Instruction: Generate impression based on findings.

Input: Female 63 years old Reason: severe History: Severe enlargement of extremely heterogeneous thyroid gland, w/ tracheal deviation RIGHT LOBE MEASUREMENTS: 2.4 transverse x 2 cm AP x 6.7 cm long. LEFT LOBE MEASUREMENTS: Markedly enlarged. Difficult to include the entire gland on the image based on comparison to the MR. Estimated at 8.7 cm length x 4.2 cm AP x 2.5 cm transverse.ISTHMUS MEASUREMENTS: 0.7 cm in thickness. Heterogeneous texture.RIGHT LOBE: Heterogeneous texture. One discrete nodules estimated at 3 x 2 cm probably in the lower pole.LEFT LOBE: Heterogeneous texture with multiple ill-defined nodules. The entire lower pole appears to be heterogeneous conglomerate of nodules estimated at 6.9 x 4.2 x 5.2 cm. Hypovascular on color Doppler imaging. ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Heterogeneously enlarged gland left much greater than right with nodular character and large conglomerate nodules in the left lower pole.


Instruction: Generate impression based on findings.

Input: 57-year-old female with right lower quadrant abdominal pain ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Several hypodense lesions in the liver are incompletely evaluated with this single phase contrast enhanced CT. ultrasound or liver MRI may be helpful for further evaluation. An index lesion in the left lobe measures two by 1.2-cm image number 25 of series number 3.SPLEEN: 1.2-cm cyst in the spleen.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral benign-appearing renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The appendix is dilated with thick walls and periappendiceal fat stranding consistent with acute appendicitis. No evidence of abscess.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: 4.6 x 3 cm cystic lesion involving the right ovary. Pelvic ultrasound is recommended for further evaluation. Left ovary contains at 1.4 cm cyst.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Acute appendicitis.Right ovarian cystic mass . further evaluation with transvaginal ultrasound is recommended.Several hypodense lesions within the liver. Their etiology is unknown. Ultrasound or MRI of the liver may be helpful for further evaluation and characterization of these lesions.


Instruction: Generate impression based on findings.

Input: 93 year-old female status post fall. Initial head CT had a question of a subdural hematoma. Please evaluate for interval change. There is no evidence of intracranial hemorrhage, mass or edema. The previously described diffuse prominence of the cervical sulci and ventricles consistent with parenchymal volume loss is unchanged. Mild diffuse periventricular hypodensities consistent with small vessel disease, age indeterminate.The previously described mild prominence along the tentorium cerebelli raising a question of subdural hematoma is unchanged when compared to the prior exam. MRI is recommended for further evaluation if clinically warranted.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: No definite acute intracranial process. Stable exam as described above.


Instruction: Generate impression based on findings.

Input: Male 38 years old; Reason: patient w/ liver failure, large hemangioma, eval for other masses History: liver failure ABDOMEN:LUNGS BASES: Small pleural effusions.LIVER, BILIARY TRACT: Hepatomegaly, liver measures 24 cm in longitudinal dimension. Large somewhat geographic area of signal abnormality involving left hepatic lobe and extending into hepatic segments 8 and 5 of right hepatic lobe (measures up to 25 cm in transverse dimension on image 40 series 1201). Areas of arterially enhancing nodular enhancement are visualized throughout this region of interest. There appears to be progressive centripetal filling in of the area on portal venous and delayed phases of postcontrast imaging. Only mild corresponding T2 hyperintensity appreciated, may reflect extensive hyalinization. Additionally there is mildly heterogeneous enhancement of the remaining right hepatic lobe, presumably related to perfusional changes secondary to aforementioned large area of signal abnormality. No definite evidence of underlying cirrhosis. Visualized portal and hepatic veins and hepatic arteries patent. Narrowed intrahepatic IVC. Gallbladder wall thickened and edematous, nonspecific in setting of ascites, no additional signs of acute cholecystitis, no significant gallbladder distention. Submitted MRCP images are nondiagnostic. However no evidence of biliary ductal dilatation on either fluid-sensitive axial and coronal images. Perihepatic/periportal lymphadenopathy, reference lymph node submitted that measures approximately 2.9 x 1.6 cm on image 127 series 13.SPLEEN: Measures 12.9 cm in longitudinal dimension.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Perihepatic/periportal lymphadenopathy as above.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Anasarca present.OTHER: Small to moderate ascites.

Output: 1. Hepatomegaly with large area of signal abnormality involving left hepatic lobe and portions of anterior right hepatic lobe that demonstrates extensive nodular arterial enhancement with progressive centripetal filling in of area on more delayed imaging. While these findings would be typical for a giant cavernous hemangioma, the absence of characteristic corresponding T2 hyperintense signal is very atypical; the appearance could reflect extensive hyalinization within the hemangioma but is still very unusual. An underlying malignancy such as lymphoma cannot be excluded on the basis of this imaging study. Perihepatic/periportal lymphadenopathy also seen. Correlation with patient's reported liver biopsy at OSH recommended and if needed re-biopsy with special processing to exclude lymphoma should be considered. Follow up with a nuclear medicine liver hemangioma RBC scan may be useful. Hemangiomatosis considered unlikely given its rare occurrence in an adult patient and again the absence of associated hyperintense T2 signal; diffuse hepatic hemangiomatosis also typically characterized by involvement of a minimum of two visceral organs and hemangiomas affecting the skin. 2. Gallbladder wall thickened and edematous, nonspecific in setting of ascites, no additional signs of acute cholecystitis, no significant gallbladder distention. 3. Submitted MRCP images are nondiagnostic. However no evidence of biliary ductal dilatation on either fluid-sensitive axial and coronal images. 4. Small to moderate ascites. 5. Small pleural effusions.


Instruction: Generate impression based on findings.

Input: Reason: pain History: pain We see no fracture. The quadriceps tendon silhouette is not well visualized perhaps due to anterior soft tissue swelling. If there is clinical concern for quadriceps tendon injury, MRI could be considered. We otherwise see no specific findings to account for the patient's pain.

Output: Possible soft tissue swelling as described above. Otherwise normal appearing knee.


Instruction: Generate impression based on findings.

Input: Female 50 years old Reason: Assess small bowel wall thickening in patient with duodenal switch History: RUQ, epigastric pain ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. No suspicious hepatic lesions. Hepatic and portal veins are patent. Gallbladder is distended containing sludge near the fundus. No biliary ductal dilatation.SPLEEN: Spleen is normal in sizePANCREAS: Pancreas is normal in morphology. No surrounding inflammatory changes. Pancreatic duct is normal in caliber.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left renal cyst located in the lower pole of the left kidney. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postsurgical changes from a duodenal switch procedure. The limb of bowel connected to the distal stomach has a thickened wall with submucosal edema. The abnormal loop of bowel extends to the level of the distal anastomosis in the right mid abdomen. About the proximal anastomosis, there is significant soft tissue thickening and hyperenhancement. No bowel obstruction is evident.There is a small amount of mesenteric edema surrounding the inflamed loop.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Left ovary contains multiple cysts.There are small cervical nabothian cysts.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Postsurgical changes in the midline abdomen.OTHER: No pelvic ascites

Output: 1.Thickening of the loop of bowel connecting the stomach to the level of the distal anastomosis. Imaging features are most suggestive of an enteritis.2.No bowel obstruction, or fluid collections.3.Gallbladder sludge and mild gallbladder distention.


Instruction: Generate impression based on findings.

Input: Malignant neoplasm of breast (female), unspecified site. Secondary malignant neoplasm of brain and spinal cord(198.3) Malignant neoplasm of breast (female), unspecified site Secondary malignant neoplasm of brain and spinal cord Since the prior exam patient has undergone left-sided suboccipital craniotomy. There are blood products present within the left cerebellar hemisphere along the left inferior semilunar lobule. One focus of heterogeneous signal with surrounding signal loss and susceptibility artifact measures 19 x 13 mm and is associated with T1 signal hyperintensity and heterogenous T2 signal suggestive of evolving blood products. Another hemorrhagic focus located at the prior tumor bed is mainly susceptibility effect. There is associated T2 and FLAIR signal hyperintensity throughout most of the left cerebellar hemisphere and cerebellar vermis. There is associated mass effect with compression of the fourth ventricle and displacement of the brainstem anteriorly.There is contrast enhancement present along the left cerebellar hemisphere including the area of the prior lesion in the left inferior semilunare lobule and also along the surgical tract in the left cerebellar hemisphere.There is a 7 x 7 mm axial dimension lesion in the right temporal lobe along the superior temporal lobe gyrus which has not changed in size when compared to the April 2015 exam.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 air fluid levels in the sphenoid sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Status post left cerebellar surgery with associated contrast enhancement and blood products at the surgical site. On the basis of this exam alone, it is not clear whether this represents residual tumor, recurrent tumor, inflammatory reaction to surgery with scar formation or a combination of this.2.There is mass effect in the left cerebellar hemisphere which appears to have increased since the preoperative exams.3.A right temporal lobe mass measuring 7 mm is stable when compared to the prior exam.


Instruction: Generate impression based on findings.

Input: History of ependymoma, status post resection and radiation therapy. Off therapy since 28 months.. Again seen are findings related to left frontal craniotomy with a resection cavity in the inferior left frontal gyrus, with unchanged T2 hyperintensity and susceptibility effect along the surgical margins. There is no evidence of acute intracranial hemorrhage, new mass, or acute infarct. There is no abnormal intracranial enhancement. No findings to suggest leptomeningeal disease. The ventricles are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues appear unchanged.

Output: Stable exam with no evidence of tumor recurrence.


Instruction: Generate impression based on findings.

