsening in intra-hepatic biliary ductal dilation associated with multi-focal intrahepatic stricturing.


Instruction: Generate impression based on findings.

Input: Male 51 years old with headaches and dizziness and decreased right-sided hearing abnormality. Visual disturbances on the right for the past 2-3 years. No trauma reported. The patient is claustrophobic. Please note that the brain exam does not include diffusion-weighted images, which are considered a standard component of our brain imaging protocol. Within this limitation, there is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears unremarkable with no evidence of pathologic signal abnormality. With contrast, there is no evidence of abnormal parenchymal enhancement.No extra-axial collection, midline shift, or hydrocephalus. There appear to be flow voids consistent with patency of the major proximal intracranial arteries. No enhancing extra-axial mass.Paranasal sinuses and mastoids are grossly clear.

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


Instruction: Generate impression based on findings.

Input: Yearly surveillance of congenital anomaly of cerebrovascular system: memory problems. There are numerous punctate foci of susceptibility artifact within the bilateral cerebral and cerebellar hemispheres, left pons and midbrain. There is unchanged mild T2 hyperintensity in the left basal ganglia region. There is no evidence of acute hemorrhage, hydrocephalus, or acute ischemia. 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, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. No appreciable interval change in the numerous intracranial cavernous malformations 2. Unchanged chronic left basal ganglia region hemorrhage and/or lacunar infarct. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Female 60 years old with worsening back and hip pain and known metastatic breat cancer to spine and hip s/p radiation. There are multiple metastatic deposits. A lesion in the right iliac wing is approximately 4.3 x 3.3 x 1.3 cm (series 4, image 12 and series 3, image 14) and is associated with cortical destruction. 2 lesions are also noted in the left iliac wing, the larger of the 2 lesions measures 2.9 x 2.3 x 1.6 cm (series 4, image 8 and series 5, image 13) and also results in cortical destruction. There is mild edema within the adjacent musculature on both sides. Several lesions are also noted in the proximal right femoral diaphysis, one of which is cortically based beneath the lesser trochanter. This lesion measures just over 1 cm in diameter (series 5, image 45) and 3 cm in length (series 6, image 12). A similar but smaller lesion is noted in the subtrochanteric left femur.The hip joints appear normal. Degenerative arthritis affects the lower lumbar spine; please refer to the separately dictated report for the lumbar spine MRI for further details. There is small amount of free fluid within the pelvis. Heterogeneous nodular and reticular signal abnormality in the fat of the buttocks likely represents fibrosis and/or fat necrosis from prior injections.

Output: Metastatic disease of the pelvis and proximal femora as above.


Instruction: Generate impression based on findings.

Input: Spinal cord anaplastic astrocytoma status post radiation and surgery. There are postoperative findings in the lower thoracic spine with a residual overlying posterior extradural fluid collection that measures up to approximately 4 cm. There is interval shrinkage of the tumor within lower spinal with development of linear T2 hypointensity and adjacent punctate foci of T2 hyperintensity in the treatment bed. The lack of intravenous contrast administration precludes assessment of the previously enhancing lesion at the T2-3 of the spinal cord, although no correlative findings is discernible on the non-contrast sequences. There is diffusely fatty vertebral bone marrow signal. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. There is no significant spinal canal stenosis.

Output: 1. Interval shrinkage of the tumor within the lower spinal cord with superimposed treatment effects. However, the lack contrast administration limits the assessment.2. The lack of intravenous contrast administration precludes assessment of the previously enhancing lesion at the T2-3 of the spinal cord, although no correlative findings is discernible on the non-contrast sequences.


Instruction: Generate impression based on findings.

Input: Squamous cell carcinoma of the right nasal bridge and left cheek with perineural invasion. Status post Mohs 9/9/2014 and radiation therapy completed 12/4/2014. Evaluate for recurrence. There are post-treatment changes in the left cheek, including a mild depression and underlying subcutaneous fat reticulation. However, there is no evidence of measurable mass lesions or significant cervical lymphadenopathy. The thyroid gland appears to be unremarkable. There is mildly asymmetric increased T2 signal diffusely within the left parotid gland, which may represent post-treatment inflammation. The other salivary glans appear unremarkable. The major cervical flow voids are grossly intact. The osseous structures are unremarkable. The orbits and imaged intracranial structures are unremarkable. There is mild scattered paranasal sinus mucosal thickening. There is persistent fluid within the left mastoid air cells and middle ear.

Output: 1. No definite evidence of local tumor recurrence, although the assessment is limited by the lack of intravenous contrast.2. No evidence of significant lymphadenopathy in the neck.3. Persistent left otomastoid effusions, which may indicate Eustachian tube dysfunction.


Instruction: Generate impression based on findings.

Input: Clinical question to be answered: Status post fall from 3 stories with low GCS upon arrival. Now with posturing. Examination redemonstrates extensive previously noted post traumatic findings of the skull fracture, small left frontal subdural and pneumocephalus. There is no evidence of parenchymal hemorrhage or definitive edema on the current exam. The ventricular size and basal cisterns remain similar and within normal limits to prior study and with no evidence of any compromise. No evidence of midline shift or hydrocephalus. No evidence of transtentorial herniation.Extensive scalp hematoma on the left is again identified. New since prior examination this placement of a intracranial pressure monitor with minimal adjacent pneumocephalus.Further evaluation for the extent of brain parenchymal injury with an MRI is again recommended.

Output: 1.No evidence of new hemorrhage or edema. Stable ventricular system and basal cisterns.2.Right frontal ICP monitor.


Instruction: Generate impression based on findings.

