Instruction: Generate impression based on findings.

Input: Status post craniotomy for posterior fossa tumor resection. Evaluate for residual posterior fossa tumor and hemorrhage. Postsurgical changes of a suboccipital craniotomy for resection of a large fourth ventricular tumor. There are small areas of restricted diffusion along the surgical cavity margins within the dorsal brainstem and the cerebellum indicating cytotoxic edema. Minimal enhancement is noted at the periphery of the surgical bed but there is no convincing evidence of residual tumor. There is small amount of susceptibility abnormality located at the perimeter of the resection cavity indicating blood products. There is also a small amount of blood products in the dependent portions of the occipital horns of the lateral ventricles bilaterally. There has been interval reduction in the size of the supratentorial ventriculomegaly and there is a right posterior parietal approach ventriculostomy catheter which terminates in the body of the right lateral ventricle after entering the posterior horn of the right lateral ventricles. There are foci of left greater than right air within the nondependent portions of the anterior horns of the lateral ventricles which are most likely postprocedural. Additional foci of pneumocephalus are visualized anterior to the frontal lobes but this causes only minimal adjacent mass effect. 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.Expected postsurgical changes of resection of a large posterior fossa tumor. No convincing evidence of residual tumor.2.Minimal areas of restricted diffusion along the surgical cavity margins along the dorsal brainstem and cerebellum are compatible with cytotoxic edema.3.A right parietal approach ventricular catheter terminates in the body of the right lateral ventricle. There is interval reduction in the size of the ventricles.


Instruction: Generate impression based on findings.

Input: Again seen are postsurgical changes of bifrontal craniotomy for resection of right frontal meningioma. There is unchanged appearance of the encephalomalacia in the right superior frontal gyrus. There is minimal linear enhancement along the medial aspect of the resection cavity compatible with postsurgical change. No findings to suggest residual or recurrent tumor. Focal linear enhancement likely representing a tiny developmental venous anomaly within the right paramedian superior frontal lobe is again incidentally noted and unchanged. No evidence of acute infarct or hemorrhage. No intracranial mass effect, midline shift, or herniation. No hydrocephalus. No extra-axial collections. Nonspecific foci of T2 hyperintensity are seen involving the globi pallidi which may be related to remote toxic or metabolic injury, but unchanged since earliest available study from 5/31/2011. Brain parenchyma is otherwise unremarkable.

Output: Postsurgical changes of right frontal meningioma resection. No findings to suggest residual or recurrent tumor.


Instruction: Generate impression based on findings.

Input: Squamous cell carcinoma of the left base of tongue, T1N2b, status post induction chemotherapy. There are recent postoperative findings in the left oropharynx, without evidence of gross residual tumor. There is decrease in size of the left level 2 lymphadenopathy, measuring up to 10 x 11 mm, previously 16 x 19 mm in axial cross-section. The right cervical lymph nodes are unchanged. There is herniation of the left sublingual gland through a mylohyoid defect. The other salivary glands are unremarkable. There is scattered paranasal sinus mucosal thickening. There is mild multilevel degenerative cervical spondylosis. The orbits and imaged intracranial structures are grossly unremarkable.

Output: 1. Postoperative findings in the left oropharynx, without evidence of gross residual tumor.2. Decreased left cervical lymphadenopathy.


Instruction: Generate impression based on findings.

Input: Ms. GrayBrodsky is a 74 year old female with screen detected mass seen on mammogram along with a sonographic correlate. She presents for same day MR evaluation and US guided biopsy. There is heterogeneous amount of fibroglandular tissue in both breasts. Mild background parenchymal enhancement is noted bilaterally.In the right upper outer breast, far posterior depth, there is an irregular enhancing mass identified measuring 1.3 x 0.7 x 1.2 cm (AP x ML x SI). This corresponds to the mammographically detected abnormality and will be the target for today's ultrasound-guided biopsy. A few additional foci of enhancement are seen in the right breast, one of which represents a benign intramammary lymph node.There is no abnormal enhancement seen in the left breast. There are a few foci of enhancement seen, none of which are more suspicious than the rest.No abnormal axillary lymph nodes are identified in either axillary region.

Output: (1) 1.3 cm enhancing mass in the right upper outer breast which corresponds to the mammographic and sonographic findings from 5/6/2016. Patient will have a same-day ultrasound-guided biopsy of this area for further evaluation.(2) No MRI evidence of malignancy in the left breast.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: A 29 year old female with history of symptomatic bradycardia postpartum (8/2015) and a cardiac MRI on 8/26/2015 which showed severe biventricular dilatation with normal systolic function, moderate mitral regurgitation with significant biatrial enlargement. Now referred to cardiac MRI for further evaluation Left VentricleThe left ventricle is mildly dilated with normal systolic function. The overall LV ejection fraction is 59%, the LV end diastolic volume index is 97 ml/m2 (normal range: 65+/-11), the LVEDV is 180 ml (normal range 109+/-23), the LV end systolic volume index is 40 ml/m2 (normal range 18+/-5), the LVESV is 74 ml (normal range 31+/-10), the LV mass index is 29 g/m2 (normal range 67+/-11), and the LV mass is 54 g (normal range 114+/-24). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. Global relative enhancement, myocardial T2 ratio, and native myocardial T1 times were all also in the normal range. No intracavitary thrombus was seen.Left AtriumThe left atrium is normal in size. The LA volume is 74 ml.Right VentricleThe right ventricle is mildly dilated with normal systolic function. The overall RV ejection fraction is 52%, the RV end diastolic volume index is 99 ml/m2 (normal range 69+/-14), the RVEDV is 184 ml (normal range 110+/-24), the RV end systolic volume index is 48 ml/m2 (normal range 22+/-8), and the RVESV is 89 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size (31 X 31mm).Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size (29mm). 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. The left ventricle is mildly dilated with normal systolic function, the LVEF is 59%. 2. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.3. The right ventricle is mildly dilated with normal systolic function, the RVEF is 52%.  When compared to the prior study, LV/ RV/ LA/ and RA volumes have improved. Also, the severity of tricuspid regurgitation has improved. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 65 years, Male, Reason: research exam History: prostate cancer. Found to have PSA elevation to 6.2. This prompted TRUS biopsy 12/23/2014 revealing Gleason 6 disease involving 6/12 cores: Right base to apex, left base to mid gland. PELVIS:PROSTATE:Prostate Size: 5.2 x 2.4 x 5.2 cmPeripheral Zone: Lesion in the mid gland/apex peripheral zone, immediately left of midline measures 0.6 x 1.0 cm (903/204) and demonstrates low signal on ADC/T2 and early enhancement, suspicious for prostatic adenocarcinoma. An additional small foci more superiorly in the left mid gland peripheral zone measures 0.4 x 0.4 cm (903/304) with low T2/ADC signal and without early enhancement, suspicious for prostatic adenocarcinoma.Central Gland: Multiple well-circumscribed heterogeneous lesions in the central gland suggest benign prostatic hypertrophy.Seminal Vesicles: No involvement.Extracapsular Extension: No extracapsular extensionBLADDER: No significant abnormality noted.LYMPH NODES: Right external iliac node measures 7 mm (2501/77)BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Two small foci within the left mid gland peripheral zone and right mid gland/apex peripheral zone with signal characteristics suspicious for prostatic adenocarcinoma.2.Indeterminate right pelvic lymph node.


Instruction: Generate impression based on findings.

Input: History of primary biliary cirrhosis. Evaluate the dilatation as well as pancreatic and hepatic lesions noted previously. ABDOMEN:LIVER, BILIARY TRACT: Small cirrhotic liver with reticular increased T2 signal throughout compatible with fibrosis. Right hepatic vein to right portal vein TIPS shunt is patent.Again seen is a lesion in the hepatic dome with mildly increased T2 signal. Postcontrast images show bright homogenous arterial enhancement which becomes isointense on the portal venous and delayed phases. This measures 2.0 x 2.0 cm, previously 1.6 x 1.5 cm. There is an additional subcentimeter focus of arterial enhancement without associated washout in segment 4/5 which measures 8 x 8 mm. This is also not significantly changed.Unchanged prominent dilatation of the extrahepatic biliary system. No intrahepatic biliary ductal dilatation.SPLEEN: Spleen is upper limit of normal in size.PANCREAS: There is essentially complete replacement of the entire pancreatic parenchyma by cysts of various sizes. The appearance is not significantly changed going back to 2008 and likely represent combined main duct and side branch IPMNs. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Unchanged left lower lobe nodule.

Output: 1.Cirrhotic liver with patent TIPS shunt. 2 dysplastic nodules with arterial enhancement, but not meeting criteria for hepatocellular carcinoma. The segment 7 lesion is slightly increased in size compared to prior.2.Unchanged appearance of the pancreas with replacement of the entire gland by cysts compatible with combined main duct and side branch type IPMNs.3.Stable marked dilatation of the extrahepatic biliary system possibly representing a type I choledochal cyst.


Instruction: Generate impression based on findings.