Input: Clinical question: Rule out brain aneurysm. Signs and symptoms: Headaches CTA of intracranial circulation:Vertebrobasilar system.There is normal appearing bilateral intracranial vertebral arteries, bilateral pica branches and basilar artery. No abnormality in particular no aneurysm is detected.Carotid system there are normal bilateral internal carotid arteries, bilateral anterior and middle cerebral arteries and their branches.There are no posterior communicating arteries identified.A very large mass within the sella with expansion of the sella and extension superiorly into the basal cistern is identified. There is no evidence of contrast within this mass. Further evaluation with dedicated MRI examination of pituitary is recommended. This mass results in significant bony remodeling/thinning and posterior displacement of dorsum sella. There is also extension of mass anteriorly and inferiorly into the sphenoid sinus and posterior right ethmoid air cells. On the right side the mass supplies mass effect and displaces the right supraclinoid internal carotid artery to the right.65 cc of Omnipaque 350 is administered for above study.

Output: 1.No evidence of vascular abnormality and in particular no aneurysm of intracranial vasculature. 2.Large expansile mass within the sella with extension into the sphenoid sinus and right posterior ethmoid air cells and with associated mass-effect and lateral displacement of supraclinoid right internal carotid artery. There is no evidence of contrast within this mass on the CTA examination.


Instruction: Generate impression based on findings.

Input: CT NECK AND FACIAL BONES: There is a well-defined mildly enhancing 28 x 19 mm mass centered within the left masticator space abutting the medial pterygoid muscle and just anterior to the internal carotid artery. It is unchanged in size compared with the 11/14/2014 MRI and is not completely imaged on the 9/10/2014 CT making comparison with that exam difficult. There is no adjacent fat stranding or osseous destruction. There is no evidence of significant cervical lymphadenopathy. The major cervical vessels are patent. The thyroid and major salivary glands are unremarkable. There are tonsilloliths.The osseous structures are unremarkable. The airways are patent. The imaged intracranial structures are unremarkable. There are nonspecific ground glass opacities within the lung apices. There is mild mucosal thickening within the maxillary sinuses.MRA NECK: There is a separate origin of the left subclavian artery, left common carotid artery, and brachiocephalic artery from the arch. The common carotid arteries and cervical internal carotid arteries are normal in course and caliber. Both vertebral artery origins are patent. There is no evidence of flow-limiting stenosis or occlusion.

Output: 1.Well-defined 28 mm left masticator space mass without evidence for lymphadenopathy or cervical metastasis. The appearance is non-specific but most compatible with a nerve sheath tumor such as neurofibroma with a pedunculated deep parotid lobe mass felt less likely. 2.No evidence of significant steno-occlusive lesion or vascular malformation within the neck.


Instruction: Generate impression based on findings.

Input: 71-year-old female with history of ovarian cancer. Known liver lesions causing biliary obstruction, stent placement on 11/10/08. Now has increased pain and worsening LFTs. Rule out pneumobilia. Evaluate for stent obstruction. ABDOMEN:LUNG BASES: There are small bilateral pleural effusions, unchanged.LIVER, BILIARY TRACT: Redemonstration of multiple solid hypodense lesions. Reference right hepatic lesion is stable measuring 3.5 x 3.2 cm on image 32/96. There an internal biliary stent but no pneumobilia. The intrahepatic portions of metallic stents are in the posterior segment of the right hepatic lobe and anterior segment of the right hepatic lobe. Distal metallic stents are in the duodenum. Contrast noted previously in the anterior segment of the right intrahepatic ducts is not seen. Persistent left intrahepatic ductal dilatation is unchanged. Interval increase in the right-sided intrahepatic ductal dilatation.Gallbladder is surgically absent. Tumor invasion in main portal vein as seen on MRI is redemonstrated (series 4, image 39/96)SPLEEN: Calcified splenic granulomata are unchanged. Large metastatic lesion in the spleen measuring 5.7 x 5 cm on image 25/96 is unchanged.PANCREAS: Mild pancreatic ductal dilatation in the pancreatic head is unchanged.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Reference lymphadenopathy encasing hepatic artery in the porta hepatis is grossly unchanged, measuring 2.5 x 1.7 cm image 39/96. There is new small amount of fluid in the hepatoduodenal ligament. There is thin, curvilinear fluid noted in medial segment of the second portion of duodenum. Adjacent inflammatory fat stranding in the second and third portions duodenum is noted. No free air is seen. Findings suggest inflammatory change from instrumentation without complete perforation.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: 1) Stable internal biliary stent location with interval increase in right intrahepatic biliary dilatation and persistent left intra-hepatic biliary dilatation and decreased pneuomobilia suggests stent occlusion. 2) Stable inflammatory change and wall edema in second portion of duodenum from recent ERCP, but no free air is seen to suggest duodenal perforation.3) Stable small bilateral pleural effusions.


Instruction: Generate impression based on findings.

Input: 69-year-old African-American male with history of hypertension and multiple myeloma. Presents with left-sided weakness for 24 hours. There is a moderate for stroke or hemorrhage. Patchy periventricular and subcortical areas of low-attenuation are consistent with small vessel disease of indeterminate age. A very small area of cortical lucency in high convexity right parietal may represent a nonhemorrhagic small acute cortical stroke (axial image 20 and 21. An MRI examination is recommended for further evaluation.

Output: Unless a small doses of indeterminate age. Suspect a small nonhemorrhagic cortical stroke in right parietal lobe.


Instruction: Generate impression based on findings.

Input: 48-year-old female with a personal history of right breast mastectomy in 2008 from mucinous IDC/DCIS treated with chemotherapy and hormonal therapy. Personal history of benign left breast biopsy. She has no current breast related complaints. Status post right breast mastectomy with bilateral retropectoral silicone implants in place.Implants appear intact. There is scattered fibroglandular tissue in the left breast.Mild parenchymal enhancement is noted in the left breast.A focus in the inferomedial right chest wall is unchanged.There is no abnormal enhancement seen in the right chest wall or left breast. Susceptibility artifact from biopsy marker clip seen in the left upper outer breast, at site of prior benign breast biopsy. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: History of recurrent Rhabdomyosarcoma. On therapy. Comparison. Status post resection. Examination redemonstrates extensive postoperative changes of tumor removal via bifrontal craniotomy. CSF filled cavity within the right frontal lobe is believed to be the site of previous tumor invagination into the brain parenchyma. This is associated with surrounding vasogenic edema. Enhancement around the posterior edge of surgical cavity is believed to represent leptomeningeal scarring. No distinct tumor is identified however follow-up with an infused MRI is recommended. Expected postoperative changes of epidural thickening with minimal enhancement in bifrontal region is noted.In comparison to the prior non-infused CT of brain dated 6 -- 2 -- 2009 there is a slight increase in the soft tissue/fluid density within the paranasal sinuses.

Output: Findings are believed to represent post operative change and not residual tumor. Follow-up with an infused MRI however is recommended for better assessment.


Instruction: Generate impression based on findings.

Input: T4N2c squamous cell carcinoma of the floor of the mouth and ventral tongue status post induction chemotherapy and radiotherapy. There is diffuse stranding and thickening involving the soft tissues of the lower face/upper neck, including the larynx, which is likely treatment-related. The midline enhancing, infiltrative mass involving the floor of the mouth and the ventral aspect of the tongue has not significantly changed in overall size, but is more T2-hyperintense and less enhancing centrally. The sublingual glands are indistinct from the tumor. The associated reference left level 1B pathologic lymph node is also not significantly changed in size, measuring 14 x 20 mm compared to 13 x 20 mm previously, but is more heterogeneous. The reference right level 3 lymph node measures 12 mm x 14 mm, previously 10 mm x 13 mm previously. A more inferiorly located right level 3 lymph node measures 10 x 13 mm, previously 9 x 14 mm. The submandibular glands, parotid glands, and thyroid are unchanged. The osseous structures are unchanged. There is a right internal jugular venous catheter.

Output: The infiltrative tumor involving the floor of the mouth and the ventral tongue as well as the associated lymph adenopathy have not significantly changed in size, but are more necrotic.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Clinical question: 74-year-old male with head and neck cancer, cerebellar metastases. Evaluate new metastases. Signs and symptoms: Seizure, dizziness, dysautonomia, orthostatic hypotension. Pre-and post enhancement MRI:Negative diffusion weighted images.Examination demonstrates a stable small hemorrhagic metastatic lesion in the left cerebellum without associated surrounding edema or significant mass effect or interval change. The lesion similar to prior exam measures approximately 7 mm. There is no evidence of any new foci of parenchymal signal abnormality or enhancement to suggest new metastatic lesions. Few punctate size foci of flair hyperintensity in the subcortical and periventricular white matter are nonspecific however could represent mild chronic small vessel ischemic strokes in proper clinical setting. This finding also remains identical to prior study.Unremarkable cerebral cortex, cortical sulci, ventricular system and the CSF spaces and with maintained midline.Calvarium and orbits are unremarkable and without abnormal enhancement.

Output: 1.No evidence of an acute or new findings since prior exam.2.Stable approximately 7 mm hemorrhagic metastatic lesion in the left cerebellum without mass effect or surrounding edema.3.No detectable new metastatic lesions.4.Negative diffusion weighted series and the findings suggestive of mild chronic small vessel ischemic strokes.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for extent of right nasal mass. Signs and symptoms of right nasal mass. CT of maxillofacial region without infusion:Complete opacification of right chamber of sphenoid sinus consistent with sinusitis. There is no associated bony changes.There is extensive opacification of right ethmoid air cells and right nasal cavity. There is possible partial erosion of the lamina papyracea and bony remodeling and elevation of the floor of the orbit and anterior lamina papyracea. No definitive destructive bony lesion is detected. There is no evidence of extension of soft tissues through the moderate floor of the orbit into the retro-orbital space. There is extensive remodeling of the medial wall of the right maxillary sinus but continuity of the soft tissues within the sinus into the right nasal cavity. There is also deviation of nasal septum to the left with thinning however no destruction. The above findings are believed to represent chronic sinus disease with expansion of the right maxillary sinus and right nasal cavity. Excessive soft tissue within the nasal cavity may indicate polyposis. Possibility of malignancy is considered less likely however further studies with an MRI is recommended to exclude this possibility. Patchy areas of mucoperiosteal thickening within the left chamber of the sphenoid sinus and left maxillary sinus is also present. Limited view of the mastoid air cells demonstrate complete opacification bilaterally however the middle ear cavities are well pneumatized. Soft tissue density within the left external auditory canal is believed to represent debris.