Input: Reason: achilles tendinosis? Please check 4-5 cm proximal to insertion History: pain TENDONS: There is minimal thickening of the Achilles tendon approximately 3 cm proximal to the level of its insertion indicating a mild tendinosis. The Achilles tendon appears intact. There is increased signal abnormality on fluid sensitive sequences along the anterior aspect of the distal Achilles tendon indicating a paratenonitis. A skin marker is present in the overlying area presumably representing the patient's area of concern. There is minimal intermediate signal intensity within the peroneus longus tendon as it courses beneath the cuboid indicating a mild tendinosis. The peroneal tendons appear intact. The flexor and extensor tendons appear intactLIGAMENTS: The lateral collateral ligament complex appears intact. The distal tibiofibular syndesmotic complex appears intact. The imaged components of the deltoid ligament appear intact.ARTICULAR SURFACES AND BONE: There is a small focus of edema within the superomedial aspect of the talar dome which may reflect degenerative change or perhaps a chronic osteochondral defect. Otherwise no bone marrow signal abnormalities identified.ADDITIONAL

Output: 1. Findings indicating a paratenonitis of the Achilles tendon as well as mild tendinosis of an intact Achilles tendon.2. Edema within the superomedial aspect of the talar dome may reflect subchondral cyst formation or a chronic osteochondral defect.3. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Reason: evaluation for MS, currently with headaches and abnormal CT scan The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There is a mild degree of periventricular and subcortical punctate 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 demonstrate minor mucosal thickening. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.Incidental note is made of partial empty sella.

Output: 1.Periventricular and subcortical white matter punctate lesions of a mild to moderate degree are nonspecific. At this age they are most likely vascular related, however, demyelination as an alternate consideration. The lesions are not particularly characteristic of demyelination.


Instruction: Generate impression based on findings.

Input: History of Crohn's disease of the sigmoid colon with stricture. History of hysterectomy and cholecystectomy. ABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy. There is a non-specific 2.4 x 2.1 cm fluid collection in the cholecystectomy bed. The liver is normal in morphology, size, signal intensity and enhancement without a focal lesion. Status post cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: Pancreas divisum. The pancreas parenchyma is normal in morphology and signal intensity. No stigmata of acute or chronic inflammation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Symmetric perirenal fluid. Simple appearing cysts. No suspicious lesion or hydroureteronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The proximal small bowel and uninvolved colon is normal in caliber, wall thickness, signal intensity and without adjacent inflammatory changes. See discussion below.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Status post hysterectomy.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Complex fistulous phlegmon within the mid pelvis involving the sigmoid colon (series 5/28). There is fistulous communication between the mid sigmoid colon and distal rectosigmoid colon. There is fistulous communication with the vaginal cuff with increasing material in the vaginal canal during the examination. Additionally there is mild tethering of the adjacent small bowel loops anterior to the rectosigmoid colon without definite fistulous communication. Additionally there is a blind-ending sinus tract extending superiorly into the mesentery. The appendix appears tethered to the fistulous phlegmon.The involved colon demonstrates significant active inflammation. There is stasis of stool proximal to the involved sigmoid colon without significant dilatation.No drainable fluid collection.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Complex clover-leaf fistulous phlegmon with colocolonic and colovaginal fistulous communication and active inflammation of the involved rectosigmoid colon. Tethering of adjacent small bowel loops and the appendix. Blind-ending sinus tract extending superiorly into the mesentery. No drainable fluid collection.2. No additional sites of active bowel inflammation or flow-limiting stricture.3. Pancreas divisum. Nonspecific 2.4 cm fluid collection in the cholecystectomy bed. Assuming the patient is asymptomatic this likely represents a benign postoperative fluid collection.


Instruction: Generate impression based on findings.

Input: Preoperative planning for tumor resection. There are postoperative findings related to prior left temporal lobe tumor surgery. Redemonstrated is a heterogeneous mass in the posterior left temporal lobe that measures up to approximately 5 cm. There is extensive surrounding confluent T2 hyperintensity. There is no significant midline shift or herniation. The ventricles are unchanged in appearance. There are skin-based fiducial markers.

Output: Preoperative planning MRI demonstrates a mass in the posterior left temporal lobe that measures up to approximately 5 cm.


Instruction: Generate impression based on findings.

Input: The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain. There is a 6 mm maximal dimension focus of relative hypoenhancement within the superior border of the left paramedian anterior pituitary gland, which is heterogeneous on both T1 and T2 noncontrast sequences. The pituitary stalk is slightly deviated leftward to this region. There is no involvement of the optic apparatus or the cavernous sinuses.

Output: There is a 6 mm maximal dimension focus of relative hypoenhancement within the superior border of the left paramedian anterior pituitary gland, which is heterogeneous on both T1 and T2 noncontrast sequences suggestive of pituitary adenoma.


Instruction: Generate impression based on findings.

Input: Reason: Patient with persistent non-traumatic left ankle pain. Please identify potential causes (fracture, injury to ligaments). History: Left ankle pain. TENDONS: The flexor and extensor tendons appear intact. The peroneal tendons appear intact. There is a lobulated fluid signal intensity within the tendon sheath of the peroneus longus tendon indicating a tenosynovitis. The Achilles tendon is normal in appearance.LIGAMENTS: The distal tibiofibular syndesmotic complex appears intact. There is disruption of the ATFL. The PTFL and calcaneofibular ligaments appear intact. The imaged components of the deltoid ligament appear intact.ARTICULAR SURFACES AND BONE: There is subchondral cyst formation within the second cuneiform likely degenerative in etiology. There is bone marrow signal abnormality within the lateral aspect of the talar dome.ADDITIONAL

Output: 1. Disruption of the ATFL.2. Bone marrow signal abnormality in the lateral aspect of the talar dome likely representing degenerative changes/subchondral cyst formation, although this could represent a chronic osteochondral defect. Other findings as described.3. Tenosynovitis of the peroneus longus tendon.