Input: 56-year-old male with squamous cell carcinoma of the right neck. Status post right neck dissection. Evaluate status. CT of the soft tissues of the neck with infusion:Images through the skull base and including cavernous sinuses are unremarkable. Paranasal sinuses and mastoid vessels are unremarkable with the exception of a small retention cyst within the right maxillary sinus. Limited images through the orbits demonstrate thickening of the right lateral rectus muscle with enhancement. This is best appreciated on axial images 11 through 13. The rest of extraocular musculature remain within normal size and morphology. Please correlate with history and follow-up with an MRI examination of orbits is recommended.The finding may represent Graves' disease. Possibility of a post traumatic change cannot be ruled out. A less likely possibility of a mass should also be considered. MRI is recommended.Images through the soft tissues of the neck demonstrate prominence of bilateral tonsils with multiple calcification which may be result of prior repetitive infection. There is effacement of partial plane on the right secondary to prior surgical intervention. No definitive evidence of a primary tumor is detected. No definitive pathologic adenopathy is identified.Limited images through the apices of the lungs and mediastinum are negative. Please review dedicated report of CT of chest performed the same date.Bony density of area of exam is unremarkable however degenerative disk disease of the cervical spine is noted.CT of brain with infusion:No evidence of hemorrhage, edema, mass-effect, midline shift or hydrocephalus. Cortical sulci, ventricular system and all CSF cisterns remain within normal limits. No evidence of metastatic disease to the brain, leptomeninges or the calvarium.80 cc of Omnipaque 350 was utilized for a bone studies.

Output: 1.No definitive mass or pathologic adenopathy in the neck.2.Post operative changes of right neck.3.Prominence of right lateral rectus muscle as detailed above. MRI is recommended.4.Unremarkable CT of brain with infusion.


Instruction: Generate impression based on findings.

Input: Clinical question: Hallucination, new. Signs and symptoms: Altered mental status. Non-enhanced CT of brain: Physiological calcification of bilateral dentate nucleus and the posterior fossa is noted. Images through the posterior fossa otherwise negative for acute findings. There is prominence of the folia of the cerebellum and vermis for age which may represent underlying parenchymal volume loss.Heavy physiological calcification of bilateral basal ganglial is also noted. There is no evidence of acute supratentorial intracranial finding. There is prominence of cortical sulci especially in the left hemisphere for patient's stated age.Correlate with history and further follow-up with an MRI is recommended. Minimal small vessel disease of indeterminate age is suspected.

Output: 1.No evidence of acute intracranial findings.2.Minimal small vessel disease of indeterminate age is suspected.3.Physiological calcification of bilateral dentate nuclei and basal ganglia as described.4.Calvarium, visualized paranasal sinuses and mastoid air cells are unremarkable


Instruction: Generate impression based on findings.

Input: Reason: pain History: pain Tiny osteophytes indicating minimal osteoarthritis of questionable clinical significance.

Output: Minimal osteoarthritis of the knee.


Instruction: Generate impression based on findings.

Input: Clinical question:R/O hematoma or abscess. Signs and symptoms: Fever. Pre and post enhanced lumbar MRI:Examination is degraded due metallic hardware artifact from transpedicular screw placement for spinal fusion at L3 and L4 levels.Leading this limitation examination demonstrate interval diskectomy at L3 -- L4 and without evidence of residual disk herniation. A previously noted cystic lesion projecting anterior to the right articulating facet at L2 -- 3 is no longer identified and presumed surgically removed.Mild grade 1 anterolisthesis at L3 -- L4 appears a slightly more prominent than prior exam. There is subtle interval increase height of the disk space at this level secondary to disk fusion procedure.Transpedicular screws demonstrate evidence of complication in this the study. There is uniform mild T2 hyperintensity of L3 and L4 which may be artifactual since this appearance is not present on sagittal T2 stir series. Examination demonstrate no spinal stenosis. Post enhanced images although compromised due to metallic hardware artifact demonstrate no evidence of epidural collection to suggest presence of abscess.There is however mild dural thickening and enhancement at the surgical site which is within expected post operative change. There is a mixed-signal intensity collection posteriorly in the cutaneous and subcutaneous tissues at the surgical site at L4 with thin irregular rim of enhancement. This collection measures approximately 19 x 16-mm in transaxial dimensions. There is a linear signal void within this collection which could represent a drain. There is however no detectable extension of this finding beyond the collection and small hemorrhagic change could possibly have this appearance. The overall appearance of this finding is within expected postop change (correlate with timing of surgery). This collection is superficially located and can be aspirated for further analysis for underlying infection.

Output: 1.Expected postoperative changes of diskectomy and posterior fusion, transpedicular screw placement at L3 -- L4 levels as detailed. Mild grade 1 anterolisthesis is again identified. No evidence of spinal stenosis.2.No abnormal enhancement of the vertebral column to suggest an infectious process or abscess formation.3.Cutaneous and subcutaneous collection along the surgical path measuring at 19 x 16 mm size and with surrounding enhancement. This finding is within expected postop change however possibility of overlapping infection cannot be entirely excluded. The lesion is superficial and can be directly aspirated for further analysis.


Instruction: Generate impression based on findings.

Input: Female, 70 years old, history of left neck sarcoma, with left vocal cord paralysis and left eye ptosis. Assess entire left recurrent laryngeal nerve. Findings are seen related to extensive surgical alteration in the left supraclavicular region. Superficial nodular tumors seen in this area on the prior examination (2/14/12) have been resected with soft tissue grafting. The left sternocleidomastoid muscle is atrophic. The left paraspinal musculature are also somewhat atrophic along with the left trapezius.The soft tissues along the left brachial plexus are diffusely thickened showing abnormal T2 hyperintensity and fairly marked pathologic enhancement. These abnormal findings extend from the level of the roots distally to at least the level of the cords but probably beyond. Although the individual neural components of the brachial plexus are not well visualized as distinct structures, it is possible that at least some of these nerves are irregularly thickened. These findings are much progressed when compared to the prior examination from 2012.Areas of abnormal signal intensity and marked enhancement are found more distally distally involving the musculature of the left shoulder girdle. Subtle ill-defined T2 hyperintensity also extends anteriorly and superiorly along the carotid space where there are several small but enhancing nodules.The visualized mucosal surfaces of the aerodigestive tract are otherwise unremarkable. The salivary glands are free of lesions. The marrow signal characteristics are unremarkable. No spinal canal stenosis is suspected. No mediastinal masses are detected on this examination.

Output: Marked abnormal signal and pathologic enhancement with diffuse soft tissue thickening is evident along the left brachial plexus. The neural elements of the brachial plexus are not well visualized individually, but at least some of these nerves could be significantly and irregularly thickened. Areas of similar signal abnormality and pathologic enhancement are seen within the soft tissues of the left shoulder girdle, as well as extending superiorly along the carotid space where there are small but enhancing nodular lesions.Given the bulky nature of the findings along the left brachial plexus, and extension into several adjacent shoulder and neck spaces, the possibility of infiltrative tumor should be considered. An aggressive radiation-induced brachial plexitis could produce some of these findings, but this would be a diagnosis of exclusion.


Instruction: Generate impression based on findings.

Input: Reason: 40yo F w/ persistent foot discoloration, swelling, pain and concern for deep tissue infection History: as above The flexor and extensor tendons appear intact. The peroneal tendons appear intact. The Achilles tendon is normal in appearance. There is a small amount of fluid within the tendon sheaths as well as slight enhancement of the extensor digitorum longus, posterior tibialis, and flexor digitorum longus tendon sheaths indicating a mild tenosynovitis. There is a small amount of enhancing fluid within the tibiotalar and subtalar joints which may represent a mild synovitis. No bone marrow signal abnormalities are identified. The imaged musculature of the ankle and midfoot is unremarkable. There is nonspecific subcutaneous edema most pronounced along the dorsal aspect of the metatarsals. No focal fluid collection is identified to suggest abscess formation. There are no findings to suggest osteomyelitis. The distal tibiofibular syndesmotic complex appears intact. The ATFL is poorly visualized and likely disrupted. The PTFL appears intact. The calcaneofibular ligament appears intact. The imaged components of the deltoid ligament appear intact. There is a small amount of fluid within the retrocalcaneal bursa which may be of no clinical significance.

Output: 1. Nonspecific subcutaneous edema along the dorsal aspect of the foot may reflect a cellulitis in the correct clinical context.2. Findings indicating a mild tenosynovitis affecting the extensor digitorum longus, posterior tibialis, and flexor digitorum longus tendons. Other findings as described above.3. Probable disruption of the ATFL which may be chronic in etiology.


Instruction: Generate impression based on findings.

Input: 20-year-old female with pain. Evaluate for stress fracture. Right tibia/fibula: The distal tibial diaphysis demonstrates abnormal bone marrow signal intensity with hyperintense signal to skeletal muscle on T2/STIR sequences and hypointense signal on T1-weighted sequences however not as hypointense as the adjacent skeletal muscle. This is compatible with marked bone marrow edema. There is mild surrounding periosteal edema as well. This is compatible with a stress reaction. We cannot identify a discrete fracture. There is associated edema in the surrounding soft tissues.Left tibia/fibula: There is bone marrow edema within the distal tibial diaphysis however to a lesser degree when compared to the right tibia. This is also compatible with a stress reaction with no discrete fracture identified. There is mild periosteal edema and edema within the surrounding soft tissues.

Output: Bilateral tibial stress fractures as described above.


Instruction: Generate impression based on findings.