Output: 1.Complete opacification of right frontal sinus, right ethmoid sinuses, right nasal cavity and right maxillary sinus with extensive bony remodeling however no bony destruction. Findings are believed to represent long-standing chronic sinus disease with possible nasal polyposis on the right. To exclude the less likely possibility of malignancy and MRI is recommended.2.Chronic sinus disease of the left sided sinuses.


Instruction: Generate impression based on findings.

Input: 40 years Male (DOB:8/30/1975)Reason: assess for lumbar radiculopathy on the R.side, look for amyloid in the nerve roots History: H/O amyloid, radicular pain in the RLEPROVIDER/ATTENDING NAME: KOUROSH REZANIA KOUROSH REZANIA Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is mild disc desiccation at this level.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is a left far lateral disc protrusion present this level which displaces the left-sided exiting nerve root after it exits the neural foramen at this level. It also mildly narrows the left neural foramen. There is mild facet and ligamentum flavum hypertrophy present at this level. There is mild loss of disc space height and disc desiccation at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is a Schmorl's node at this level.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina. There are Schmorl's nodes at this level.There is a Schmorl's node at T12-L1.

Output: There are mild degenerative changes present in the lumbar spine without significant compromise to spinal canal. There is some encroachment of left-sided exiting nerve roots after it exits the neural foramen at L4-5 due to a far lateral disc protrusion.


Instruction: Generate impression based on findings.

Input: 25-year-old female with recurrent pancreatitis, with history of multiple pseudocysts. Transferred from outside hospital for further evaluation of pseudocysts. Now with fevers and acute renal failure. Evaluate for progression of pseudocysts. Evaluate for hydronephrosis, urinary obstruction. Fever to 42 degrees with a previous right lower lobe pneumonia. This examination is limited by the absence of intravenous contrast.ABDOMEN:LUNG BASES: Small bilateral, right greater than left, pleural effusions. Subcentimeter lesion in the fat pad at the right cardiophrenic angle is a borderline enlarged lymph node. LIVER, BILIARY TRACT: Re-demonstration of the lesions in the liver as seen on MRI study. A lesion in the right hepatic dome, with central target-like enhancement is identified. Two additional hyperdense lesions are also seen. With review of MRCP study, hepatic adenoma is favored for the dome lesion and slightly atypical hemangiomas are favored for the other two lesions. No new lesions. SPLEEN: No significant abnormality notedPANCREAS: There is mild pancreatic ductal dilatation, most pronounced in the pancreatic head. Pancreatic head is enlarged with surrounding fat stranding and fluid compatible with acute pancreatitis.Superiorly there is a 3.2 x 4.8 cm cystic lesion (axial image 81/215) seen near the gastroesophageal junction, which likely represents a pancreatic pseudocyst when reviewed with current MRCP study performed here. Smaller cystic lesions in region of pancreatic head are probably smaller pseudocysts, but these are not well seen on this exam.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality noted. No hydronephrosis. RETROPERITONEUM, LYMPH NODES: Multiple enlarged and borderline enlarged mesenteric and retroperitoneal lymph nodes are probably reactive to theBOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Posterior surgical fusion Harrington rods with mild scoliosis are noted. The surgical appliances are in the expected position and appear intact. Metallic streak artifact from the surgical appliances limit detailed evaluation of adjacent structures.OTHER: Mild abdominal and pelvic ascites is stable.PELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Posterior surgical fusion rods with mild scoliosis is notedOTHER: Mild abdominal and pelvic ascites is seen.

Output: 1) Findings consistent with focal pancreatitis in pancreatic head and multiple pancreatic pseudocysts are stable. 2) Three hepatic lesions are stable, most like due to a hepatic adenoma and slightly atypical hemangiomas.3) Multiple additional findings are unchanged.


Instruction: Generate impression based on findings.

Input: Cervical spinal stenosis. C6 -- C7 stenosis. Left arm pain. CT of cervical spine without infusion:Sagittal reformatted images demonstrate moderate to advanced degenerative disk disease at C5 -- C6 and C6 -- C7 levels as well as hypertrophic and calcification of posterior longitudinal ligament and to a lesser degree degenerative changes of disks at the other levels.There is complete loss of cervical lordosis. There is straightening and minimal kyphotic deformity of the cervical spine centered at C4 -- C5 level. The bony density of the vertebral column is unremarkable with the exception of sclerotic changes related to disk disease.Foramen magnum.Examination at this level is unremarkable.C2 -- C3.Minimal degenerative disk disease is noted and otherwise unremarkable.C3 -- C4.Minimal degenerative disk disease and minimal hypertrophic changes of the articulating facets on the left. Hypertrophic changes at the level of the left uncovertebral is also present. Combination of a bald changes causes compromise of the left neuroforamina at this level.C4 -- C5.Calcification of posterior longitudinal ligament posterior to C4 is present. This causes indentation of thecal sac. There is mild hypertrophic changes of disks and posterior elements. Hypertrophic changes at the level of right uncovertebral causes compromise of right neural foramina. There is broad-based bulge of disk material which minimally flattens the ventral thecal sac. There is also suspected compromise of the left neural foramina secondary to degenerative changes.C5 -- C6.Heavy calcification of posterior longitudinal ligament which is in contact with the ventral aspect of the cord. Extensive hypertrophic changes of uncovertebral causes compromise of bilateral neural foramina. Bulge of disk material and ventral hypertrophic changes appear to do cause indentation of the ventral aspect of the cord and suspected central spinal stenosis.C6 -- C7.Advanced degenerative disk disease and extensive hypertrophic changes of uncovertebral bilaterally. Compromise of bilateral neural foramina. I suspect central spinal stenosis at this level however please reviewed dedicated report of MRI examination of cervical spine. C7 -- T1.Mild degenerative changes. No detectable central spinal stenosis or neural foramina compromise.limited view of upper thoracic spine to T4 level demonstrate normal degenerative changes and is otherwise unremarkable.

Output: Degenerative changes of disks, posterior elements, posterior longitudinal ligament as detailed above. Constellation of above findings results in multilevel neural frontal compromise and central spinal stenosis as detailed.


Instruction: Generate impression based on findings.

Input: 60 year-old male with history of lung cancer with new onset of seizure possible brain metastasis on outside hospital. Multiple intracranial enhancing tumors are consistent with multiple metastatic foci.The largest lesion measures 9.3-mm times 14-mm in height convexity left posterior parietal (axial image 22). Extensive surrounding edema causes effacement of the adjacent cortical sulci. No evidence of midline shift is detected. No evidence of hydrocephalus is present. There are 4 lesions identified however further evaluation with an MRI is highly recommended for precise evaluation.No evidence of hemorrhage is present.No definitive evidence of calvarial metastatic lesion is detected.

Output: Multiple non-hemorrhagic enhancing intracranial metastatic lesions of both cerebral hemispheres.


Instruction: Generate impression based on findings.

Input: Neck mass. There is a rather ill-defined lesion in the right submental subcutaneous tissues that measures up to approximately 2 cm beneath the skin marker. The lesion demonstrates diffuse enhancement and contains areas of low T1 and T2 signal. There is no evidence of measurable mass lesions or significant cervical lymphadenopathy based on size criteria. The thyroid and major salivary glands are unremarkable. The osseous structures are unremarkable. The imaged intracranial structures, paranasal sinuses, and orbits are unremarkable.

Output: Differential considerations for the lesion in the right submental subcutaneous tissues that measures up to approximately 2 cm include vascular malformations, fibromatosis, or neoplasm. An ultrasound of the lesion with Doppler may be useful for further evaluation.


Instruction: Generate impression based on findings.

Input: History of prostate cancer, biopsy to follow. PELVIS:PROSTATE:Prostate Size: 5.5 x 3.4 x 4.9 cmPeripheral Zone: There is a 6 x 7 mm focus of decreased T2 and ADC signal in the right mid gland (series 704, image 284) which is suspicious for neoplasm. No additional suspicious foci are identified.Central Gland: Several well-defined nodules compatible with benign prostatic hypertrophy.Seminal Vesicles: No significant abnormality.Extracapsular Extension: No significant abnormality.BLADDER: No significant abnormality noted.LYMPH NODES: A couple nonspecific small left obturator lymph nodes are present measuring 5 mm or less.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 6 x 7 mm signal abnormality in the right mid gland peripheral zone suspicious for neoplasm.


Instruction: Generate impression based on findings.

Input: Female, 59 years old. Reason: Right ankle pain, evaluate healing of anterior process of calcaneous fracture History: Right ankle pain TENDONS: No significant abnormality noted.LIGAMENTS: No significant abnormality noted.ARTICULAR SURFACES AND BONE: There is a fracture through the anterior process of the calcaneus, with mild surrounding bone marrow edema. The fracture line is distinct, without evidence of osseous union. The fracture fragments are in anatomic alignment. No other fractures are identified. There is a small amount of fluid in the tibiotalar joint.ADDITIONAL

Output: Fracture through the anterior process of the calcaneus, without evidence of osseous union.