Instruction: Generate impression based on findings.

Input: Lewy body dementia with worsening symptoms, including left neglect and worsening gait. There is a moderate degree of global parenchymal volume loss with slightly greater involvement of the bilateral parietal lobes appearing similar to the MRI from 2/18/2013. There is no disproportionate volume loss in the hippocampus, brainstem, or cerebellum. There is no evidence of mass effect. There are no abnormal extra-axial collections. There is no significant vascular disease. There is prominent mineralization/calcification involving the bilateral cerebellar hemispheres as well as the basal ganglia as seen before. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is no hydrocephalus. There is partial opacification of the bilateral ethmoid air cells and minimal opacification elsewhere in the paranasal sinuses. The orbits, skull, and scalp soft tissues are grossly unremarkable.

Output: 1. No acute findings. Specifically, no evidence of infarct or intracranial mass effect.2. Moderate global parenchymal volume loss with slightly greater involvement of the bilateral parietal lobes appearing similar to the prior MRI.3. Prominent mineralization/calcification involving the cerebellar hemispheres and basal ganglia appearing similar to prior studies. This finding is nonspecific but can be seen in a variety of acquired and inherited metabolic disorders, for example.


Instruction: Generate impression based on findings.

Input: Headache. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild scattered cerebral white matter T2 hyperintensity. There is no abnormal intracranial enhancement. There is a partially empty sella. 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. The left maxillary sinus is relatively small.

Output: No evidence of intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: Lung cancer in two brain metastases treated with CyberKnife. Surveillance imaging. There is interval decrease in size of the ring-enhancing lesion in the left superior frontal gyrus, now measuring up to 14 mm, previously 18 mm, although the vasogenic edema persists. However, there is interval increase in size of an enhancing lesion in the inferior right parietal lobe, which now measures up to 5 mm, previously 2 mm, and there is development of associated vasogenic edema. There is also interval increase in size of the right inferior temporal gyrus enhancing lesion, now measuring up to 8 mm, previously 5 mm, as well as increased associated vasogenic edema. In addition, there are two new punctate enhancing lesions in the left middle frontal gyrus with trace vasogenic edema. 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, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Interval decrease in size of the left superior frontal gyrus metastasis, but interval increase in size of the inferior right parietal lobe and right inferior temporal gyrus metastases and associated vasogenic edema and new punctate metastases is in the left middle frontal gyrus.


Instruction: Generate impression based on findings.

Input: 67-year-old with previously diagnosed unifocal left breast invasive lobular carcinoma status post lumpectomy. Patient now presents for further evaluation. There is scattered fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally. This limits the sensitivity of MRI in detecting subtle lesions.LEFT BREAST: There are postsurgical changes which include diffuse skin thickening and trabecular edema. A lobulated fluid collection is seen in the left lateral breast at the lumpectomy site measuring up to 7.4 cm in AP dimension, consistent with a seroma. Along the anterior and inferior aspect of the seroma, there is non mass enhancement measuring up to 4 cm. There is also a non mass enhancement along the anterior superior aspect of seroma measuring up to 1.8 cm. While findings are nonspecific, residual carcinoma cannot be excluded. Additional scattered subcentimeter foci of enhancement are seen throughout the right breast, nonspecific and likely secondary to background parenchymal enhancement.Postsurgical changes in the left axilla include a small seroma measuring up to 1.4 cm in the high axilla and edema in the subcutaneous tissues.RIGHT BREAST: There are two well-circumscribed masses with fatty hilum in the upper outer quadrant, consistent with benign intramammary lymph nodes. These are correlated to the most recent mammogram and appear similar. Additional scattered subcentimeter foci of enhancement are seen throughout the right breast, nonspecific and likely secondary to background parenchymal enhancement.No abnormal enhancement in the right axilla.

Output: Postsurgical changes of the left breast with seromas in the lumpectomy bed and axilla. Nonspecific non mass enhancement along the anteroinferior and anterosuperior aspect of the seroma as described. Residual carcinoma cannot be excluded.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: 52-year-old male with history of prostate cancer who presents for MRI evaluation. PELVIS:PROSTATE:Prostate Size: 3.9 x 5.4 x 3.4 cmPeripheral Zone: The entire right peripheral zone is asymmetrically atrophied and demonstrates diffuse T2 hypointensity, diffusion restriction, and early enhancement. This is felt to be focal atrophy and prostatitis. Superimposed on the aforementioned findings, there is a subcentimeter lesion in the right apex (series 1004, image 164) which measures 9 x 4 mm.There is a T2 hypointense focus in the anterior apex which may be the transition zone given delayed contrast enhancement.Central Gland: Central gland is nodular and heterogeneous compatible with benign prostatic hypertrophy.Seminal Vesicles: No evidence of extension into the seminal vesicles.Extracapsular Extension: No extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Findings as detailed above are felt to be a combination of focal right peripheral zone atrophy and prostatitis with superimposed suspicious subcentimeter right apex lesion.


Instruction: Generate impression based on findings.