Input: Male, 38 years old, with history of communicating hydrocephalus and deterioration of gait. Reassess ventricular size. Findings compatible with a classic Dandy-Walker malformation are again seen. This includes a large posterior fossa cyst which communicates with the fourth ventricle and which expands the posterior fossa with torcular lambdoid inversion. The vermis is small and up-turned and the cerebellar hemispheres are hypoplastic. There has been no significant interval change in these findings, and in particular, the posterior fossa cyst has not increased in size. Also noted is a small cleft which partially traverses the right upper spinal cord, also appearing similar to prior.A left parietal approach ventricular shunt catheter is in stable position traversing the left lateral ventricular body. An orphaned right parietal approach catheter is also redemonstrated in stable position. The lateral ventricles and the third ventricle are decompressed similar to prior.Thinning of the mid body of the corpus callosum is again seen along with T2 hyperintensity within the adjacent white matter, unchanged. No new areas of parenchymal signal abnormality are seen. No acute intracranial hemorrhage is seen. No evidence of restricted diffusion is detected.

Output: 1. Stable findings related to classic Dandy-Walker malformation.2. Stable shunted ventricular system with decompressed supratentorial ventricles.3. No new or acute intracranial abnormalities.


Instruction: Generate impression based on findings.

Input: Decreased visual acuity of the left eye: blurry vision. Brain: Many of the images are degraded by motion artifact. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull and scalp soft tissues are grossly unremarkable. There is mild scattered paranasal sinus mucosal thickening.Orbits: Many of the images are degraded by motion artifact. The bilateral globes and ocular adnexa are unremarkable. There is no evidence of abnormal intraorbital enhancement or mass lesions.

Output: 1. No evidence of acute intracranial hemorrhage, mass, or acute infarct, although many of the images are degraded by motion artifact.2. No evidence of orbital lesions, although many of the images are degraded by motion artifact.


Instruction: Generate impression based on findings.

Input: 78-year-old woman with history of endocarditis following cardiac valvular repair, evaluate for emboli. The previously seen, punctate foci of diffusion restriction have resolved and, at these locations, there is minimal residual T2/FLAIR hyperintensity. There is no restricted diffusion to suggest acute ischemia or cerebrovascular embolic disease. There is no abnormal parenchymal or meningeal enhancement. There is no intracranial hemorrhage. There is no intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. Extensive patchy T2/FLAIR hyperintensity in the bilateral subcortical and periventricular white matter has not appreciably changed and is nonspecific but compatible with chronic small vessel ischemic changes. There is associated global parenchymal volume loss. Scattered, punctate foci of susceptibility artifact are noted, likely prior microhemorrhages or mineralization. The major flow-voids are preserved. Incidentally noted partially empty sella. The orbits, paranasal sinuses, skull, and overlying scalp are otherwise unremarkable.

Output: 1.Resolution of previously seen punctate infarcts without evidence of acute infarcts or abscesses.2.Extensive signal abnormality in the bilateral subcortical and periventricular white matter with volume loss, not appreciably changed and compatible with chronic small vessel ischemic changes.


Instruction: Generate impression based on findings.

Input: 61 year old female with a family history of breast cancer in her mother at age 49 and maternal aunt at age 75. History of benign right breast biopsy. There is scattered fibroglandular tissue in both breasts.Minimal parenchymal enhancement is noted bilaterally.Stable non-enhancing benign masses are again seen in the lower aspect of both breasts.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: 42-year-old female with multiple sclerosis. Please evaluate for progression. Please do Dr javed MS protocol with DTI and compare to prior. Innumerable bilateral periventricular white matter lesions are redemonstrated, which are not significantly changed. No evidence of any new lesions is seen and no pathologic enhancement is detected on the present study.No mass effect is present. No abnormal extra-axial fluid collections are seen. Mild prominence of the ventricles and sulci is unchanged and compatible with volume loss.

Output: Innumerable white matter lesions are redemonstrated compatible with multiple sclerosis have not significantly changed.


Instruction: Generate impression based on findings.

Input: Reason: Evaluate for osteomyelitis 1st MTH right foot History: Ulcer sub 1st MTH right foot with increase in size and edema There is diffuse soft tissue swelling about the ankle and foot, predominantly about the first metatarsal. There has been interval amputation through the distal diaphysis of the third metatarsal. Deformity of the distal ray of the fourth metatarsal is consistent with prior surgery. Former deformity of the second metacarpal is consistent with a prior healed fracture. Medial subluxation of the proximal phalanx of the fifth toe appears new since the prior study. There is deformity and bony hypertrophy of the first metatarsal head, however we see no frank osteolysis to confirm osteomyelitis. If there is clinical concern for osteomyelitis, MRI may be considered.

Output: Diffuse soft tissue swelling about the first metatarsal without frank osteolysis to confirm osteomyelitis. If there is clinical concern for osteomyelitis, MRI may be considered.


Instruction: Generate impression based on findings.

Input: 26-year-old female with knee pain, instability and swelling after sports injury MENISCI: The medial and lateral menisci are intact.ARTICULAR CARTILAGE AND BONE: There is increased signal intensity within the articular cartilage of the medial facet of the patella indicating degeneration with a partial thickness fluid-filled cleft along the medial facet and superficial tearing along the median eminence. There is also mild heterogeneity of the articular cartilage of the lateral tibial plateau, which may reflect mild degeneration. The remaining articular cartilage is intact. The bone marrow signal is within normal limits.LIGAMENTS: The cruciate and collateral ligaments are intact.EXTENSOR MECHANISM: The patella tendon and quadriceps tendon are intact.ADDITIONAL

Output: 1. Degeneration and fissuring of the articular cartilage of the patella as described above.2. Intact cruciate and collateral ligaments.


Instruction: Generate impression based on findings.

Input: Secondary malignant neoplasm of brain [C79.31] / Secondary malignant neoplasm of other parts of nervous system [C79.49], Reason for Study: ^Reason: meningioma History: ha Post left suboccipital craniectomy with left cerebellar hemispheric lesion resection status.Multiple susceptibility artifacts on the left cerebellar hemisphere indicate post operative blood products.Comparing to preoperative scan, majority of enhancing mass lesions are not seen. However, there are somewhat irregular linear enhancement along the anterior and inferior aspects of the left cerebellar hemisphere. It is unclear if these enhancing lesions could represent residual lesion or postoperative changes. Therefore, follow up imaging is warranted.There is left cerebellar tissue defect with CSF collection which is continuous to extra axial fluid collection indicating possible pseudomeningocele. The size of extracranial fluid collection is measured about 59mm (RL) x 24.6mm (AP) x 61.6mm (CC). The MR signal intensity of the content of pseudomeningocele is following that of the CSF.Ventricular system is slightly dilated but stable since prior scan in terms of size.There are multiple intra axial enhancing lesions which suggest multifocal metastatic lesions are unchanged since prior scan.There is no evidence of new ischemic or hemorrhagic lesion.The paranasal sinuses and mastoid air cells are clear.

Output: 1. Near total resection status of the left cerebellar lesion with some irregular linear enhancement of anterioinferior aspect of the cerebellar hemisphere as described above.2. Interval development of pseudomeningocele through the left suboccipital craniectomy site.3. Unchanged multiple metastatic nodules.4. No evidence of new ischemic or hemorrhagic lesion.


Instruction: Generate impression based on findings.

Input: Nasopharyngeal cancer, status post RT, surveillance. Again seen are post-treatment findings in the neck without discrete mass to suggest recurrent nasopharyngeal tumor. There is no evidence of significant cervical lymphadenopathy based on size criteria. The thyroid and major salivary glands are unremarkable. The major cervical arterial flow voids appear to be intact. No suspicious osseous lesions. There is T1 shortening involving the skull base and upper cervical spine likely reflecting post radiation change. The imaged intracranial structures are unremarkable. There is diffuse opacification of the sphenoid sinuses and right worse than left posterior ethmoid air cells. There is also mild right anterior ethmoid opacification as well as a tiny fluid level within the left maxillary sinus.. These findings are significantly progressed since prior.

Output: 1. Post-treatment findings in the neck without measurable residual nasopharyngeal tumor. No significant cervical lymphadenopathy.2. Interval increase in paranasal sinus opacification, particularly the sphenoid sinus and posterior ethmoid air cells bilaterally.


Instruction: Generate impression based on findings.

Input: Male 24 years old; Sacral decubitus ulcer, concern for osteomyelitis The images are degraded by motion artifact.A peripherally enhancing sacral decubitus ulcer is present, measuring 6 cm in CC dimension. This also extends down to the level of the coccyx, with the loss of normal bone marrow signal on T1 sequences, compatible with osteomyelitis.A second larger ulcer more inferiorly in the left buttock measures approximately 10 cm in transverse dimension with two deeper extensions, one to the posterior acetabulum and another to the left femur greater trochanter. There is indistinctness of the cortices of the bones with loss of the normal bone marrow signal, compatible with osteomyelitis. The medial aspect of this ulcer extending towards the perineum is not fully visualized due to extensive motion artifact, though appears grossly similar to the prior study.An third soft tissue ulcer extends through the right lateral soft tissues to the right femur greater trochanter. There is indistinctness of the cortex along the greater trochanter, compatible with osteomyelitis. The previously seen associated fluid collection suspicious for abscess is again noted.Diffuse soft tissue edema is present in the subcutaneous fat. Diffuse fatty atrophy is noted.

Output: Limited study due to extensive motion artifact. Multifocal soft tissue ulcers with associated osteomyelitis, as above.


Instruction: Generate impression based on findings.