Instruction: Generate impression based on findings.

Input: Nausea, vomiting; Elevated LFTs, gallbladder wall thickening ABDOMEN: Examination limited by patient motion and lack of intravenous contrast.LUNG BASES: Pleural effusions right greater than left. Cardiomegaly. LIVER, BILIARY TRACT: Distended gallbladder with pericholecystic fluid compatible with cholecystitis. Limited MRCP images with non-visualization of the proximal common bile duct. The distal common bile duct is normal in diameter without evidence of stones. 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: Extensive body wall edema.

Output: 1.Findings compatible with cholecystitis without evidence of distal common bile duct stones. The proximal common bile duct is not visualized.2.Right greater than left pleural effusions.


Instruction: Generate impression based on findings.

Input: 17-year-old female with pain. Evaluate for meniscus injury. MENISCI: The medial and lateral menisci appear normal.ARTICULAR CARTILAGE AND BONE: The articular cartilage and bone marrow signal intensity is normal.LIGAMENTS: The cruciate and collateral ligaments appear normal.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: No MRI findings to account for the patient's right knee pain.


Instruction: Generate impression based on findings.

Input: Reason: right knee pain after fall MENISCI: The anterior and posterior horns of the medial and lateral menisci are intact. Note is made of a prominent interface of the meniscofemoral ligament of Wrisberg with the posterior horn of the lateral meniscus, resulting in what we believe to be a pseudotear.ARTICULAR CARTILAGE AND BONE: The articular cartilage appears normal. There is geographic curvilinear signal abnormality containing fat within the distal femoral metastasis and proximal tibial metadiaphysis likely representing peculiar islands of red marrow or perhaps areas of chronic osteonecrosis.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The quadriceps and patellar tendons are intact.ADDITIONAL

Output: 1. No acute injury.2. Bone marrow signal abnormalities suggestive of peculiar islands of red marrow or perhaps chronic osteonecrosis.


Instruction: Generate impression based on findings.

Input: Female 57 years old. Reason: right gluteal pain and fluctuance with hematoma, concern for mass. History: as above Heterogeneous thickening and inflammation within the gluteal musculature most prominent in the medial aspect of the gluteus medius. There is stranding and inflammation of the subcutaneous tissues. This extends from the midline to the muscles overlying the hip laterally without extension into the anterior muscles or the pelvic compartment. This correlates with abnormalities seen on the CT study from 4/27/2015 and possibly minimally progressed but more likely mild shifting and dispersement along the entire muscle.  There is a discrete, more nodular intramuscular mass like focus in the lateral aspect of the gluteal musculature, which is isointense to muscle on T1 weighted images, heterogeneous on T2 weighted imaging with mild heterogeneous enhancement largely involving the periphery. The findings are most suspicious for contusion superimposing an intramuscular hematoma with a more discreet thrombus. Bone marrow signal is otherwise unremarkable. The anterior components of the musculature and pelvic structures are otherwise unremarkable, given the limitations due to motion artifact and patient positioning.

Output: Findings most suspicious for contusion and intramuscular hematoma within the gluteal musculature.


Instruction: Generate impression based on findings.

Input: Male, 72 years old, with positive Hoffman sign, assess for spinal stenosis. Sagittal alignment is within normal limits. Vertebral body height and morphology are unremarkable. No concerning marrow replacement or marrow edema is seen.The visualized spinal cord demonstrates normal signal intensity and morphology except as discussed below. No pathologic epidural process is suspected.C2-3: Severe right and moderate left facet hypertrophy. Ligamentum flavum thickening. No significant spinal canal stenosis. Moderate right foraminal narrowing. No interval changes.C3-4: Moderate bilateral facet hypertrophy. Minimal posterior disc-osteophyte complex formation. Ligamentum flavum thickening. No significant spinal canal stenosis. Severe left and moderate right foraminal narrowing. No interval changes. C4-5: Moderate bilateral facet hypertrophy. Ligamentum flavum thickening. Posterior disc-osteophyte complex formation particularly in the left paracentral region with mild flattening of the ventral cord, not significantly changed from prior. Severe right and moderate left foraminal narrowing, unchanged. C5-6: Bilateral facet hypertrophy. Posterior disc-osteophyte complex formation with a superimposed central disc protrusion which is mildly larger than on the prior exam. This causes mild flattening of the ventral spinal cord and a mild to moderate generalized spinal canal stenosis, progressed from prior. Moderate bilateral foraminal narrowing, unchanged.C6-7: Facet hypertrophy. Minimal posterior disc-osteophyte complex formation with right uncovertebral hypertrophy. No significant spinal canal stenosis. Moderate to severe right foraminal narrowing. No interval changes.C7-T1: Facet hypertrophy. Very small right paracentral disc protrusion. No significant spinal canal or foraminal stenosis. No interval changes.

Output: 1.Posterior disc-osteophyte complex formation with a central disc protrusion at C5-6 appears to be mildly increased from the prior exam. This results in a progressive mild to moderate generalized spinal canal stenosis with mass effect on the ventral spinal cord but no cord edema.2.Posterior disc-osteophyte complex formation at C4-5 with mild mass effect on the ventral spinal cord is unchanged from prior.3.Scattered foraminal narrowing shows no significant interval change with the most significant stenoses on the left at C3-4, on the right at C4-5, and on the right at C6-7.


Instruction: Generate impression based on findings.

Input: 69-year-old male presents with right shoulder pain. ROTATOR CUFF: Heterogeneity of the supraspinatus tendon likely representing a combination of degenerative tendinosis, calcification as seen on the prior radiographs, and mild inflammation. There is a defect along the bursal surface fibers of the supraspinatus measuring just under 1 cm in length and approximately 7 to 8 mm in AP dimension. The defect involves 50% of the tendon thickness indicating a focal bursal surface tear. There is additional mild fraying along the undersurface of the tendon. The supraspinatus muscle appears intact.The aforementioned tendinosis extends posteriorly to involve the anterior fibers of the infraspinatus, which otherwise appears normal. The infraspinatus muscle appears normal. Subscapularis and teres minor tendons and muscles are intact.SUPRASPINATUS OUTLET: Moderate osteoarthritis affects the acromioclavicular joint resulting in mild impression upon the superior fibers of the supraspinatus. A small amount of fluid is present in the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Small amount of fluid is present within the glenohumeral joint, but there is no large joint effusion. Mild osteoarthritis affects the glenohumeral joint. Intermediate signal intensity within the superior labrum likely reflects degeneration/degenerative tearing which extends into the anterior labrum. The posterior labrum appears blunted, but otherwise intact.BICEPS TENDON: Mild tendinosis of the tendon of the long head of the biceps from its transition from the rotator cuff interval to the intertubercular groove. ADDITIONAL

Output: 1. Partial-thickness bursal surface tear of the supraspinatus as described above with additional heterogeneity of the tendon likely reflecting a combination of degenerative tendinosis, calcification, and inflammation.2. Osteoarthritis and other findings as described above.


Instruction: Generate impression based on findings.

Input: 55-year-old man with history of elevated LFTs, evaluate for ductal dilatation. ABDOMEN:LIVER, BILIARY TRACT: There is mild hepatomegaly. The liver appears normal in signal and morphology. The gallbladder is markedly dilated with intraluminal sludge.SPLEEN: A 7 x 4.2 cm subcapsular or perisplenic cyst with simple septation is seen immediately anterior to the spleen (series 501, image 32). The spleen is otherwise normal.PANCREAS: The pancreas appears normal.ADRENAL GLANDS: The adrenal glands appear normal.KIDNEYS, URETERS: Subcentimeter renal cysts are seen in the lower pole of the right kidney. The left kidney appears normal.RETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: The partially visualized small bowel and colon appear normal. There is ascites present.BONES, SOFT TISSUES: There is soft tissue anasarca.OTHER: Please note that the patient has situs inversus totalis. The patient has moderate bilateral pleural effusions with adjacent atelectasis.

Output: 1.Incomplete examination with limited sequences obtained secondary to patient discomfort and inability to tolerate examination.2.Mild hepatomegaly but no focal hepatic lesion or biliary duct dilatation.3.Hydropic gallbladder with sludge.4.Ascites and bilateral pleural effusions.5.Situs inversus totalis.


Instruction: Generate impression based on findings.

Input: History of intestinal malrotation as a child. Previous partial small bowel obstructions. Evaluate for adhesive disease or small bowel inflammation. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Malrotated small bowel with normally distended jejunal/proximal ileal loops in the right hemiabdomen.The small bowel is adequately distended with oral contrast. There is mild postcontrast enhancement of a short segment of jejunum in the right upper quadrant which is asymmetric from the remainder of the jejunum and small bowel. No associated bowel wall thickening or restricted diffusion. No other evidence of active inflammation or flow limiting stricture. No free fluid or loculated fluid collection. No evidence of obstruction. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No evidence of active inflammation or flow-limiting stricture. No evidence of obstruction. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Mild nonspecific active inflammation of a short segment of jejunum in the right hemiabdomen. Small bowel malrotation without evidence of obstructive complication. No flow limiting stricture.


Instruction: Generate impression based on findings.