Input: Coronal acquisitions best demonstrate dextrorotoscoliosis centered at the lower thoracic spine. The degree of scoliosis could be better defined with radiography.Cervical spine:There is slight reversal of normal upper cervical curvature. There are no fractures or subluxations. The marrow signal is benign. The cervical cord is normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable. Incidental note is made of a small right submandibular gland.There are no osseous dysplasias.C2/3: UnremarkableC3/4: Mild disc bulge and left uncinate hypertrophy without stenosis.C4/5: Posterior osteophyte disc complex, bilateral facet hypertrophy, and slight ligamentum flavum thickening. There is mild bilateral neural foraminal stenosis.C5/6: UnremarkableC6/7: Right facet hypertrophy without stenosisC7/T1: UnremarkableThoracic spine:Marrow signal intensity is benign throughout. The spinal cord is normal in signal. There are no masses.There are no osseous dysplasias.T1/2 demonstrates no significant disc bulge or cord encroachment.T2/3 demonstrates no significant disc bulge or cord encroachment. T3/4 demonstrates no significant disc bulge or cord encroachment. T4/5 demonstrates no significant disc bulge or cord encroachment. T5/6 demonstrates no significant disc bulge or cord encroachment.T6/7 demonstrates no significant disc bulge or cord encroachment. T7/8 demonstrates no significant disc bulge or cord encroachment. Right facet hypertrophy causes moderate right neural foraminal stenosis.T8/9 demonstrates no significant disc bulge or cord encroachment. Right facet hypertrophy causes severe right neural foraminal stenosis.T9/10 demonstrates no significant disc bulge or cord encroachment. Right facet hypertrophy encroaches the right neural foramen without significant stenosis.T10/11 demonstrates no significant disc bulge or cord encroachment. Right facet hypertrophy encroaches the right neural foramen without significant stenosis.T11/12 demonstrates no significant disc bulge or cord encroachment. Bilateral facet hypertrophy (left greater than right) causes moderate left neural foraminal stenosis.T12/L1 demonstrates no significant disc bulge or cord encroachment. Left facet hypertrophy without foraminal stenosis.Lumbar spine:Alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign. The conus is normal in signal and morphology and terminates at an appropriate level. The visualized intra-abdominal and paraspinal contents are unremarkable.There are no osseous dysplasias.Disc desiccation is present at L4/5 and L5/S1.L1/2: Asymmetric bulge to the left with endplate spurring as well as bilateral facet hypertrophy. There is mild left neural foraminal stenosis.L2/3: Bilateral facet hypertrophy without stenosis.L3/4: Diffuse annular disc bulge, ligamentum flavum thickening, and bilateral facet hypertrophy. There is mild central and mild bilateral neural foraminal stenosis.L4/5: Diffuse annular disc bulge, ligamentum flavum thickening, and bilateral facet hypertrophy. There is mild bilateral neural foraminal stenosis.L5/S1:Asymmetric bulge to the right, endplate spurring and bilateral facet hypertrophy. Bilateral S1 nerve sheath origins are abutted without significant deformation or displacement. There is mild right neural foraminal stenosis.

Output: 1.Coronal acquisitions best demonstrate dextrorotoscoliosis centered at the lower thoracic spine. The degree of scoliosis could be better defined with radiography.2.There are no osseous dysplasias.3.The spinal cord and conus are normal in signal.4.C4/5: Mild bilateral neural foraminal stenosis.5.T7/8: Moderate right neural foraminal stenosis.6.T8/9: Severe right neural foraminal stenosis.7.T11/12: Moderate left neural foraminal stenosis.8.L1/2: Mild left neural foraminal stenosis.9.L3/4: Mild central and mild bilateral neural foraminal stenosis.10.L4/5: Mild bilateral neural foraminal stenosis.11.L5/S1:Mild right neural foraminal stenosis.


Instruction: Generate impression based on findings.

Input: Urinary difficulties. Evaluate for cord re-tethering. Multiple prior untethering. More recent repair of dural defect and pseudomeningocele in June 20, 2015. Again seen are findings related to prior tethered cord release. Unchanged appearance of the ectatic thecal sac at the lumbosacral junction. The distal spinal cord syrinx shows no significant interval change from the prior examination, which begins at approximately the T12 level and continues to the L4 level with a maximum caliber of approximately 3 x 4 mm, not significantly changed allowing for differences in measurement technique. As on the prior examination, the distal spinal cord is closely opposed and may be adherent to the posterior thecal sac. The cord terminus is difficult to ascertain but it appears to be at the lumbosacral junction. Prone images demonstrate no significant ventral motion.The lumbar lordosis is straightened. Vertebral body height, morphology and signal characteristics are otherwise unremarkable. No evidence of marrow edema or pathologic marrow enhancement is seen. No significant compromise of the spinal canal or neural foramina is seen at any level. No new fluid collections in the paraspinous soft tissues.

Output: 1. Postoperative changes related to multiple prior cord untetherings. There is no significant change in appearance and position of the distal cord and cauda equina nerve roots which abut the dorsal thecal sac. No significant motion on the prone sequences. Findings would be compatible with cord re-tethering in the appropriate clinical setting.2. No significant change in small syrinx involving the distal cord.


Instruction: Generate impression based on findings.

Input: Provided history of ileocolonic Crohn's. No surgical history is available. No surgery reported in EPIC progress notes. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Portions of the jejunum are suboptimally distended limiting evaluation without specific evidence of active inflammation.The terminal ileum is well seen (series 6/20). It is normal in morphology and signal intensity. There are multiple regions of active inflammation involving the proximal and mid ileum including a 6 cm segment in the left hemiabdomen (series 6/21). There is an adjacent approximately 6 cm skip lesion. In the right hemiabdomen there is a 5 cm actively inflamed stenotic segment with significant chronic appearing dilatation of the upstream small bowel loop up to 5.9 cm.There is surrounding fibrofatty proliferation. No free fluid or loculated fluid collection.No evidence of sinus tract or fistula formation.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Active inflammation of several segments of the proximal and mid ileum, increased from the prior. Actively inflamed 5 cm stenotic segment in the right hemiabdomen is associated with severe upstream chronic appearing dilatation, this is also new from the prior.2.No evidence of sinus tract or fistula formation. No specific evidence of active large bowel inflammation.


Instruction: Generate impression based on findings.