Input: Neoplasm of uncertain behavior, unspecified [D48.9], Reason for Study: ^Reason: brain mets History: metastatic thymic NE tumor with LE weakness Multifocal various sized skull lesions showing low T1, high or iso T2 with enhancement on Gad enhanced T1 images. There is no definitive evidence of adjacent inner or outer table invasion of each lesion nor associated scalp soft tissue mass. Constellation of these findings indicate possible multifocal skull metastasis.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Multifocal various sized skull lesions suggesting multifocal metastatic lesions as described above. 2. No evidence of acute ischemic or hemorrhagic lesion. No intra axial abnormal enhancement.


Instruction: Generate impression based on findings.

Input: 67-year-old male with prostate cancer PELVIS:PROSTATE: Significant artifact from right hip arthoplasty device most notably on DWI sequence.Prostate Size: 5.3 x 3.2 x 4.8 cm.Peripheral Zone: There is a T2 hypointense focus in the right apex of the peripheral zone with corresponding restricted diffusion and mild early arterial enhancement measuring approximately 5 x 5 mm.Central Gland: Moderate degree benign prostatic hypertrophy.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: None.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Colonic diverticulosis without evidence of diverticulitis.

Output: 1.Limited study due to artifact from right hip arthoplasty device most notably on DWI sequence. Hypointense focus in the right peripheral zone apex as described above suspicious for malignancy.


Instruction: Generate impression based on findings.

Input: Female, 65 years old, with neck pain. Assess for stenosis or disk herniation. Evidence of instrumented anterior spinal fusion is seen from C5 to C6. The cervical lordosis is straightened at the fused levels but alignment is otherwise unremarkable.Vertebral body pathology is within normal limits allowing for surgical changes at C5-C6. No concerning marrow signal abnormality is detected.Spinal cord morphology is unremarkable except as discussed below.C2-3: Minimal central disk protrusion. No significant spinal canal or foraminal stenosis. C3-4: Minimal central disk protrusion. No significant spinal canal or foraminal stenosis. C4-5: Broad posterior disk osteophyte complex. Moderate generalized spinal canal stenosis with flattening of the ventral cord. No cord signal abnormality. Moderate bilateral foraminal narrowing. C5-6: Surgical fusion across the disk space. No significant spinal canal or foraminal stenosis. C6-7: Posterior disk osteophyte complex asymmetric towards the left. Moderate generalized spinal canal stenosis with flattening of the ventral cord. No cord signal abnormality. Mild left foraminal narrowing. C7-T1: Mild posterior disk osteophyte complex. No significant spinal canal or foraminal stenosis.

Output: 1. Evidence of instrumented anterior spinal fusion across C5 and C6.2. Posterior disk osteophyte complexes at C4-5 and at C6-7 cause moderate canal stenoses with deformation of the spinal cord but no evidence of cord edema.


Instruction: Generate impression based on findings.

Input: History of multiple myeloma presenting with left gaze deviation. Patient also has bilateral lower extremity weakness and probable lumbar plasmacytoma noted on prior limited cord compression MRI. Brain:There is a soft tissue mass centered within the clivus that is isointense to gray matter on T1 and T2 sequences which measures 2.1 x 3.0 x 1.9 cm (transverse by AP by cc). There is avid homogenous enhancement on the postcontrast images. Given the patient's history of multiple myeloma and the predominantly intraosseous location this most likely represents a myelomatous lesion. This extends intracranially into the left prepontine cistern and extends into the inferior left cavernous sinus as well as abutting the left Meckel's cave. There appears to be at least partial encasement of the left internal carotid artery, without significant associated stenosis. Lobular enhancing soft tissue also extends into the left sphenoid sinus. The wall of the sinus appears eroded, however this would be better with evaluated CT. There is no evidence of intracranial hemorrhage edema. The ventricles and basal cisterns are normal in size and configuration. Aside from the left sphenoid sinus, the paranasal sinuses are clear. The visualized mastoid air cells are clear. The orbits are unremarkable. The calvarium is diffusely decreased T1 marrow signal compatible with the history of myeloma.Lumbar spine:Redemonstration of an pathologic compression fracture involving the T12 vertebral body resulting in approximately 40% loss of vertebral body height. There is no significant associated retropulsion of the fracture fragments. The remaining vertebral body heights are preserved. Alignment is within normal limits.There is diffusely abnormal bone marrow signal and patchy intraosseous enhancement throughout the visualized osseous structures compatible with the history of myeloma. There is enhancing epidural soft tissue posterior to the L4 vertebral body. Minimal enhancement dorsal to the L5 vertebral body may represent minimal epidural tumor versus venous plexus. Epidural tumor at the L4 level measures 8 mm in maximum thickness with encroachment of the lateral recesses. Neural foramina more laterally are patent. Additional poorly defined enhancing soft tissue anterior to the L3 and L4 vertebral bodies measuring up to 2.6 x 1.3 cm is compatible with additional extraosseous tumor extension. No convincing evidence of leptomeningeal tumor involvement.There is additional extensive tumor involvement involving the right sacral body and bilateral iliac bones which is partially imaged.Partially visualized markedly distended bladder.Additional level by level findings are as follows:T12-L1: No disc bulge, spinal canal stenosis, or neuroforaminal narrowing.L1-L2: Mild diffuse disc bulge. No spinal canal stenosis or neuroforaminal narrowing.L2-L3: Moderate disc bulge. Minimal spinal canal and bilateral neural foraminal narrowing.L3-L4: No disc bulge, spinal canal stenosis, or neuroforaminal narrowing.L4-L5: Ventral epidural tumor as described above resulting in minimal central canal stenosis and significant encroachment on the lateral recesses, left greater than right. No significant neural foraminal stenosis.L5-S1: Minimal ventral epidural tumor extension is questioned dorsal to L5 vertebral body. There is a mild disc bulge. No significant neural foraminal or spinal canal stenosis.

Output: 1. Enhancing soft tissue mass centered within the clivus with intracranial extra-axial extension into the left prepontine cistern and left cavernous sinus. Findings consistent with a myeloma lesion.2. Multifocal multiple myeloma tumor involvement in the lumbar spine with extension of tumor into the ventral epidural space at the L4 level. There is encroachment of the lateral recesses and mild central canal narrowing. Enhancement dorsal to the L5 vertebral body is more nonspecific but may represent minimal epidural tumor.3. There is additional extensive tumor involvement involving the right sacral body and bilateral iliac bones which is partially imaged.4. Distended bladder. Correlate for signs and symptoms of neurogenic bladder/urinary retention.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 67-year-old male with right upper and lower extremity weakness and stenosis of the left internal carotid artery. There are several foci of diffusion restriction in the left frontal, parietal, and occipital lobe watershed zones, with associated high T2 signal. The right cerebral hemisphere and infratentorial structures are intact. There is no evidence of intracranial hemorrhage or mass. There is mild diffuse cerebral volume loss. 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 minimal prominence of the paranasal sinus mucosa.

Output: Multiple punctate recent infarcts involving the left cerebral hemisphere watershed zones.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Knee pain, evaluate for meniscal tear. MENISCI: The medial and lateral menisci are intact. Small para meniscal cysts are present along the posterior aspect of the medial meniscus.ARTICULAR CARTILAGE AND BONE: No fractures are identified. Small focus of reactive bone marrow edema is present within the subchondral medial tibial plateau. An additional small focus of reactive bone marrow edema is present within the subchondral lateral patellar facet. There is diffuse near full-thickness cartilaginous thinning within the medial tibiofemoral compartment. There is also mild diffuse thinning of cartilage within the lateral tibiofemoral compartment. There is moderate cartilaginous thinning of the patellofemoral compartment, lateral greater than medial, without full-thickness cartilaginous defects.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: Degenerative osteoarthritic changes with near full-thickness cartilage loss in the medial tibiofemoral compartment with underlying reactive bone marrow edema. Menisci and ligaments are intact.


Instruction: Generate impression based on findings.

Input: 4 month old male; rule out bleed. Prominent extra-axial fluid bilaterally with questionable peripheral high attenuation that could represent intracranial hemorrhage; if clinically concerned for bleed, recommend MRI for further evaluation.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: Prominent extra-axial fluid bilaterally with questionable peripheral high attenuation that could represent intracranial hemorrhage; if clinically concerned for bleed, recommend MRI for further evaluation.


Instruction: Generate impression based on findings.

Input: Female, 61 years old, with neck pain and hand weakness. History of metastatic breast cancer. Evaluate for bony metastases. Marrow signal is mildly heterogeneous with scattered foci of T1/T2 hypointense signal. However, no T2 hyperintense or edematous lesions are detected and there is no definite pathologic enhancement. Minimal edema and enhancement along the superior endplate of T3 is nonspecific.The visualized spinal cord demonstrates normal signal intensity throughout. No focal lesions are seen. No pathologic intramedullary or leptomeningeal enhancement is observed. No epidural abnormalities are suspected.C2-3: Right facet hypertrophy. No significant spinal canal or foraminal stenosis. C3-4: Bilateral facet hypertrophy. Ligamentum flavum thickening. Minimal posterior disc-osteophyte complex formation. Mild generalized spinal canal stenosis. Mild left foraminal narrowing. C4-5: Bilateral facet hypertrophy. Ligamentum flavum thickening. Minimal posterior disc-osteophyte complex formation. Mild generalized spinal canal stenosis. Mild left foraminal narrowing.C5-6: Bilateral facet hypertrophy. Posterior disc-osteophyte complex formation asymmetric to the right. Effacement of the right ventral thecal sac with a mild generalized spinal canal stenosis. Severe right and moderate left foraminal narrowing. C6-7: Bilateral facet hypertrophy. No significant spinal canal or foraminal stenosis. C7-T1: No significant spinal canal or foraminal stenosis.