Input: tuberous sclerosis, concussion, hyponatremia There is no evidence of acute ischemic or hemorrhagic lesion on this scan.On FLAIR images, there are multifocal scattered high signal intensities on subcortical white matter and periventricular white matter indicating non specific small vessel disease. Among them, there is relatively well defined high signal intensity lesion on the Cingulate gyrus (series 7, image 7/28) and right inferior frontal lobe (series 7, image 11/28) but the lesions are more likely confined to subcortical white matter and continuous to other non specific high signal lesions on periventricular white matter. Thus, this is more likely represent extension of small vessel ischemic disease instead of cortical tuber.There is no evidence of subependymal nodules.There is no evidence of abnormal enhancing lesions either. The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.The pituitary gland is normal in size, morphology, signal intensity and enhancement. There is no hypo-enhancement or signal abnormality suggestive of neoplasm. The pituitary stalk is located at midline without deviation, and is normal in caliber, signal intensity and enhancement. The suprasellar cistern, optic chiasm, hypothalamus, and cavernous sinuses are unremarkable. The orbits and contents are unremarkable.

Output: 1. Multifocal scattered high signal intensities on FLAIR images indicate non specific small vessel ischemic disease.2. No evidence of acute ischemic or hemorrhagic lesion.3. No evidence of cortical tuber, subependymal nodule or abnormal enhancement.


Instruction: Generate impression based on findings.

Input: 46 years, Female, breast cancer metastases to brain post surgery and radiation therapy. Surveillance. There are postoperative findings related to resection of right medial cerebellar metastasis. There is linear enhancement along the resection cavity and persistent T2 FLAIR hyperintensity. Slight decrease in size of enhancing right pontine lesion measuring 11 x 7 mm, previously 11 x 12 mm, with decreased associated T2 hyperintensity. There is no new mass or mass effect. No midline shift or herniation. The right medial occipital enhancing nodule is not significantly changed. There are unchanged faint punctate foci of enhancement within the right corona radiata and the left middle frontal gyrus. There is encephalomalacia of the anterior aspect of the left superior medial frontal lobe, unchanged. There is scattered cerebral white matter T2 hyperintensity, which is nonspecific. There is no restricted diffusion to suggest acute ischemia. There is intracranial hemorrhage. The ventricles are within normal limits in size and configuration. Major flow-voids are preserved.

Output: 1.No new or enlarging lesion is identified to suggest disease progression. Slight interval decrease in size of right pontine lesion and decrease in surrounding edema. Additional tiny enhancing foci are not significantly changed.2.No significant change in postoperative findings related to resection of a right medial cerebellar metastasis, with no evidence of recurrence.3.No evidence of recurrence within the left anterior frontal lobe treatment bed.


Instruction: Generate impression based on findings.

Input: Diagnosis: Epilepsy, unspecified, not intractable, without status epilepticusClinical question: Evaluation of seizure focusSigns and Symptoms: staring spellsComments: Please perform with seizure II protocol | The CSF spaces are appropriate for the patient's stated age with no midline shift. The tip of the temporal horn of the right lateral ventricle is asymmetrically larger than the left. The right choroid fissure is also slightly larger than the left choroid fissure.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: No abnormal lesion is appreciated within the brain parenchyma to explain the patient's seizures. There is no convincing evidence for mesial temporal sclerosis. Some asymmetry in the size of the temporal horns of the lateral ventricles is a nonspecific finding and could very well just be variant of normal


Instruction: Generate impression based on findings.

Input: Diagnosis: Migraine, unspecified, without mention of intractable migraine without mention of status migrainosus Headache(784.0)Clinical question: Outside Request: headaches 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 are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: MRI of the brain is within normal limits


Instruction: Generate impression based on findings.

Input: Right Achilles pain TENDONS: There is abnormal enlarged morphology and intermediate signal of the Achilles tendon but no discrete fluid-filled gap is appreciated. There is a mild amount of fluid within the retrocalcaneal bursa and mildly increased signal of the calcaneus at the attachment of the Achilles.LIGAMENTS: No significant abnormality noted.ARTICULAR SURFACES AND BONE: Mild osteoarthritic changes of the midfoot and talocalcaneal articulations are noted. ADDITIONAL

Output: Achilles tendinopathy without discrete tear.


Instruction: Generate impression based on findings.

Input: Reason: hx Gleason 3+3 prostate ca. Interval exam History: see belowProstate, left mid medial and lateral: Prostate adenocarcinoma PELVIS:PROSTATE:Prostate Size: 6.4 x 5.0 x 5.3 cmPeripheral Zone: 5 mm T2/ADC hypointense focus in the left mid gland peripheral zone appears similar to the prior exam. A right apical lesion is not well visualized.Central Gland: Multiple BPH nodules.Seminal Vesicles: No evidence of seminal vesicle involvement.Extracapsular Extension: No evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Left mid gland peripheral zone lesion appears similar to the prior exam. No evidence of extracapsular extension.2.No pelvic lymphadenopathy.


Instruction: Generate impression based on findings.

Input: 4-mm nodule in the left middle frontal gyrus (series 501 image 125), previously remeasured as 4 mm. Punctate focus of susceptibility in the right prefrontal gyrus is unchanged. No new enhancing lesions identified. The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. The pituitary gland is normal in size. There are no extraaxial fluid collections or subdural hematomas. The paranasal sinuses and mastoid air cells are clear.

Output: No change in the left frontal middle gyral and right medial prefrontal gyral lesions.


Instruction: Generate impression based on findings.

Input: Clinical question: Change in tumor size. Signs and symptoms: Small pituitary tumor, elevated prolactin. Pre- and post enhanced pituitary MRI:Examination demonstrate mild leftward deviation of the pituitary stalk identical to prior exam. It demonstrate normal signal intensity and enhancement.There is homogeneous signal intensity of pituitary gland on all MRI sequences and including postenhanced series without convincing evidence of a detectable mass within the dictated. Deviation of pituitary stalk to the left however is suspicious for presence of a small intrapituitary mass/microadenoma. This examination is overall identical to prior study. The basal cistern and the suprasellar visual complex remains within normal. Bilateral cavernous sinuses are within normal. No detectable abnormality of the skull base or the sphenoid sinus is detected.

Output: 1.Subtle mass effect and deviation of the pituitary stalk to the left without convincing evidence of a defined pituitary mass/microadenoma.2.No evidence of any interval change since prior exam from an outside institution dated 6-30-14.3.Unremarkable pre and post enhanced pituitary MRI otherwise.


Instruction: Generate impression based on findings.

Input: 41 year old male with a history of transposition of great arteries status-post Mustard/Senning procedure in infancy and status-post occlusion of baffle leak in 2011. The patient has worsening right ventricle function with symptoms including a recent history of VT storm (with multiple discharges of patient's right sided ICD). He is referred for cardiac MRI for further evaluation. Overall AnatomyDue to artifact from the patient's right sided ICD, limited protocol prioritizing LGE was performed. Dextrocardia with situs solitus. The pulmonary venous flow is directed to the TV, c/w post surgical baffling. Baffle patency / stenosis / thrombosis cannot be excluded. The morphologic left ventricle is left-sided and communicates with main pulmonary artery. The morphologic right ventricle is right sided and communicates with the aorta. These findings are c/w surgical correction of d-TGA present.Systemic Ventricle (i.e. Morphologic Right Ventricle)The right ventricle is severely dilated and hypertrophied with severely reduced systolic function. The overall RV ejection fraction is 22%, the RV end diastolic volume index is 176 ml/m2 (normal range 82+/-16), the RVEDV is 422 ml (normal range 142+/-31), the RV end systolic volume index is 136 ml/m2 (normal range 31+/-9), and the RVESV is 329 ml (normal range 54+/-17). There is no clear late gadolinium enhancement noted.Pulmonary Venous ReturnNot well visualized.Sub-Pulmonary Ventricle (i.e. Morphologic Left Ventricle)The left ventricle is normal in size with mildly reduced systolic function. The overall LV ejection fraction is 44%, the LV end diastolic volume index is 82 ml/m2 (normal range: 74+/-15), the LVEDV is 199 ml (normal range 142+/-34), the LV end systolic volume index is 46 ml/m2 (normal range 25+/-9), the LVESV is 111 ml (normal range 47+/-19), The interventricular septum bows into the left ventricle but does not cause an obvious obstruction to flow through the left ventricular outflow tract. There is no clear late gadolinium enhancement noted.Aortic ValveThe aortic valve opens widely and there is mild aortic regurgitation.Mitral ValveNot well seenPulmonic ValveThe pulmonic valve opens widely. There is at least mild significant pulmonic regurgitation.Tricuspid ValveNot well seenPericardiumThere is no obvious pericardial disease.Extracardiac Findings . This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Dextrocardia with situs solitus. The pulmonary venous flow is directed to the TV, c/w post surgical baffling. Baffle patency / stenosis / thrombosis cannot be excluded. The morphologic left ventricle is left-sided and communicates with main pulmonary artery. The morphologic right ventricle is right sided and communicates with the aorta. These findings are c/w surgical correction of d-TGA present.2. Due to artifact from the patient's right sided ICD, limited protocol prioritizing LGE was performed. There is no obvious delayed myocardial enhancement, although the images are limited.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for abnormality; history of sarcoma. Signs and symptoms: None. Pre and post enhanced brain MRI:No acute intracranial process and negative diffusion weighted series.Examination demonstrate normal anatomical morphology and signal intensity of brain parenchyma on all MRI sequences.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination for stated age of 56.There is a well demarcated uniformly enhancing extra-axial left temporal mass measuring 19 x 12 x 15 mm. The finding results in buckling of the adjacent brain parenchyma however without evidence of vasogenic edema. The lesion demonstrate T2 and FLAIR hypointense signal and isointense on T1-weighted images. Finding is not associated with any abnormality of adjacent calvarium and is highly suggestive of a meningioma. There are no prior studies for comparison. If there are outside prior exams available and provided to radiology department and an addendum to this report will be submitted after review and comparison.There is a focus of enhancement (approximately 15 x 11 mm) at the apex of the left petrous bone abutting the left carotid canal (axial post enhanced series 1/1/2001 images 10 through 12). Considering provided clinical inflammation of malignancy possibility of an osseous metastasis lesion should be considered. Possibility of vascular/venous enhancement can cannot be entirely excluded. Follow-up with thin cut CT imaging of the skull base is recommended.There is a small well-demarcated CSF signal intensity extending medially from the right Meckel's cave and invaginating into the right aspect of the clivus (axial T2 series 501 image 11 and sagittal T1 series 301 image 21 and coronal T2-weighted series 701 image16) without enhancement. Finding is believed to represent abnormal enlargement of Meckel's cave or more likely a small meningocele.Unremarkable images through the orbits and including axial fat sat post enhanced series.There is improvement demarcated round T1 hyperintense masslike lesion without enhancement in the inferior aspect of the right inferior turbinate likely representing a benign cyst. A right maxillary sinus retention cyst is also present.