Input: The ventricles and sulci are within normal limits. The basal cisterns remain patent. There is no midline shift or mass effect. There are no areas of abnormal signal. There is no diffusion abnormality. No extra-axial fluid collection is identified. There is no susceptibility artifact to indicate prior hemorrhage.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. The left maxillary sinus is smaller than the right but otherwise the visualized paranasal sinuses and extracranial soft tissues are unremarkable.

Output: Normal brain MRI specifically there is no MRI evidence of prior infarct, intracranial hemorrhage or diffuse axonal injury.


Instruction: Generate impression based on findings.

Input: New onset dizziness. Chronic myeloid leukemia in remission. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are minimal punctate nonspecific foci of T2 hyperintensity in the cerebral white matter. 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: No evidence of intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: Hemangioblastomatosis. There are postoperative findings to posterior fossa surgery with a defect in the medial left cerebellar hemisphere. There has been interval increase in size of the enhancing nodular anterior bifrontal interhemispheric lesions, which collectively measure up to 16 mm in width, previously 13 mm. There is extensive surrounding vasogenic edema in the bilateral frontal lobes. Likewise, multiple infratentorial enhancing lesions with surrounding vasogenic edema have increased in size. For example, a superior right cerebellar hemisphere lesion measures up to 10 mm in thickness, previously 7 mm. There is also a lesion in the left aspect of the upper cervical spine that measures up to 11 mm. There are scattered nonspecific foci of cerebral white matter hyperintensity separate from the vasogenic edema. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is a right maxillary sinus retention cyst.

Output: Overall interval increase in size of the lesions related to hemangioblastomatosis.


Instruction: Generate impression based on findings.

Input: History of prostate cancer. Pathology dated 1/13/2016 showed 3+4 in right base lateral 1 mm 5%, right base lateral 2.5 mm 15%, right mid lateral 7 mm 50%, right Apex lateral 5 mm 30%. PELVIS:PROSTATE:Prostate Size: 2.9 x 5.3 x 6.0 cmPeripheral Zone: Dominant lesion in the medial aspect of the mid gland extending to the apex measuring up to 1.1 x 0.8 cm in maximal cross section demonstrating T2 weighted hypointensity (series 401 image 11 through 13) and restricted diffusion (series 603 image 244 through 164)Central Gland: Mild changes of benign prostatic hyperplasia.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: The right mid gland to apex lesion has a broad base of abutment with the prostate margin with suspected focal extension posteromedially (series 401/11).BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: Along the course of the right obturator nerve between the pectineus muscle and adductor brevis muscle there is a well-defined oval mass measuring up to 2.9 x 1.8 x 4.5 cm. The lesion is isointense to the musculature on T1-weighted imaging and heterogeneously hyperintense on T2-weighted imaging, demonstrating heterogeneous postcontrast enhancement. Punctate focus of T1-hyperintensity and low signal intensity suggests blood product and/or calcifications.OTHER: No significant abnormality noted.

Output: 1.1.1 cm right peripheral zone mid gland to apex lesion with broad-based abutment of the prostate margin with suspected extraprostatic extension posteromedially. No enlarged pelvic lymphadenopathy.2.Incidental 2.9 cm oval enhancing well-defined mass along the course of the right obturator nerve extending into the medial thigh. Differential considerations include a peripheral nerve sheath tumor or hemangioma, amongst others. Referral to orthopedic oncology is recommended for further evaluation, including dedicated imaging, including radiographs to evaluate for calcifications. (Discussed with urology service Dr. Eggener/Karens (sp?) at 1539 on 03/09/2016.)


Instruction: Generate impression based on findings.

Input: 53 year-old female status post aneurysm clipping with known cerebral cavernous malformation disease. The patient is experiencing right arm ulnar palsy and atrophy as well as right leg pain. Brain MRI:Redemonstrated are postsurgical changes from a left-sided craniotomy for placement of an aneurysm clip in the region of the anterior communicating artery. Susceptibility from the aneurysm clip obscures local structures.Encephalomalacia with adjacent gliosis is noted involving the anterior left temporal lobe, consistent with evolution of previously demonstrated vasogenic edema involving the anterior temporal lobe.Redemonstrated are a few scattered punctate foci of T2 hyperintensity primarily in subcortical white matter locations without associated mass effect, restricted diffusion, enhancement, or susceptibility abnormality. These are unchanged in appearance.There are no new masses, mass effect, or midline shift. Ventricular sizes are within normal limits.Redemonstrated is susceptibility artifact involving the left occipital lobe, unchanged in appearance, without associated perilesional edema. Additionally, enhancement images demonstrate an associated developmental venous anomaly. A small rounded focus of susceptibility is again noted involving the posterolateral right putamen, without associated developmental venous anomaly, and without perilesional edema, unchanged in appearance. There are no other foci of subcutaneous susceptibility abnormality.Paranasal sinuses and mastoid air cells remain clear. Orbital contents remain unremarkable.Brain MRA:Artifacts from the aneurysm clip obscures visualization circle of adjacent Willis including the proximal left ACA and MCA. There is normal flow enhancement in vertebral-basilar arteries (posterior-inferior cerebellar, anterior-inferior cerebellar, and superior cerebellar arteries) and distal intracranial vasculature.

Output: 1.Encephalomalacia with adjacent gliosis is noted involving the anterior left temporal lobe, consistent with evolution of previously demonstrated vasogenic edema involving the anterior temporal lobe.2.Stable susceptibility artifact involving the left occipital lobe is consistent with a cavernous malformation, without lesional edema, with an associated developmental venous anomaly. 3.A small rounded focus of susceptibility is again noted involving the posterolateral right putamen, without associated developmental venous anomaly, and without perilesional edema, unchanged in appearance. This may represent a tiny cavernous malformation versus mineralization or prior microhemorrhage.4.Unremarkable MRA brain apart from artifacts from the aneurysm clip obscuring visualization circle of Willis and proximal left ACA and MCA.