Output: 1.No definite evidence of any active osseous or paraspinal metastatic disease is seen. Heterogeneous low signal within the vertebral body marrow could represent treated metastatic disease or may simply be degenerative in nature. Mild edema and enhancement along the superior endplate of T3 is nonspecific.2.Multilevel degenerative findings are noted as described above. For the most part this results in only mild generalized spinal canal stenosis and mild foraminal narrowing. However, at C5-6, the right neural foramen appears to be severely narrowed.


Instruction: Generate impression based on findings.

Input: Right lower facial droop. History of Parkinson disease and CLL. ? Bell's palsy. There is no acute infarct or intracranial hemorrhage. Tiny T2 FLAIR hyperintense foci in the frontoparietal white-matter, are more pronounced on the left side, are nonspecific but reflect chronic microvascular ischemia. The CSF-containing spaces are mildly enlarged, reflecting underlying volume loss. There is no midline shift or brain herniation. There is no abnormal extra-axial fluid collection. Major intracranial vascular flow voids are preserved, reflecting gross vessel patency. There is no abnormal brain contrast enhancement. There is no definite abnormal enhancement along the course of the facial nerves.Orbits are notable for changes of previous bilateral cataract surgery. Mastoid air cells are clear. Minimal mucosal thickening is present in the inferior aspect of the maxillary sinuses. There is no destructive skull lesion. Hyperostosis frontalis interna is a common finding. There is a focal erosion or cyst involving the dens, probably degenerative in nature.

Output: 1.There is no acute brain infarct or intracranial hemorrhage.2.Mild chronic microvascular ischemia.


Instruction: Generate impression based on findings.

Input: 43 years, Female, paresthesias and history of multiple sclerosis, evaluate for progression.. Brain:There are innumerable foci of T2/FLAIR hyperintensity in the bilateral periventricular and subcortical white matter in morphology and distribution consistent with known demyelinating disease. Numerous lesions with T1 hypointensity are also noted. There is also moderate degree of brain parenchymal loss including thinning of the corpus callosum. Few infratentorial lesions are also again seen. Abnormal signal involving the bilateral optic nerves is also suspected although would be better assessed with dedicated orbital imaging if clinically indicated. Compared to 11/1/2010, there appears to progression with multiple new or larger areas of T2/FLAIR hyperintensity at the left posterior frontal operculum, left frontal cingulate gyrus, left inferior parietal lobule, right frontal subcortical and periventricular white matter, posterior limb of the right internal capsule, right supramarginal gyrus, and right lateral occipital lobe.No intracranial mass or mass effect. No hydrocephalus. Calvarium and extracranial soft tissues are grossly unremarkable. Cervical spine:There are multiple T2 hyperintense lesions throughout the cervical cord affecting all levels and consistent with known demyelinating disease. Subtle areas of volume loss are seen such as at the dorsal C3 level, although overall cord parenchymal volume is grossly preserved.Vertebral body heights and alignment are maintained. Small disc osteophyte complexes and uncovertebral hypertrophy are noted at C3-C4, C4-C5, and C5-C6. There is no significant spinal canal stenosis. There is up to moderate right C3-C4, right worse than left C4-C5, and left worse than right C5-C6 neural foraminal stenoses. Bone marrow signal is benign. Paraspinous soft tissues are unremarkable.

Output: 1. Numerous T2/FLAIR hyperintense lesions in the brain compatible with known demyelinating disease. Several new T2/FLAIR hyperintense lesions in the brain are seen compared to 11/1/2010 as described above and compatible with progression of demyelinating disease.2. Moderate degree of brain parenchymal volume loss including thinning of the corpus callosum.3. T2 hyperintense lesions throughout the cervical cord also consistent with known demyelinating disease. No prior cervical spine MRI is available for comparison.4. Degenerative changes in the cervical spine with neural foraminal narrowing at C3-C4, C4-C5, and C5-C6 as above.


Instruction: Generate impression based on findings.

Input: No evidence for acute intracranial hemorrhage, mass effect, or edema. Ventricular size is normal. There are no midline shift. Basal cisterns are patent.There is no evidence of restricted diffusion.There are dispersed foci of susceptibility signal throughout the brain. A large focus of susceptibility is seen in the left cingulate gyrus and a smaller one in the right frontal lobe. There are linear dark susceptibility signals along the anterior and the posterior interhemispheric fissures, suggestive of old subarachnoid hemorrhage and residual siderosis. Foci of susceptibility artifacts are also seen in the cerebellum. In comparison to the previous study of 2013, these susceptibility foci were present but increased in number and size. These are due to old blood products from microhemorrhages and residual siderosis.The vascular flow voids are unremarkable.MRA BRAIN:The anterior, middle, and posterior cerebral arteries are within the normal limits. Internal carotid arteries are widely patent. Anterior communicating artery is patent. The bilateral posterior communicating arteries are diminutive. The basilar and vertebral arteries are patent with no evidence of stenosis or aneurysm. There is trifurcation of the anterior cerebral arteries. The left jugular branch of the ascending pharyngeal artery is enlarged as is the left posterior meningeal artery, as compared to the contralateral side. There are some meningeal arteries extending to the torcula and adjacent superior sagittal sinus. There is enlargement of the middle meningeal artery bilaterally.MRA NECK:The common carotid arteries, the cervical internal carotid arteries, and the vertebral arteries are widely patent with no evidence of stenosis or aneurysm.

Output: 1.No acute findings. No evidence for acute intracranial hemorrhage, mass effect, or edema. No abnormal enhancement.2.MRA of the brain suggests dural arteriovenous fistula with potential posterior meningeal artery and middle meningeal supply to the torcula and superior sagittal sinus.3.Siderosis predominantly involving posterior aspect of the falx, tentorium and adjacent sulci is stable since prior available exams. This suggests a prior history of subarachnoid hemorrhage and possibly subdural hemorrhage.4.Progression of microhemorrhages within subcortical white matter in the supratentorial and infratentorial brain since 2013. It is certainly possible that this progression is related to her thrombocytopenic state associated with CML.5.Findings were discussed with Lauren Ziskind APN at 10:30 am.


Instruction: Generate impression based on findings.

Input: Again seen is enlargement of the lateral ventricles, particularly the left greater than right atria and occipital horns. There is thinning of the overlying periventricular white matter without significant gliosis or edema. There is mild prominence of the temporal horns, third ventricle, and fourth ventricle and unchanged. There are several scattered foci of T2/FLAIR hyperintensity in the periventricular and subcortical white matter which are similar to prior and may represent prior ischemia, inflammation, or other injury.Unchanged expansile CSF intensity involving the pineal cistern which appears to communicate with the third ventricle. The cystic space measures approximately 23 x 12 x 14 mm (APxTRVxCC) which is not significantly changed allowing for slight differences in imaging plane and slice selection.There is no evidence of acute infarct, hemorrhage, suspicious mass or new mass effect. No midline shift or herniation. Major flow-voids are patent. Bone marrow signal and extracranial soft tissues are grossly unremarkable.

Output: 1. Unchanged mild chronic ventriculomegaly, primarily involving the trigone and occipital horn of the left lateral ventricle. 2. Unchanged cystic expansion of the pineal cistern which appears to communicate with the third ventricle and may represent an arachnoid cyst. There is minimal if any local mass effect.


Instruction: Generate impression based on findings.

Input: 58 years Male (DOB:6/14/1957)Reason: pt with persistent bacteremia endorsing back pain, r/o osteomyelitis vs. Abscess History: back painPROVIDER/ATTENDING NAME: KIRK T SPENCER KIRK T SPENCER Cervical spine:Exam is degraded by patient motion artifact.The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is mild reversal of the normal cervical curvature.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina. There is T2 signal hyperintensity and T1 signal hyperintensity present within the C5 and C6 vertebral bodies adjacent to the C5-6 disc. This is stable compared to prior exam.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.Incidental note is made of a Thornwaldt cyst.MRI thoracic spine:Exam is degraded by patient motion artifact.The thoracic vertebral bodies are appropriate in the overall alignment and height. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots. There is T2 signal hyperintensity within the vertebral bodies along the anterior and lateral aspects (left more than right) adjacent to the T6-7 disc space. The endplates are partially preserved. There is T2 signal hyperintensity within the intervening disc. This is new since the prior exam.Findings suggest loculated pleural effusions.Lumbar spine:Exam is degraded by patient motion artifact.Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is a mild disc bulge present at this level.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is mild ligamentum flavum hypertrophy at this level. There is a disc bulge at this level. There is effacement of the fat at the lateral recess bilaterally at this level and overall mild to moderate degree of spinal stenosis. This is stable compared to prior exam.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is mild ligamentum flavum hypertrophy at this level. There is a disc bulge at this level. There is partial effacement of the fat at the left lateral recess and effacement of the fat at the right lateral recess at this level and overall mild to moderate degree of spinal stenosis. This is stable compared to prior exam.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 cysts along the left kidney

Output: 1.There is abnormal signal within the T6-7 disc associated with some endplate reactive change. This has progressed since the prior exam at which time it did not appear to involve the disc. The possibility of discitis cannot be excluded. Other possibilities include repetitive injury and renal spondylarthropathy.2.There are degenerative changes in the lumbar spine with mild to moderate degrees of spinal stenosis at L4-5 and L3-4 as detailed above. This is stable compared to prior exam.3.There are degenerative changes present in the cervical spine without significant compromise to spinal canal or exiting nerve roots. This is stable compared to prior exam.4.Exam is degraded by patient motion artifact which will obscure more subtle abnormalities.5.There are loculated pleural effusions present. These are new compared to the prior exam.