Output: 1.Normal signal intensity of brain parenchyma and without abnormal enhancement.2.Right petrous apex 15 x 11 mm focus of enhancement concerning for a bony metastasis and less likely prominent venous plexus. Follow-up with thin cut CT images is recommended for further assessment. 3.Extra-axial dural based left temporal enhancing mass highly suggestive of a meningioma measuring at 19 x 12 x 15 mm.4.Well-demarcated CSF signal intensity lesion contiguous with the right Meckel's cave and with invagination into the right aspect of clivus likely representing a meningocele.5.Please see above comments.


Instruction: Generate impression based on findings.

Input: Male 65 years old staging of prostate cancer. Outside biopsy showed left lateral Gleason 3+3 ~2% of specimen, left sextant 3+4 5%, right lateral 3+4 2%, right sextant 3+4 2%. PELVIS:PROSTATE:Prostate Size: 4.9 x 4.0 cmPeripheral Zone: A 4 mm nodule within the left mid gland is low on T2 and ADC with contrast enhancement suspicious for prostate carcinoma. There is haziness on T2 images throughout the right gland and a area of low T2 and ADC signal adjacent to the transition zone indicating a possible additional site of prostate carcinoma.Central Gland: Multiple benign nodules.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: None.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy.BONES, SOFT TISSUES: Bone marrow signal intensity is within normal limits.OTHER: No significant abnormality noted.

Output: Left mid gland nodule is suspicious for prostate carcinoma. A nodule on the right adjacent to the transition zone may represent a second site of disease. No extracapsular extension.


Instruction: Generate impression based on findings.

Input: 50 years, Female, Reason: elevated bili and transaminases, wedge-shaped liver hypodensity on CT. Evaluate gallbladder, biliary tree, hepatic vasculature History: see above. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT:There are large gallstones with submucosal edema of the gallbladder wall. The adjacent hepatic parenchyma has increased T2 signal with small rim enhancing areas. The gallbladder wall remains distinct without evidence of definite invasion.There is geographic loss of signal in the left hepatic lobe on opposed phase imaging which suggests hepatic steatosis.Mild intrahepatic biliary ductal dilatation with narrowing of the proximal common bile duct, possibly from mass effect from adjacent large cholelithiasis in the gallbladder. The portal vein is mildly narrowed but remains patent.SPLEEN: Small cyst without enhancementPANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Severe right hydronephrosis with large obstructing stones within the right renal pelvis and cortical scarring and thinning.RETROPERITONEUM, LYMPH NODES: Multiple enlarged periportal nodes including a node measuring 2.0 x 2.5 cm (501/26). Additional enlarged gastrohepatic, paraaortic and portacaval nodes.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1. Submucosal gallbladder wall edema and large gallstones with rim enhancing foci and edema in the adjacent hepatic parenchyma. Enlarged localized primarily periportal and portocaval adenopathy. Acute cholecystitis with early intrahepatic abscess formation versus metastatic gallbladder adenocarcinoma (particularly given the adjacent enlarged heterogeneous and perhaps necrotic lymph nodes) are differential considerations. Correlation with patient's clinical history and laboratory values recommended. Definitive diagnosis complicated by patient's reportedly asymptomatic status (making complicated cholecystitis less likely though an element of chronicity is possible) and apparent preservation of gallbladder wall near hepatic parenchymal heterogeneity (making invasive gallbladder malignancy less likely). 2. Mild intrahepatic biliary ductal dilatation.3. Extensive retroperitoneal lymphadenopathy.4. Large obstructing stones in the right renal pelvis with severe hydronephrosis and scarring/thinning, likely acute on chronic findings.


Instruction: Generate impression based on findings.

Input: Diagnosis: Postconcussional syndrome. Unspecified injury of head, initial encounter. Post-traumatic headache, unspecified, not intractableClinical question: structural abnormalitySigns and Symptoms: head injury, lose of tone with shaking The CSF spaces are appropriate for the patient's stated age with no midline shift. No foci of diffusion restriction are appreciated intracranially. There is no evidence for intracranial hemorrhage.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: MRI of the brain is within normal limits. There is no evidence for traumatic brain injury on the basis of this exam.


Instruction: Generate impression based on findings.

Input: Nonhealing coccyx wound. Evaluate for fistula. PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Multiple moderately prominent inguinal and femoral lymph nodes are likely reactive.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Small left complex hydrocele. There is diffuse moderate anasarca of the soft tissues. The bone marrow signal intensity of the visualized osseous structures is unremarkable.There is mild linear enhancement extending from the 5 to 6:00 position of the anus extending superiorly along both the right and left intergluteal cleft. This is not associated with a discrete T2 weighted hyperintense fluid tract and likely represents residua granulation/healing tissue of the previously described perianal fistula. On the right the enhancement does not extend as cranially as on the prior study. On the left the enhancement appears to extend deep to the coccyx (series 1102/207). There is no discrete fluid collection.OTHER: No significant abnormality noted.

Output: No discrete T2 intense sinus tract and/or fistula. Residual linear enhancement in a similar distribution to the previously described perianal fistula favored to represent granulation/healing tissue. No drainable fluid collection.


Instruction: Generate impression based on findings.

Input: Headache. Evaluate for mass, Chiari. There is no evidence of acute intracranial hemorrhage, mass, mass effect, or acute infarct. The cerebellar tonsils are normal in position without evidence of Chiari malformation. The brain parenchyma appears unremarkable. The sulcation and myelination pattern are within normal limits. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable. There is moderate left greater than right mucosal thickening of the bilateral maxillary sinuses.

Output: 1. Unremarkable brain MRI for age. No evidence of intracranial mass, mass effect, or Chiari malformation, as questioned.2. Moderate left greater than right mucosal thickening of the bilateral maxillary sinuses.


Instruction: Generate impression based on findings.

Input: Reason: Right knee pain, no improvement with conservative treatment, no improvement with NSAIDs, x-rays taken at Midwest bone and joint were negative, evaluate for lateral meniscal tear versus chondral injury. MENISCI: The medial meniscus demonstrates abnormal signal within the posterior horn without distinct horizontal component extending to the inferior articular surface (image 12 series 501). A more globular signal is observed in the central body and the anterior aspect is unremarkable other than mild fraying of the inner edge. Lateral meniscus is unremarkable and intact.ARTICULAR CARTILAGE AND BONE: Diffuse mild thinning of the cartilage with mild heterogeneous signal greater in the medial compartment and along the femoral condylar surface. Similar changes are also observed under the patella most pronounced along the lateral facet with mild shallow defects underlying immediate marrow changes are also observed with suspected contusion in the lateral femoral condyleLIGAMENTS: No significant abnormality noted, specifically the ACL appears intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Medial meniscal tear as described with associated large parameniscal cyst extending posteriorly and a small to moderate effusion. See detail providedI personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Posterior fossa site of ependymoma: gross total resection on 10/27/15; proton beam radiation from 12/9/15 - 1/25/16: normal neurologic exam. There are expected postoperative findings related to posterior fossa tumor resection. There is no abnormal intracranial enhancement. There is no evidence of acute intracranial hemorrhage, mass, or acute infarct. There are punctate foci of susceptibility effect in the right parietal lobe along the path of a prior ventricular catheter, along the margins of the and diffusely in the right cerebral hemisphere adjacent to the lateral ventricle. There is a small amount of pneumoventricle, but the ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are unchanged.

Output: No evidence of recurrent posterior fossa tumor.


Instruction: Generate impression based on findings.

Input: 42-year-old female with periumbilical abdominal pain and history of Crohn's disease status post colectomy and end ileostomy. Evaluate for active disease or fistula. ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. No suspicious hepatic lesions. Hepatic and portal veins are patent. No biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: Mild prominence of the pancreatic duct. Pancreatic tail appears bifid. These findings are similar to prior exam.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postsurgical changes from total colectomy with right lower quadrant ileostomy. The distal ileum both intra-abdominal and traversing through the subcutaneous soft tissues at the site of the ostomy over a total length of approximately 17 cm demonstrates mild-to-moderate wall thickening with increased enhancement and mild adjacent edema, most compatible with active inflammatory bowel disease. No evidence of fistula or abscess.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Small amount of endometrial fluid and small right ovarian cysts, likely physiologic changes.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: As above.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small amount of nonspecific pelvic free fluid, which may be physiologic or chronically-related to postoperative change.

Output: Findings most compatible with active inflammatory bowel disease of the distal ileum at level of ostomy.


Instruction: Generate impression based on findings.

Input: 70 year-old female with altered mental status. Evaluate for hematoma. The small area of low attenuation in the left cerebellum seen on axial image number 7 is suspicious for an old small stroke. The age is unable to be determined due to the small size of the hypodense region. MRI may help further evaluate if indicated. There are no noted supratentorial abnormalities.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: Small area of low attenuation in the left cerebellum likely representing an old stroke. MRI may help further evaluate if indicate.


Instruction: Generate impression based on findings.