Instruction: Generate impression based on findings.

Input: 42-year-old male with a history of Crohn's disease and ascending colon stricture. Please assess proximal bowel. ABDOMEN:LIVER, BILIARY TRACT: Gallstones without evidence of acute cholecystitis. No intra- or extra-hepatic biliary ductal dilation. No common duct stone is identified.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is wall thickening with associated enhancement of a short segment of ascending colon at the level of the hepatic flexure, measuring 4.0 cm in length, consistent with acute on chronic fibro-stenotic disease. Additionally, there is mild wall thickening of a short segment of the terminal ileum with associated enhancement on postcontrast sequences, consistent with acute on chronic fibro-stenotic disease, measuring approximately 5 cm in length. There are no dilated loops of bowel suggest obstruction. No fistula is identified.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is wall thickening with associated enhancement of a short segment of ascending colon at the level of the hepatic flexure, measuring 4.0 cm in length, consistent with acute on chronic fibro-stenotic disease. Additionally, there is mild wall thickening of a short segment of the terminal ileum with associated enhancement on postcontrast sequences, consistent with acute on chronic fibro-stenotic disease, measuring approximately 5 cm in length.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Wall thickening with associated enhancement and narrowing of 4.0 cm segment of ascending colon at the level of the hepatic flexure, consistent with the stated history of a colonic stricture. These findings likely represent acute or chronic fibro-stenotic disease.2.Mild wall thickening of a 5-cm short segment of the terminal ileum is also compatible with acute on chronic fibro-stenotic disease.


Instruction: Generate impression based on findings.

Input: Urinary retention with elevated inflammatory markers, rule out epidural abscess. Examination is motion degraded especially the sagittal post gadolinium sequences. There is no evidence of abscess within the lumbar spinal canal. There is an 11 x 12 x 7 mm focus (axial series 13, image 37) with T2 hyperintensity and peripheral enhancement at the right L4-L5 level posterior lateral to the thecal sac which may represent postoperative fluid collection, with abscess not excluded. This finding is grossly unchanged in size since 9/29/2016. There is right lower lumbar paraspinous enhancement consistent with postoperative change. Mild epidural enhancement at the L3-L5 levels is nonspecific and is not associated with a discrete fluid collection.Again seen is evidence of posterior instrumented fusion is again seen with pedicle screws on the right at L4-S1, and on the left at L5 and S1. Interbody devices have also been placed at L4-5 and L5-S1. Evidence of laminectomy/facetectomy is also seen on the right at L4-5 and on the left at L5-S1. There is edema involving the L4 and L5 vertebral bodies similar to prior study from 9/29/2016 including involvement of the prevertebral space. This finding is nonspecific given recent spine surgery.Straightening of the cervical lordosis is again seen. Vertebral body heights are preserved. At L3-4, facet arthropathy, ligamentum flavum thickening, and a disc bulge contribute to moderate spinal canal stenosis. There is also some effacement of the left lateral aspect of the thecal sac at the L4-L5 level but without high-grade central canal stenosis. Spinal canal at the L5-S1 level is also well decompressed. Right L4-L5 neural foramen is surgically decompressed. There is fairly mild multilevel neural foraminal narrowing in the remainder of the lumbar spine as seen previously but suboptimally evaluated due to artifact at the level of the pedicle screws.

Output: 1. There is an 11 x 12 x 7 mm fluid collection posterior lateral to the thecal sac in the laminectomy bed at the right L4-L5 level which may represent postoperative fluid although abscess is not excluded by imaging. There is also edema and enhancement involving the right posterior paraspinous and prevertebral soft tissues as well as the L4 and L5 vertebral bodies. These findings are nonspecific in the postoperative setting and suggest correlation with clinical findings for possibility of infection. There is also minimal epidural enhancement from L3 to L5 which may be reactive without discrete epidural fluid collection to suggest epidural abscess.2. Moderate spinal canal stenosis at the L3-L4 level. There is also stenosis involving the left aspect of the thecal sac at the L4-L5 level.


Instruction: Generate impression based on findings.

Input: Hemangioma of intracranial structures [D18.02], Reason for Study: ^Reason: CCM History: CCM Yearly Surveillance Redemonstration of multifocal cavernous malformations involving supra and infratentorial regions.The number, approximate maximum diameter on T2 weighted images and the degree of susceptibility artifacts do not show any significant interval change since prior scan.There is no evidence of surrounding edema of each cavernous malformation.The right middle frontal gyrus lesion appears to be associated with a DVA, unchanged. The right cerebellar hemispheric encephalomalacia with susceptibility lesion on the left middle cerebellar peduncle is again demonstrated, unchanged.The right middle frontal, left parietal and left posterior aspect of the superior temporal gyrus lesions (series1404, image65; image 66, image 59) show subtle peripheral enhancement, unchanged.Right suboccipital craniotomy is again seen, unchanged.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: Unchanged multifocal cavernous malformations, right cerebellar hemispheric encephalomalacia and postoperative changes since prior scan.No evidence of new ischemic or hemorrhagic lesion.


Instruction: Generate impression based on findings.