Instruction: Generate impression based on findings.

Input: 55 years Female (DOB:3/17/1961)Reason: aphasia etiology History: aphasiaPROVIDER/ATTENDING NAME: AGNIESZKA ANNA ARDELT RIMAS V LUKAS There are patchy foci of FLAIR and T2 signal hyperintensity present within the gray and white matter adjacent to the superior frontal sulci medial parietal lobes and occipital lobes as well as along the medial straightening bilaterally and the medial aspects of the thalami. Couple punctate foci of T2 signal hyperintensity are also present in cerebellum.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin.

Output: Patchy lesions scattered in the medial aspects of the frontal lobes, parietal lobes and occipital lobes as well as neostriatum, thalami and to lesser degree cerebellar are present. Differential considerations include posterior reversible encephalopathy syndrome with some atypical features. Other considerations such as severe hypoglycemia and encephalitis are conceivable in the right clinical setting. There is no significant diffusion restriction appreciated. .


Instruction: Generate impression based on findings.

Input: Bilateral adrenal masses seen on CT ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic morphology of the liver noted. No intrahepatic biliary ductal dilatation. Gallbladder appears unremarkable.SPLEEN: Mild splenomegaly. A splenule is noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Lipid rich adrenal adenoma that demonstrates drop of signal on out of phase imaging on the left gland medial limb measures 1.5 x 1.9 cm and with similar characteristics in the right adrenal gland lateral limb measures 1.4 x 1.3 cm. Remainder adrenal glands maintain normal morphology but hyperplastic. No abnormal enhancement noted.KIDNEYS, URETERS: Right lower pole nonenhancing renal cyst is identified. No hydronephrosis.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.Bilateral lipid rich adrenal adenomas2.2. Cirrhotic morphology of the liver


Instruction: Generate impression based on findings.

Input: Drug resistant temporal lobe epilepsy treated with laser ablation of the left mesial temporal lobe. There are expected findings related to left medial temporal lobe laser ablation. There is no gross evidence of other intracranial abnormalities. The ventricles are unchanged is size.

Output: Expected postoperative findings related to left medial temporal laser ablation.


Instruction: Generate impression based on findings.

Input: This exam is degraded by motion artifact, especially the postcontrast sequences..ORBITS: There is a 16 x 24 x 20 mm sellar lesion with suprasellar extension that displays intermediate to high signal peripherally and low signal centrally on both T2 and T1-weighted sequences, as well as areas of central and peripheral enhancement. There is mass effect upon the adjacent optic apparatus. There is also mild mass effect upon the bilateral cavernous sinuses. There orbits are unremarkable.BRAIN: There is no evidence of acute cerebral infarction. There are minimal nonspecific scattered punctate foci of T2 hypertensity within the supratentorial white matter that may represent chronic small vessel ischemic disease. There is a small right superior frontal gyrus developmental venous anomaly. The ventricles 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 mild paranasal sinus mucosal thickening and fluid within the bilateral mastoid air cells.

Output: An acutely hemorrhagic sellar lesion with suprasellar extension that results in compression of the optic apparatus is most compatible with pituitary apoplexy, possibly superimposed on an underlying mass such as a pituitary adenoma or Rathke's cleft cyst. These findings were discussed with Dr. Elizabeth Poli at 12:20 PM on 6/21/2015.


Instruction: Generate impression based on findings.

Input: Abnormal ultrasound demonstrating numerous liver lesions. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology, signal intensity and size. Normally distended gallbladder. No intra or extrahepatic biliary duct dilatation.There are several T2 intrinsic hyperintense well-defined lesions with lobular margins in both the right and left hepatic lobe. The largest is a segment 5 lesion measuring 5.8 x 5.2 cm (series 500/64) with a subtle T2 hyperintense central scar. The lesions demonstrate homogeneous arterial enhancement and remain mildly hyperintense on subsequent imaging. One hour delayed imaging in the hepatobiliary phase demonstrates hepatobiliary agent uptake.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Several bilobed liver lesions with characteristics most compatible with multiple focal nodular hyperplasia the largest of which measures 5.8 cm in segment 5. Given their size and location 1-year-old follow-up is recommended to confirm size stability.


Instruction: Generate impression based on findings.

Input: Pain, check for medial meniscal tear MENISCI: A complex tear observed in the posterior horn of the medial meniscus is identified with extension to the superior articular surface towards the apical aspect. A horizontal extension is also noted towards the body extending towards the inferior articular surface. The anterior aspect is otherwise intact as well as the lateral meniscus. Both menisci remain well anchored posteriorly.ARTICULAR CARTILAGE AND BONE: Minimal osteoarthritic changes and small scattered bone islands within the femoral condyles, however no superimposed osseous or cartilaginous abnormality.LIGAMENTS: The ACL, PCL, MCL and LCL are all intact EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Complex tear of the medial meniscal posterior horn with a small effusion, as described


Instruction: Generate impression based on findings.

Input: Increased seizure activity, rule out acute pathology. Neck pain. Brain: There are postsurgical changes of right-sided craniotomy including resection of the right anterior temporal lobe. There is T2/FLAIR hyperintensity surrounding the resection cavity consistent with gliosis. There is ex vacuo dilatation of the right temporal horn. There is an additional area of FLAIR hyperintensity and volume loss compatible with encephalomalacia in the right frontal lobe including primarily the right middle frontal gyrus and extending to the right frontal periventricular white matter.Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild chronic small vessel ischemic changes. Several punctate foci of FLAIR hyperintensity are noted in the right superior frontal gyrus which may also represent chronic infarcts. There is severely diminished flow-void involving the visualized right upper cervical, petrous and cavernous internal carotid arteries with improved flow-void of the right supraclinoid ICA and its branches, which may be related to collateral flow.No restricted diffusion to suggest acute ischemia. Punctate focus of diffusion hyperintensity seen in the right anterior frontal lobe without corresponding ADC abnormality. No intracranial mass or mass-effect. No hydrocephalus. Mild mucosal thickening is noted throughout the paranasal sinuses. Bone marrow signal within normal limits.Cervical spine: Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate height. There is mild reversal of cervical lordosis. Alignment is otherwise maintained. Bone marrow signal is benign. The cervical spinal cord has normal signal characteristics and overall morphology.The cervical spinal canal appears mildly narrow on a congenital basis with superimposed minimal degenerative changes as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: No significant compromise to the spinal canal. Minimal bilateral neural foraminal narrowing relatively worse on the left related to uncovertebral hypertrophy and mild facet arthropathy.C4-5: No significant compromise to the spinal canal. Minimal left foraminal stenosis related to uncovertebral hypertrophy and facet arthropathy.C5-6: No significant compromise to the spinal canal or neural foramina.C6-7: No significant compromise to the spinal canal or neural foramina.C7-T1: Minimal disc bulge. No significant compromise to the spinal canal or neural foramina.Right vertebral artery flow-void is diminutive which may be related to hypoplasia and/or proximal stenosis. Paraspinous soft tissue structures appear within normal limits.

Output: 1. Postsurgical changes involving the right anterior temporal lobe, presumably related to epilepsy surgery. There is gliosis surrounding the right anterior temporal resection cavity.2. Encephalomalacia in the right frontal lobe suspected to be related to chronic infarct. No evidence of acute infarct. Punctate focus of mild diffusion hyperintensity seen in the right anterior frontal lobe (image 250) with corresponding FLAIR hyperintensity and without corresponding ADC abnormality; finding may represent a punctate subacute infarct.3. Severely diminished flow-void is seen involving the right upper cervical, petrous and cavernous segments of the internal carotid artery which may be related to occlusion or high-grade proximal stenosis. Consider dedicated MRA or CTA evaluation to better assess the vasculature. 4. No intracranial mass or mass effect.5. Mild congenital narrowing of the cervical spinal canal with superimposed mild degenerative changes as detailed above. No high-grade spinal canal or neural foraminal stenosis at any level is appreciated. No cord signal abnormality.


Instruction: Generate impression based on findings.

Input: Male, 36 years old, with right-sided weakness, worsening right leg weakness, history of MS. Numerous predominantly periventricular T2 hyperintense lesions are demonstrated. Some of these involve the corpus callosum or are oriented radially with respect to the ventricles. Most demonstrate significant T1 hypointensity. The brainstem and cerebellum are affected to a very mild degree. Brain parenchymal volume is well-preserved. No evidence of edema or mass effect is seen. No abnormal extra-axial fluid collections are detected. Ventricular size and morphology are within normal limits. A mucous retention cyst is present in the right maxillary sinus.

Output: Multiple brain lesions are evident showing morphology and distribution compatible with demyelinating disease.


Instruction: Generate impression based on findings.