Input: Reason: characterize liver lesions History: hx liver lesions ABDOMEN:LIVER, BILIARY TRACT: There is redemonstration of a T2 hyperintense structure within hepatic segment 5 which measures 1.2 x 1.4 cm, not significantly changed in size. This structure demonstrates peripheral nodule enhancement and centripetal fill-in and meets imaging criteria for a benign hemangioma. No additional hepatic lesions are identified. The hepatic vasculature appears patent.Cholelithiasis without evidence of cholecystitis. No biliary ductal dilatation.SPLEEN: Probable splenule, unchanged.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Mild prominence of the retroperitoneal lymph nodes, not significantly changed.BOWEL, MESENTERY: Diverticulosis without specific evidence of diverticulitis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Chronic elevation of the left hemidiaphragm.

Output: Hepatic segment 5 lesion compatible with a benign hemangioma, not significantly changed in size. No suspicious hepatic lesions are identified.


Instruction: Generate impression based on findings.

Input: Lung cancer with metastases. There has been overall slight interval decrease in size and number of the enhancing lesions in the brain. For example a right superior frontal lobe lesion now measures up to 2 mm, previously 5 mm and a right globus pallidus lesion is now inconspicuous. A few lesions demonstrate punctate foci of susceptibility effect, which may represent hemorrhage or calcifications. However, there is is generally negligible or no appreciable associated vasogenic edema. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull and scalp soft tissues are unremarkable. There is mucosal thickening within the bilateral maxillary sinuses.

Output: Overall slight interval decrease in size and number of the intracranial metastases.


Instruction: Generate impression based on findings.

Input: Follow up pituitary bleed. There is a T1 and T2 hyperintense cystic lesion in the right anterior pituitary lobe that measures up to 7 mm. The infundibulum, cavernous sinuses, and optic apparatus are intact.

Output: No significant interval change in size of the subcentimeter cystic right pituitary lesion.


Instruction: Generate impression based on findings.

Input: Female, 58 years old. Reason: r/o increase in size of nodules, r/o adenopathy, suspicious lesions History: multiple thyroid nodules RIGHT LOBE MEASUREMENTS: 5.8 x 1.9 x 1.7 cmLEFT LOBE MEASUREMENTS: 5.6 x 1.8 x 1.8 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: Heterogeneous echotexture. A right mid thyroid nodule measures 0.9 x 0.4 x 0.8 cm, unchanged from prior, heterogeneous, hypoechoic, poorly marginated, non-calcified, non-vascular.LEFT LOBE: Heterogeneous echotexture. A left mid thyroid nodule measures 2.0 x 1.5 x 0 .8 cm, unchanged from prior, heterogeneous and spongiform, nonvascular, with a few scattered punctate echogenic structures suggestive of inspissated colloid. A left lower pole thyroid nodule measures 0.9 x 0.7 x 0 .6 cm, similar to prior, isoechoic, with a hypoechoic rim and internal vascularity.ISTHMUS: Heterogeneous echotexture.PARATHYROID GLANDS: Benign cervical lymph nodes are identified. A right level 3 lymph node measures 0.8 x 0.4 x 1 .5 cm, with a fatty hilum. A left level 3 lymph node measures 0.7 x 0.2 x 2.1 cm. A left level 4 lymph node measures 0.7 x 0.3 x 0.8 cm.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Heterogeneous thyroid with bilateral nodules, stable from prior. No lymphadenopathy.


Instruction: Generate impression based on findings.

Input: Transphenoidal surgery for pituitary apoplexy: Left eye 3rd nerve palsy. There has been interval postoperative findings related to transphenoidal surgery. There is a non-enhancing area in the left sella alongside the left cavernous sinus, which measures 10 mm in width, 8 mm in height, and 5 mm anteroposteriorly, which may represent residual hemostatic agent or necrotic pituitary tumor, but there is no mass effect upon the optic apparatus. The pituitary infundibulum is slightly deviated to the right. There is interval resolution of the diffuse dural thickening and enhancement. There is scattered cerebral white matter T2 hyperintensity, which may be related to chronic small vessel ischemic disease. There is a small amount of residual mucosal thickening in the sphenoid sinuses.

Output: 1. Interval postoperative findings related to transphenoidal surgery for resection of an infarcted pituitary adenoma with no residual massa effect upon the optic apparatus.2. Interval resolution of the diffuse dural thickening and enhancement.


Instruction: Generate impression based on findings.

Input: History of pancreas divisum status post sphincterotomy. Now with abdominal pain. ABDOMEN:LIVER, BILIARY TRACT: Hepatic steatosis. Status post cholecystectomy. The common bile duct is normal in caliber and tapers smoothly to the ampulla.SPLEEN: No significant abnormality noted.PANCREAS: Pancreas divisum.The pancreas is atrophic and mildly decreased in intrinsic T1 weighted signal intensity. No peripancreatic inflammatory changes. It enhances homogeneously. No complication of prior pancreatitis.Following secretin administration the pancreatic duct demonstrates normal dilatation without side branch ectasia. Expected secretory response of the pancreas. No flow-limiting stricture is evident.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: Pancreas divisum. Expected secretory response of the pancreas without a flow-limiting stricture evident. Hepatic steatosis.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for cervical disk disease. Signs and symptoms: Right shoulder pain. Non-enhanced cervical MRI:There is normal anatomic alignment the vertebral column.There is normal signal intensity of vertebral column.There is no evidence of spinal canal compromise stenosis at any level.There is no evidence of neural foraminal compromise at any level.Very mild degenerative changes of cervical spine is detected.There is normal caliber and signal intensity protocol and the uppermost visualized thoracic cord through T3 level.

Output: 1.Minimal degenerative changes without central spinal stenosis or neural foraminal compromise at any level.2.Normal signal intensity and caliber of the cervical and uppermost visualized thoracic cord.


Instruction: Generate impression based on findings.

Input: Planning for stereotactic brain biopsy. Brain lesion. Enhanced head CT:75 cc of Omnipaque 350 was administered for this study.Enhanced axial 1 mm CT images of the entire brain were obtained for presurgical planning brain biopsy.Examination demonstrates diffuse lower density of bihemispheric white matter likely result of prior therapy. Multiple periventricular irregularly-shaped highly suspected calcific lesions similar to prior MRI examination from 8 -- 5 -- 11. There is suggestion of subtle enhancement of these lesions as well. There are no non-infused CT images for confirmation of calcification however the very high density of these lesions is highly suspected of calcification. Review of prior head CT from 5 -- 12 -- 08 demonstrated no calcification. Findings could represent posttreatment changes of patient's known lymphoma. Recommend non-infused head CT for further evaluation. When compared with prior recent MRI there is no appreciable change.

Output: Multiple irregularly-shaped and highly suspected calcific lesions similar to prior MRI. Subtle enhancement of these lesions is present in. Please see above comments.


Instruction: Generate impression based on findings.

Input: Altered mental status, unspecified [R41.82], Reason for Study: ^Reason: meningitis History: encephalopathy Subtle focal restricted diffusion on the left side of the mid Pons unchanged since prior scan indicating acute ischemic infarct. There is no evidence of acute hemorrhagic lesion.There is evidence of tissue loss on the left basal ganglia thalamus as well as caudate head indicating prior ischemic infarct evidence of hemorrhage, unchanged.Patchy T2/flair high signal intensity lesions on bilateral periventricular white matter indicating small vessel ischemic disease, unchanged.There is no evidence of abnormal enhancement on the scan.The ventricles, sulci and cisterns are unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, 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. Left mid pontine acute ischemic infarct without evidence of hemorrhagic transformation, unchanged since prior scan.2. No evidence of acute hemorrhagic lesion. 3. No evidence of abnormal enhancement.3. Chronic ischemic lesion on the left basal ganglia, caudate head and thalamus with the tissue loss, unchanged since prior scan.4. Nonspecific small vessel ischemic disease, unchanged since prior scan.


Instruction: Generate impression based on findings.

Input: Bilateral carotid stenosis and episodes of spacing out for 3-5 min. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is a punctate focus of encephalomalacia in the left thalamus and a small area of encephalomalacia in the right parietal lobe. There is diffuse patchy cerebral and pontine white matter T2 hyperintensity. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The bilateral cavernous internal carotid artery flow voids are diminished. There also appears to be focal stenosis of the left intracranial vertebral artery. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There are bilateral lens implants.

Output: 1. Chronic infarcts in the right parietal lobe and left thalamus, as well as probable chronic small vessel ischemia, but no evidence of acute infarct. 2. Steno-occlusive disease involve ing the carotid arteries and a small left PICA aneurysm are better depicted on the recent CTA.


Instruction: Generate impression based on findings.

Input: Female, 49 years old, unspecified disturbances of skin sensation/pure sensory syndrome for evaluation of possible spinal cord mass. There is straightening of the normal cervical lordosis, without subluxation. Vertebral body heights are maintained. There is multilevel disc desiccation with mild loss of intervertebral disc height from C3-4 through C6-7. There are associated endplate degenerative marrow signal changes. A small round area of increased T1 and T2 signal in the superior aspect of the T3 vertebral body, likely relates to a intraosseous hemangioma or focal fatty marrow. Bone marrow signal intensity is otherwise within normal limits. There is no abnormal cord signal. There is no abnormal intrathecal enhancement.Additional level specific findings are as follows:C2-3: Small posterior disc osteophyte complex. Left greater than right facet arthropathy and uncovertebral hypertrophy. No significant spinal canal stenosis. Mild left neural foraminal narrowing.C3-4: Axial images degraded by motion. A small posterior disc osteophyte complexes suggested with right greater than left facet arthropathy. No significant spinal canal stenosis is evident. Neural foraminal stenoses are not able to be evaluated.C4-5: Axial images degraded by motion. Posterior disc osteophyte complex. Right greater than left facet arthropathy and uncinate hypertrophy. No significant spinal canal stenosis. Mild right neural foraminal narrowing.C5-6: Posterior disc osteophyte complex with a prominent right paracentral disc protrusion, which causes mild spinal canal stenosis, effacing the ventral thecal sac and flattening the spinal cord. Right greater than left facet arthropathy and uncinate hypertrophy. Mild to moderate right and mild left neural foraminal narrowing.C6-7: Small posterior disc osteophyte complex. Bilateral facet arthropathy and uncinate hypertrophy. Mild bilateral neural foraminal narrowing.C7-T1: No disc herniation. No significant spinal canal or neural foraminal stenoses.