Input: Male, 58 years old, with severe pain in the mid cervical region of the neck and between the shoulder blades after trauma on 02/19/16. Please evaluate soft tissues for muscle or ligament tear. Please evaluate cervical and thoracic spine for nerve entrapment. Cervical:Anterior fusion instruments are in place spanning from C3 to C4. An interbody fusion device has also been placed within the C3-4 disc space. Sagittal spinal alignment is within normal limits. Vertebral body heights are preserved. No evidence of marrow replacement or significant marrow edema is detected. No pathologic marrow enhancement is seen. No evidence of soft tissue edema or ligamentous injury is seen.The visualized spinal cord shows normal signal intensity and morphology throughout. No epidural abnormalities are suspected. No pathologic intraspinal enhancement is seen.C2-3: No spinal canal stenosis or neuroforaminal narrowing. C3-4: The disc space has been surgically obliterated. No significant spinal canal or foraminal stenosis is seen, an improvement from the preoperative examination of 10/14/14. C4-5: Mild facet arthropathy. Mild left uncovertebral hypertrophy. No spinal canal stenosis. Moderate left foraminal narrowing. No interval changes.C5-6: Mild facet arthropathy. Minimal posterior disc-osteophyte complex formation and uncovertebral hypertrophy asymmetric towards the left. Minimal effacement of the left ventral thecal sac. No significant generalized spinal canal stenosis. Severe left foraminal narrowing. No interval changes. C6-7: Facet arthropathy. Minimal posterior disc-osteophyte complex formation. No spinal canal stenosis. Moderate left foraminal narrowing. No interval changes. C7-T1: Facet arthropathy. Ligamentum flavum thickening. Mild posterior disc-osteophyte complex formation with slight effacement of ventral thecal sac. No significant generalized spinal canal stenosis. Moderate left foraminal narrowing. No interval changes. Thoracic:Sagittal alignment is within normal limits. Vertebral body heights are preserved allowing for one or two scattered Schmorl's nodes. No evidence of marrow replacement or edema is seen. No pathologic marrow enhancement is observed. There is no evidence of paraspinal soft tissue edema or of ligamentous injury.Visualized spinal cord shows normal signal intensity and morphology throughout. No epidural abnormalities are suspected. No pathologic intraspinal enhancement is seen.The intervertebral discs demonstrate preservation of height. No significant bulging or herniation is seen. No spinal canal or foraminal stenosis is detected.A hepatic cyst is partially visualized.

Output: 1.No evidence of any paraspinal soft tissue edema or ligamentous injury is seen in the cervical or thoracic spine.2.In the cervical spine, there is evidence of anterior and interbody fusion at C3 and C4. This intervention has relieved the spinal canal and foraminal stenoses seen at this level on the preoperative examination.3.Elsewhere in the cervical spine, no definite high-grade spinal canal stenosis is seen. However, significant left-sided foraminal narrowing is demonstrated at most levels, particularly at C5-6 where the stenosis is severe. These findings have not significantly changed over the prior exams.4.In the thoracic spine, there are no areas of spinal canal stenosis, foraminal narrowing or other abnormal findings to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: 55 year old woman with history of nonischemic cardiomyopathy and atrial arrhythmias referred for cardiac MR to evaluate for etiologies of her CM. Left VentricleThe left ventricle is mild-moderately dilated with severely reduced systolic function. The overall LV ejection fraction is 27%, the LV end diastolic volume index is 101 ml/m2 (normal range: 65+/-11), the LVEDV is 235 ml (normal range 109+/-23), the LV end systolic volume index is 74 ml/m2 (normal range 18+/-5), the LVESV is 173 ml (normal range 31+/-10), the LV mass index is 82 g/m2 (normal range 67+/-11), and the LV mass is 191 g (normal range 114+/-24). There is abnormal wall motion, with evidence of hypokinesis of the inferior, inferoseptum and anteroseptum, and possibly anterior wall but wall motion evaluation is suboptimal (unable to obtain long-axis views). Late gadolinium imaging is of limited diagnostic quality, but the following observations can be made: There is late gadolinium enhancement in the mid to apical inferior and inferolateral walls, which involves the subendocardium and could suggest previous myocardial infarction. There is no visual evidence of iron overload.Left AtriumThe left atrium is severely dilated.Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 38%, the RV end diastolic volume index is 68 ml/m2 (normal range 69+/-14), the RVEDV is 159 ml (normal range 110+/-24), the RV end systolic volume index is 42 ml/m2 (normal range 22+/-8), and the RVESV is 61 ml (normal range 35+/-13). Right AtriumThe right atrium is upper limits of normal. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is at least mild 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 no obvious pericardial disease.Extracardiac Findings 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. The left ventricle is moderately dilated with severely reduced systolic function (EF 27%).2. Late gadolinium imaging is of limited diagnostic quality, but the following observations can be made: There is late gadolinium enhancement in the mid to apical inferior and inferolateral walls, which involves the subendocardium and could suggest previous myocardial infarction. 3. The right ventricle is normal in size with moderately reduced systolic function (EF 38%).4. At least mild mitral regurgitation. 5. 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: 52 year old man with history of non-ischemic cardiomyopathy with previous LV dysfunction, now recovered but with significant hypertrophy and ICD, referred for cardiac MRI to evaluate for possible scar Left VentricleThe left ventricle is severely hypertrophied (basal septal thickness 16mm) in a concentric pattern. The systolic function is normal, but due to artifact cardiac volumes cannot be calculated. Visually it is LVEF 60-65%. On late gadolinium enhancement imaging, a small portion of the mid anterior wall can not be evaluate due to artifact from the ICD. There is a small patch of late gadolinium enhancement involving the apical inferolateral wall suggesting the presence of underlying myocardial fibrosis, inflammation, or infiltration. The pattern is not suggestive of prior myocardial infarction or cardiac amyloidosis. Less than 5% of the myocardium has late gadolinium enhancement. Left AtriumThe left atrium is grossly normal in size. Right VentricleThe right ventricle is normal in size and systolic function. An ICD lead is noted in the right ventricle. Right AtriumThe right atrium is not well visualized.Aortic ValveThe aortic valve is not well seen.Mitral ValveThe mitral valve is not well seen.Pulmonic ValveThe pulmonic valve is not well seen.Tricuspid ValveThe tricuspid valve is not well seen. AortaThere is a left sided aortic arch. Venous AnatomyThe SVC and IVC are not well seen PericardiumThere is a trivial pericardial effusion. Extracardiac FindingsThere is a defibrillator lead in the RV and pulse generator in the chest wall with associated artifact . 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. Severe, concentric left ventricular hypertrophy with normal systolic function (LVEF 60-65%). Less than 5% of the myocardium has late gadolinium enhancement. The pattern of late gadolinium enhancement is atypical for prior myocardial infarction or cardiac amyloidosis but does suggest the presence of underlying myocardial fibrosis, inflammation, or infiltration. Because of artifacts from the ICD, a small amount of mid anterior wall myocardium could not be adequately evaluated. 2. Normal RV size and systolic function. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Reason: abnormal stress MRI 6/21/16 with concern for anterior ischemia but alternatively could be her LBBB causing the abnormalitiy. EF 53%. Eval for obstructive CAD. LDL 181. History: chest painCPT Code: 75574 Coronary arteries: LM: The left main coronary artery arises normally from the left sinus of valsalva and bifurcates into the left anterior descending and left circumflex coronary arteries. A portion of the mid left main artery is not visualized due to artifact. There are no significant stenoses present in the left main.LAD: The left anterior descending coronary artery courses normally in the anterior interventricular groove, supplying the diagonal and septal branches. There are no significant stenoses in the LAD.LCx: The left circumflex coronary artery is non-dominant. It courses normally in the left AV groove. It gives rise to the obtuse marginal branches. There is a small non-flow limiting calcified plaque in the proximal circumflex coronary artery.RCA: The right coronary artery is large and arises normally from the right sinus of valsalva. It is the dominant coronary artery supplying a posterior descending artery and a posterolateral branch. There are no significant stenoses in the right coronary artery.Left Ventricle: The left ventricular late diastolic volume is within normal limits.Right Ventricle: Visually the right ventricular late diastolic volume is within normal limits.Left Atrium: Visually, the left atrial volume appears normal in size. There are four distinct pulmonary veins which drain normally into the left atrium. There is no evidence of left atrial appendage thrombus.Right atrium, vena cavae, and coronary sinus: The right atrial volume appears to be normal in size. The superior and inferior vena cavae are grossly normal. The coronary sinus is normal in size. A left sided approach central venous catheter tip is in the right atrium.Valves: There is no calcification on the aortic or mitral valves.Great vessels: The visualized portions of the thoracic aorta demonstrate no evidence of dissection or aneurysm. The aortic arch is not seen. The main pulmonary artery is normal in size.Pericardium: The pericardium is normal in thickness. There is no pericardial effusion.CHEST:LUNGS AND PLEURA: Visualization of the lung parenchyma is limited by the field of view and length of scan which excludes a substantial amount of the lungs. No significant abnormality noted. Minimal bibasilar dependent atelectasis.MEDIASTINUM AND HILA: No significant abnormality noted in the extracardiovascular portions of the mediastinum.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: No significant abnormality noted.