Input: Ms. Muzzarelli is a 67 year old female with a personal history of right breast mastectomy in April 2013 for IDC and reduction surgery in the left breast (July 2014). She received radiation chemotherapy and hormonal therapy. Family history of breast cancer in her sister (diagnosed at age 50), maternal cousin (diagnosed at age of 40), maternal aunt and two paternal aunts. There is heterogeneous amount of fibroglandular tissue in the left breast. Mild parenchymal enhancement is noted. Patient is status post right breast mastectomy with DIEP-flap reconstruction.Multiple enhancing foci are identified in the left breast, none of which are more suspicious than the rest. No abnormal enhancement is identified in the left breast.No abnormal enhancement is identified in the right reconstructed breast. Previously identified seroma in the right axillary region is smaller when compared to prior examination.No abnormal axillary lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Encephalitis and encephalomyelitis, unspecified [G04.90] / Epilepsy, unspecified, not intractable, without status epilepticus [G40.909], Reason for Study: ^Reason: Follow up scan re evaluated anterior temporal lobe lesion History: Seizure disorder There is no acute hemorrhagic lesion.There is no abnormal enhancement.There is focal DWI high signal intensity on the right basal ganglia (series 601, image 242) which shows suspicious diffuse restriction on ADC map but clearly showing T1/FLAIR high signal intensity. Thus, this lesion is likely represent T2 shine through instead of acute ischemic lesion.Previously demonstrated subtle increased FLAIR/T2 signal intensity on bilateral mesial temporal lobe appear to be stable, unchanged since prior scan. Left posterior inferior thalamic tissue defect indicating chronic stroke. Non specific patchy multifocal somewhat confluent bilateral periventricular white matter and centrum semiovale, unchanged since prior scan.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. No acute ischemic or hemorrhagic lesion.2. No abnormal enhancement.3. Unchanged subtle increase of bilateral mesial temporal lobe on FLAIR/T2 images.4. Interval development of focal T2/FLAIR high signal intensity lesion on the right basal ganglia. This is non specific but differential diagnosis includes chronic ischemic lesion or small vessel disease.


Instruction: Generate impression based on findings.

Input: Clinical question: Surveillance scan, status post as SRS. Signs and symptoms: As above. Nonenhanced brain MRI:Examination is performed as it was requested without intravenous contrast extending reduces the sensitivity of the exam for detection of small metastatic lesions.Negative diffusion weighted series.Within the limitation of noncontrast study a previously noted approximately 8 mm left parietal metastatic lesion cannot be identified with certainty. There is however slight interval increased vasogenic edema at this site compared to prior study. There is no evidence of hemorrhage or mass effect.A smaller right posterior parietal-occipital 3 mm enhancing metastatic lesion cannot be identified on this unenhanced study.Diffuse and scattered foci of FLAIR hyperintensity in the subcortical and periventricular white matter of bilateral cerebral hemispheres demonstrate no significant change since prior exam and suspected of chronic nonhemorrhagic small vessel ischemic strokes.The ventricular system, cortical sulci and the CSF spaces are unremarkable and similar to prior exam.

Output: 1.Nonenhanced brain MRI failed to demonstrate previously noted enhancing metastatic lesions. Note however should be made that the lack of intravenous contrast significantly reduces the sensitivity of the exam for detection of small metastatic lesions.2.Minimal interval increased vasogenic edema at the site of treated left parietal metastatic lesion is observed.3.Negative diffusion-weighted series and findings suggestive of mild chronic nonhemorrhagic small vessel ischemic strokes without significant change since prior study.


Instruction: Generate impression based on findings.

Input: Pain in right shoulder [M25.511], Reason for Study: ^Reason: ? Radiculopathy History: pain Examination is slightly limited by motion artifact. There is straightening of the cervical lordosis which may be positional. The vertebral body heights and intervertebral disc spaces are maintained. The vertebral bodies are normally aligned. No worrisome focal marrow signal is identified. The spinal cord demonstrates normal signal and morphology. There is developmental narrowing of the spinal canal with superimposed degenerative changes as described below:C2-3: No significant disc herniation, neuroforaminal stenosis, or spinal stenosis is noted.C3-4: There is a minimal posterior disc osteophyte complex causing mild spinal stenosis without neural foraminal stenosis.C4-5: There is a minimal disc osteophyte complex eccentric to the right causing minimal right neuroforaminal stenosis. Left neural foramen is patent. Minimal narrowing of the spinal canal.C5-6: There is a small disc osteophyte complex including small central protrusion causing mild spinal stenosis without significant neuroforaminal stenosis.C6-7: Left uncovertebral joint hypertrophic degenerative changes results in mild left neuroforaminal stenosis without spinal or right neuroforaminal stenosis.C7-T1: There is small right foraminal disc osteophyte complex with minimal right neural foraminal narrowing. No spinal canal or left neural foraminal narrowing.

Output: Developmental narrowing of the spinal canal with superimposed degenerative changes resulting in mild spinal stenosis at C3-4 and C5-6. Additional multilevel mild neural foraminal narrowing as described above.


Instruction: Generate impression based on findings.

Input: Left knee pain and swelling. Evaluate for meniscus tear versus a loose body. MENISCI: There is a bucket handle tear of the medial meniscus with the displaced fragment along the medial tibial spine.Again seen is attenuation and irregularity of the free edge of the posterior horn of the lateral meniscus that likely represents a combination of prior surgery and chronic tearing. There is also a partial thickness radial tear of the body of the lateral meniscus. These findings are similar to those seen on the prior study. ARTICULAR CARTILAGE AND BONE: Again seen is full thickness loss of articular cartilage along the lateral femoral condyle above and anterior to the torn posterior horn of the lateral meniscus appearing similar to that seen on the prior study with mild signal abnormality in the underlying subchondral bone. Also again seen is a depression of the articular surface of the lateral femoral condyle just above the anterior horn of the lateral meniscus compatible with an old impaction fracture with focal loss of overlying cartilage. Articular cartilage of the medial and patellofemoral compartments is relatively intact. LIGAMENTS: Again seen are postoperative changes of ACL reconstruction using a bone-patellar-tendon-bone graft. The graft appears slightly thickened but intact. The posterior cruciate ligament is intact. The medial and lateral collateral ligamentous complexes are intact.EXTENSOR MECHANISM: There is mild thickening of the proximal patellar tendon and mild edema within the inferior pole of the patella appearing similar to the prior study. ADDITIONAL

Output: 1.New bucket handle tear of the medial meniscus 2.Additional findings as described above appear similar to the prior study.


Instruction: Generate impression based on findings.

Input: 50 year old man with heart transplant referred to evaluate for possible rejection. Left VentricleThe left ventricle is normal in size and systolic function. There are no regional wall motion abnormalities present. The native myocardial T1 relaxation time is significantly elevated (1195ms) but similar to the prior study. The myocardial T2 ratio is within normal limits (1.74), and a little better than before. Left AtriumThe left atrium has transplant morphology.Right VentricleThe right ventricle is normal in size and systolic functionRight AtriumThe right atrium is has transplant morphology.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThe pericardium is mildly thickened. The pericardial T2-signal is increased along the basal lateral wall, suggesting active inflammation and a little more than before. A small loculated pericardial effusion is noted. Extracardiac FindingsSmall left pleural effusion noted. Sternal wires noted. Gynecomastia noted. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Normal LV size and systolic function with significant elevation in native myocardial T1 relaxation time but normal T2-ratio. These findings are similar to or a little better than before.2. Normal RV size and systolic function. 3. Mild pericardial thickening with evidence of active inflammation along the lateral wall, which is a little more than before. 4. See extra-cardiac findings.5. No contrast was used in this study because of renal dysfunction.6. Quantification of chamber size and function to follow as an addendum.


Instruction: Generate impression based on findings.

Input: Reason: nash cirrhosis with liver lesion ABDOMEN: Exam is mildly limited by artifact from sternotomy wires.LIVER, BILIARY TRACT: There is enhancing 2.5 x 2.6 cm segment 8 lesion near the hepatic dome with washout and diffusion restriction (series 10 image 10). The lesion abuts the right hepatic vein. Patient is 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: No significant abnormality noted.BONES, SOFT TISSUES: Fat-containing ventral hernia.OTHER: No significant abnormality noted.

Output: 1.Segment 8 lesion abutting the right hepatic vein, suspicious for HCC.


Instruction: Generate impression based on findings.

Input: The ventricles and sulci are appropriate in size for age. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. 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. Mucosal thickening is present within a single posterior right ethmoid air cell as well as within a single anterior ethmoid air cell. The remaining paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain.

Output: Negative MRI of the brain including gadolinium enhancement. Specifically, there are no MRI findings to explain the patient's fever and neck stiffness.


Instruction: Generate impression based on findings.

Input: 68 years, Female, with metastatic small cell lung carcinoma. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. There are numerous small foci of enhancement within the supratentorial brain, measuring up to 5 mm. Most of these are well seen on the axial 3-D T1 postcontrast images (series 1200) including; lesions in the right frontal lobe (image 113), left frontal lobe (image 94), right basal ganglia (image 80) left basal ganglia (image 71), left temporal lobe (image 65), left temporal lobe (image 60), left temporal lobe (image 47), left frontal lobe (image 102). A tiny lesion in the left gyrus rectus is best seen on sagittal 3-D postcontrast T1 (series 11 image 14). There is also a tiny ill-defined focus of enhancement in the pons just to the right of the midline (series 1200 image 50), possibly an additional lesion. No significant surrounding edema or mass-effect. The ventricles are within normal limits in size and configuration. Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with chronic small vessel ischemic changes. Sella and orbits are grossly within normal limits. Mild mucosal thickening is present in the anterior ethmoid air cells. Paranasal sinuses and mastoid cells are otherwise clear. There is nonspecific heterogeneous enhancement of the calvarium without large discrete destructive osseous lesions. Extracranial soft tissues are within normal limits.