Output: No abnormal cord signal or enhancement.Multilevel moderate degenerative changes throughout the cervical spine, most prominent at the C5-6 level with mild spinal canal stenosis and mass effect on the spinal cord.


Instruction: Generate impression based on findings.

Input: Rule out osteomyelitis. Gas in soft tissues on x-ray. History of diabetes, recurrent ulcer. There is soft tissue edema at the lateral aspect of the base of the fifth metatarsal suggesting inflammation or infection with overlying skin irregularity, compatible with stated history of ulceration. No underlying osseous signal abnormalities to suggest osteomyelitis. Soft tissues and tendons of the foot are otherwise unremarkable. Moderate osteoarthritis affects the midfoot.

Output: Ulceration and edema suggestive of soft tissue inflammation or infection without evidence of osteomyelitis.


Instruction: Generate impression based on findings.

Input: HIV, heroin abuse. Recently admitted with ataxia and neurocognitive changes. MRI showed cerebellar lesion and white matter lesions. Here again with the same presentation, repeat imaging for many acute changes. There are multiple scattered foci of predominantly subcortical white matter T2 hyperintensity without restricted diffusion, which have not significantly changed. There is also patchy T2 hyperintensity and swelling within the central pons and within the medial cerebellar hemisphere white matter, with increase in size of the left cerebellar lesion. The cerebellar tonsils remain mildly low-lying. There is a punctate focus of susceptibility effect in the periventricular white matter adjacent to the frontal horn of the left lateral ventricle. There is no evidence of acute intracranial hemorrhage, mass, or acute infarct. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift. The major cerebral flow voids are intact. The orbits are grossly unremarkable. The calvarial bone marrow is diffusely heterogeneous. The adenoids are prominent and contain punctate retention cysts. There are bilateral partially imaged parotid nodules.

Output: 1. Multiple supratentorial and infratentorial white matter lesions that likely represent the effects of opiate intoxication have not significantly changed except for a left cerebellar lesion, which has enlarged, but no evidence of acute intracranial hemorrhage or acute infarct.2. An unchanged punctate focus of susceptibility effect in the periventricular white matter adjacent to the frontal horn of the left lateral ventricle is nonspecific. 3. Nonspecific prominence of the adenoids may be related to HIV, for example.4. The appearance of the calvarial bone marrow may also be attributable to HIV. 5. Bilateral partially imaged parotid nodules may represent lymphoepithelial lesions. Dedicated imaging of the neck and parotid gland may provide further insights, nevertheless.


Instruction: Generate impression based on findings.

Input: T1N0 acinic cell carcinoma of the left posterior alveolus status post WLE on 4/29/2015 with primary closure. There is no evidence of measurable mass lesions or significant cervical lymphadenopathy, including a left level 2A lymph node that measures up to 10 mm in short axis. There is mild diffuse prominence of the palatine tonsils, which is nonspecific. The tongue and rest of the upper aerodigestive tract appear to be intact. The thyroid and major salivary glands are unremarkable. The major cervical vessels flow voids are intact. The osseous structures are unremarkable. The airways are patent. The imaged intracranial structures are unremarkable. There is residual thymic tissue in the anterior superior mediastinum.

Output: No evidence of measurable mass lesions or significant cervical lymphadenopathy.


Instruction: Generate impression based on findings.

Input: Male 60 years old Reason: peri-lunate dislocation? Chronic vs acute? Sagittal sequence is degraded by motion. LIGAMENTS: The scapholunate and lunotriquetral ligament are disrupted.TRIANGULAR FIBROCARTILAGE COMPLEX: The triangular fibrocartilage complex is grossly intact.TENDONS: T2 hyperintense fluid signal surrounding the majority of the flexor tendons indicating a tenosynovitis, possibly traumatic in etiology.BONES: The lunate is rotated and partially subluxed anteriorly in relation to the capitate which is perched posteriorly upon it. Findings consistent with a perilunate dislocation. Cysts are present within the scaphoid, capitate, trapezium, and base of the fifth.ADDITIONAL

Output: 1.Perilunate dislocation and associated disruption of the scapholunate and lunotriquetral ligaments.2.Tenosynovitis of the flexor tendons, possibly traumatic in etiology.


Instruction: Generate impression based on findings.

Input: Systemic lupus erythematosus with altered mental status and seizures. Assess for lupus cerebritis.. There is a gyriform area of restricted diffusion, susceptibility artifact, and peripheral enhancement in the right frontal lobe with surrounding vasogenic edema. The lesion is associated with peripheral contrast enhancement that measures up to 25 mm. There is a similar appearing lesion involving the left basal ganglia that measures up to 15 mm. There are also areas of T2 hyperintensity and swelling involving the bilateral thalami, right basal ganglia, and right midbrain. In addition, there are patchy areas of restricted diffusion and T2 hyperintensity without associated enhancement in the bilateral corona radiata and centrum semiovale. There is no midline shift or herniation. The major cerebral flow voids are intact. There is a partially-empty sella. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is a subcentimeter right maxillary alveolar cystic lesion, which may represent a periapical or globulomaxillary cyst.

Output: Multifocal focal supratentorial and infratentorial lesions associated with areas of hemorrhage, peripheral enhancement, as well as surrounding vasogenic edema may represent infarcts of varying ages related to lupus vasculitis. Septic emboli from endocarditis (Libman-Sacks) or other infectious process, such as Hurst disease (acute hemorrhagic leukoencephalitis), are alternative considerations.


Instruction: Generate impression based on findings.

Input: Male, 92 years old, with altered mental status, aphasia. No evidence of restricted diffusion is seen. Moderate periventricular FLAIR hyperintensity is noted without edema or mass effect. No evidence of intracranial hemorrhage or any abnormal extra-axial fluid collection is seen. The ventricles and sulci are moderately and proportionately prominent compatible with parenchymal volume loss. Moderate pannus formation is seen at the odontoid without impingement of the brainstem. Mucosal thickening and frothy secretions are evident in the right maxillary sinus.

Output: 1.No evidence of acute ischemia.2.Findings compatible with chronic microvascular ischemic disease.3.Possible right maxillary sinus mucosal inflammation.


Instruction: Generate impression based on findings.

Input: Reason: assess for osteomyelitis History: draining ulcer, plantar surface L foot, dry ulcers 3rd and 4th toes The patient has undergone amputation of the great toe through the base of the proximal phalanx. We see no signal abnormality in the first metatarsal or remaining base of the proximal phalanx to suggest osteomyelitis. The second toe has been amputated through the neck of the second metatarsal. The amputation margin appears relatively sharp and while there is mild edema-type signal within the distal aspect of the remaining metatarsal, we suspect that this is chronic in etiology, perhaps reflecting sequela of prior infection rather than acute osteomyelitis. More pronounced signal abnormality within the base of the second metatarsal as well as the middle cuneiform bone is favored to be degenerative in etiology or perhaps represent early neuropathic arthropathy. We see no ulcer or sinus tract leading to this joint to confirm osteomyelitis.There is mild deformity of the head of the third metatarsal with mild signal abnormality in the subchondral bone. Again, we favor this to be chronic in etiology perhaps reflecting sequela of prior infection rather than acute osteomyelitis as we see no sinus tract leading to the bone. Osteoarthritic changes affect the third tarsometatarsal joint. There is thickening of the skin of the third toe with ulceration dorsally. There is increased signal intensity within the distal phalanx, middle phalanx, and head of the proximal phalanx on the fat-suppressed T2-weighted images. The fat signal intensity within the middle phalanx and head of the proximal phalanx is largely preserved on the T1-weighted images and therefore this likely represents reactive osteitis. However, there is intermediate signal intensity within the distal phalanx that is suspicious for early osteomyelitis.There is mild edema-type signal intensity within the head of the fourth metatarsal which may be degenerative in etiology as we see no sinus tract leading to bone to support osteomyelitis. There is mild thickening of the skin of the fourth toe with mild subcutaneous edema. Minimal edema-type signal in the distal phalanx of the fourth toe is favored to represent reactive osteitis rather than osteomyelitis. Mild osteoarthritis affects the fourth tarsometatarsal joint.There is deformity and tapering of the fifth metatarsal, perhaps reflecting prior surgery and/or sequela of old infection. There appears to be ulceration of the dorsal aspect of the fifth toe. Abnormal signal intensity within the distal phalanx of the fifth toe, particularly on the T2 weighted images, is suspicious for osteomyelitis. Mild osteoarthritis affects the fifth tarsometatarsal joint.There is generalized edema of the soft tissues, particularly dorsally, as well as atrophy of the plantar musculature of the foot. Mild irregularity of the plantar medial skin surface at the level of the first metatarsal head may represent ulceration.

Output: Signal abnormality affecting multiple bones as described above likely represents a combination of postsurgical changes, osteoarthritis, sequela of remote infection and reactive osteitis. However, more pronounced signal abnormality within the distal phalanges of the third and fifth toes is suspicious for acute osteomyelitis.