Output: 1. Small non-flow limiting calcified plaque in the proximal circumflex coronary artery.2. A segment of the left main coronary artery is not visualized due to artifact. Within this limitation, no significant coronary artery stenoses are present.This portion of the report pertains to the heart and great vessels only. The remaining soft tissues of the thorax and upper abdomen will be interpreted by the attending chest radiologist and included as an addendum to this report.


Instruction: Generate impression based on findings.

Input: 59-year-old female with a history of left breast mastectomy with reconstruction in 2012 for IDC followed by chemoradiation and arimidex therapy. History of right breast reconstruction surgery. Three standard views of the right breast and two spot compression views of the right breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. An asymmetry in the right inferior outer breast disperses on spot compression views and is likely superimposed glandular tissue or related to her prior breast reconstruction procedure(s). A cyst in the right upper outer breast, confirmed by prior MRI is less discretely visible on today's exam. A few scattered benign calcifications are present.There is no new mass, suspicious microcalcifications or areas of architectural distortion identified in the right breast.

Output: No mammographic evidence of malignancy. Benign asymmetries may relate to her reconstruction surgery. As long as the patient's physical examination remains normal, right unilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: History of colon cancer now with PET avid lesion in the liver. Evaluate metastatic disease. ABDOMEN:LIVER, BILIARY TRACT: Borderline hepatomegaly with the liver measuring 17 cm in length. There is diffuse hepatic parenchymal signal loss in the out of phase images compatible with hepatic steatosis. The extrahepatic portal vein is occluded and there is cavernous transformation of the portal venous system. The hepatic veins and hepatic arteries are patent.There is patchy minimally increased T2 signal in the right hepatic lobe at the site of increased FDG activity seen on prior PET. This is not associated with restricted diffusion. There is mildly heterogeneous postcontrast enhancement throughout the liver likely secondary to the altered hemodynamics from portal venous occlusion. No suspicious masslike enhancement.Status post cholecystectomy. Scattered areas of minimal intrahepatic biliary ductal dilatation including in the right hepatic lobe at the region of interest.SPLEEN: No significant abnormality noted.PANCREAS: Postsurgical changes related to prior Whipple procedure. Stable minimal prominence of the distal pancreatic duct.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Numerous bilateral simple cysts.RETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy. Unchanged mildly prominent mesenteric lymph node in the right upper quadrant.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Hepatic steatosis and borderline hepatomegaly. There is heterogeneous signal throughout the liver likely related to the altered hemodynamics from portal vein occlusion. No definite enhancing mass lesion to indicate metastatic disease.2.Stable mildly prominent right upper quadrant mesenteric lymph node.3.Postoperative changes from prior Whipple with stable mild prominence of the distal pancreatic duct.