Output: 1. Approximately 10 small enhancing lesions in the brain most consistent metastatic disease. No significant mass effect. 2. Heterogeneous enhancement of the calvarium with a large discrete destructive osseous lesions. Finding may be treatment-related but suggest correlation with prior PET or bone scan.


Instruction: Generate impression based on findings.

Input: Female; 41 years old. Reason: Evaluate for Endometriosis. History of Fibroids / Endometriosis. History: Pelvic Pain. Dysfunctional Uterine Bleeding. PELVIS:UTERUS, ADNEXA: Normal endometrial stripe and junctional zone. Two small uterine fibroids are seen. 0.8 x 1 cm subendometrial anterior uterine body fibroid (series 5/18). 1.2 x 1.9 cm partially exophytic myometrial versus subserosal anterior fundal fibroid (series 5/17). No adnexal masses.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: Trace pelvic free fluid, likely physiologic.

Output: Two small uterine fibroids as detailed above. No evidence of endometriosis.


Instruction: Generate impression based on findings.

Input: Potential focus for seizure activity: Complex febrile seizure. The hippocampi are intact. There is no evidence of heterotopia or hamartomas. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. Partially imaged prominent upper cervical lymph nodes bilaterally can be an expected finding in infants or may be reactive.

Output: No evidence of potential seizure foci.


Instruction: Generate impression based on findings.

Input: 63-year-old woman with history of cirrhosis and HCC status post TACE RFA 4/6/2015. ABDOMEN:LIVER, BILIARY TRACT: Within segment 5 of the liver (series 901, image 18) there is an area of T2 hyperintensity compatible with the ablation cavity. There is no evidence of abnormal enhancement. The liver is cirrhotic in morphology with diffusely low parenchymal signal indicating siderosis. Scattered, geographic areas of delayed enhancement and slightly hyperintense T2 signal are likely related to perfusional abnormalities and fibrosis.SPLEEN: The spleen is normal.PANCREAS: The pancreas is normal.ADRENAL GLANDS: The adrenal glands are normal.KIDNEYS, URETERS: Left renal cysts are noted, otherwise the kidneys are normal and enhance symmetrically.RETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: Partially visualized small bowel and colon is normal.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Ablation cavity in the liver without residual disease.


Instruction: Generate impression based on findings.

Input: Reason: Eval for TIA/stroke like symptoms History: transient paresthesias, dyscoordination, numbness MRI of the brainNo diffusion weighted abnormalities are appreciated.There is a small T2 and flair signal hyperintensity present along the right pons.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mild mucosal thickening in the ethmoid air cells. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries and the proximal anterior, middle and posterior cerebral arteries.The right vertebral artery demonstrates normal antegrade flow beyond the origin of the right posterior inferior cerebellar artery. The left vertebral artery is diminutive distally. The basilar artery appears to be occluded or near occluded beginning at the vertebrobasilar junction. The posterior communicating arteries appear to be the main supply to the posterior cerebral arteries and the P1 segments.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. The posterior communicating arteries are intact. The vertebral arteries are similar in size.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. The left common artery originates from the innominate artery. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is mild narrowing of the proximal right internal carotid artery with approximately 20% focal narrowing approximately 15 mm from the origin of the right internal carotid artery. There is no significant stenosis along the course of the vertebral arteries.

Output: 1.Findings are compatible with occlusion or near occlusion of the distal right vertebral artery intracranially as well as the basilar artery with reconstitution of posterior circulation flow via collaterals from the anterior circulation as well as the posterior inferior cerebellar arteries.2.There is no evidence for acute ischemic infarction appreciated.3.Findings suggest an old lacunar infarct in the right pons


Instruction: Generate impression based on findings.

Input: Male 61 years old Reason: left renal lesion and liver lesion - eval if metastatic vs hemangioma History: Left renal lesion ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. There are a few scattered hepatic cysts. The reference lesion in the right hepatic lobe measuring 1.3 x 1.4 cm by MRI on image 120/series 9 is hypointense on T2-weighted imaging. The lesion is enhances and is isointense to the portal vein with subtle connections to the adjacent hepatic vein and likely represents a portal vein to hepatic venous shunt. No suspicious lesions in the liver.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Solid enhancing mass at the lower pole of the left kidney measures 5.0 x 5.3 cm. The lesion is mildly hyperintense on T2-weighted imaging. The main left renal vein is patent. There is mild perinephric infiltration.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.Right hepatic lobe lesion in question represents a portal vein to hepatic venous shunt. No suspicious hepatic lesions.2.Left lower pole renal cell carcinoma as detailed above.


Instruction: Generate impression based on findings.

Input: Male, 41 years old, with back pain. Alignment is anatomic. Vertebral body height and morphology are within normal limits. No concerning marrow replacement or edema is seen.The distal spinal cord, conus and cauda equina demonstrate normal signal intensity and morphology. No epidural abnormalities are suspected.L1-2: Unremarkable. L2-3: Unremarkable. L3-4: Facet arthropathy with bilateral facet effusions. Loss of disc height and T2 signal. Right paracentral disc protrusion causing mild effacement of the right ventral thecal sac. The right neural foramen is minimally narrowed. Left neural foramen is patent. L4-5: Facet arthropathy. Loss of disc height and T2 signal. Central disc protrusion causing effacement of the ventral thecal sac but no obvious nerve root impingement. Mild bilateral foraminal narrowing. L5-S1: Facet arthropathy. Loss of disc height and T2 signal. No significant spinal canal stenosis. Mild bilateral foraminal narrowing. Incidental note is made of a partially visualized cystic structure apparently arising from the left kidney.

Output: Degenerative disc disease is seen most notably at L3-4 and L4-5 where there are disc protrusions which efface the thecal sac but which do not appear to impinge upon any specific nerves. No high-grade foraminal stenosis is seen.


Instruction: Generate impression based on findings.

Input: There is no acute infarct, mass effect, or cerebral edema. There are no foci of susceptibility effect to suggest microhemorrhages, in particular the corpus callosum, and gray-white matter junctions and brain stem. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There is mild scattered ethmoid air cell mucosal thickening. The skull and extracranial soft tissues are unremarkable.

Output: No evidence of diffuse axonal injury.


Instruction: Generate impression based on findings.

Input: 74 year-old female history of Crohn's disease. PELVIS:UTERUS, ADNEXA: Bilateral ovaries, the left with a 1.5 cm cyst.BLADDER: The bladder contains debris with a moderate amount of wall thickening.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is a wide T2 hyperintense fistulous connection between the rectum at the 12 o 'clock position and the posterior aspect of the vagina (image 58 of series 501). Additionally, there is a thin connection from the bladder at the 7 o'clock position to the anterior vagina (image 59 of series 501). These channels are in continuation with one another.There is an additional fistulous connection between the superior aspect of the rectal stump to a loop of tethered small bowel (image 77 of series 501).Right lower quadrant ostomy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: There is moderate right hydroureter and ureteral wall thickening measuring up to 10 mm (image 90 of series 501).

Output: 1.Rectovaginal, vesicovaginal, and rectoenteric fistulae as above.2.RIght hydroureter and ureter thickening and inflammation measuring up to 10 mm concerning for infection.


Instruction: Generate impression based on findings.

Input: Female, 76 years old, with right lower extremity radiculopathy in the L4 dermatome. Evaluate for stenosis. A mild levoscoliosis is demonstrated. Vertebral body alignment is otherwise within normal limits.Vertebral body heights are grossly preserved allowing for endplate irregularity and scattered Schmorl's nodes, particularly affecting the L3-4 level where there is evidence of edematous degenerative endplate signal abnormality. Edema also involves the right L3-4 facet complex. Elsewhere, no evidence of concerning marrow signal abnormality is detected.The visualized spinal cord, conus and cauda equina are within normal limits.The disks show diffuse loss of T2 signal. There is significant loss of disk height at L2-3 and mild loss of height at L3-4. Additional level specific findings are as follows:T11-12: Minimal bulging disk and very small central superiorly directed disk extrusion. No significant spinal canal stenosis. Mild neuroforaminal narrowing.T12-L1: No significant spinal canal stenosis or neuroforaminal narrowing.L1-2: Mild facet hypertrophy and moderate ligamentum thickening. No significant spinal canal stenosis. Mild neuroforaminal narrowing. L2-3: Mild facet hypertrophy. Moderate ligamentum flavum thickening. Mild bulging disk asymmetric to the right. Effacement of the right lateral recess but no significant generalized spinal canal stenosis. Moderate left and severe right neuroforaminal narrowing. L3-4: Moderate to severe facet hypertrophy on the right with a facet effusion. Moderate facet hypertrophy on the left. Moderate ligamentum flavum stenosis. Severe bilateral foraminal narrowing. L4-5: Moderate facet hypertrophy with small bilateral facet effusions. Moderate ligamentum flavum thickening. Mild bulging disk. No significant generalized spinal canal stenosis. Moderate left and mild right neuroforaminal narrowing. L5-S1: Moderate facet hypertrophy. Moderate ligamentum flavum thickening. Mild bulging disk. No significant spinal canal stenosis. Mild left foraminal narrowing.

Output: 1. Multilevel degenerative findings, most severely affecting the L2-3 level where there is severe loss of disk height, and the L3-4 level where there is edema along the endplates and moderate to severe degeneration of the right facet with edema and joint effusion.2. No significant generalized spinal canal stenosis. Severe foraminal narrowing is evident bilaterally at L3-4 and on the right at L2-3.