Instruction: Generate impression based on findings.

Input: Female, 11 years old, with episodic pain in the bilateral lower legs and bilateral forearms preceded by abnormal smell sensation. Evaluate for structural cause of bilateral upper and lower extremity episodic pain. Brain:The morphology and signal characteristics of the brain are within normal limits. No evidence of focal signal abnormality, edema or restricted diffusion is seen. No migrational anomalies are detected. On postcontrast imaging, there is no pathologic parenchymal or extra-axial enhancement. No evidence of intracranial hemorrhage or any abnormal extra axial fluid collection is seen. Ventricular size and morphology are within normal limits.C-spine:Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. Marrow signal characteristics are unremarkable. No pathologic enhancement is seen. The visualized spinal cord shows normal signal intensity and morphology and is likewise free of pathologic enhancement. No epidural lesions are detected. The intervertebral discs are preserved. No compromise of the spinal canal or neural foramina is seen.

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


Instruction: Generate impression based on findings.

Input: No evidence of acute fracture or subluxation. The marrow signal intensity is benign throughout. Alignment is within normal limits. Multilevel disk desiccation is noted, particularly affecting the cervical spine with mild ventral thecal sac effacement at C3/4 and C4/5. No evidence of acute cord edema or mass effect upon the cord to suggest cord compression.The cerebellar tonsils are in normal position. The conus is normal in signal and morphology and terminates at an appropriate level.

Output: No acute cord compression. Dedicated segment-specific MRI is recommended if symptomology localizes.


Instruction: Generate impression based on findings.

Input: Alzheimer versus NPH: memory deficits and wobbly gait. There is mild diffuse cerebral volume loss that is most pronounced in the bilateral medial temporal horns, left more than right. There is scattered cerebral white matter T2 hyperintensity. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. Mild diffuse cerebral volume loss that is most pronounced in the bilateral medial temporal horns, left more than right, is suggestive of Alzheimer disease rather than normal pressure hydrocephalus.2. Scattered cerebral white matter lesions likely represent chronic small vessel ischemic disease.3. No evidence of acute intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: Male 44 years old Reason: thyroid nodule, please assess for changes History: thyroid nodule RIGHT LOBE MEASUREMENTS: Right lobe measures 4.8 x 1.8 x 1.7 cmLEFT LOBE MEASUREMENTS: Left lobe measures 5.3 x 1.5 x 1.7 cmISTHMUS MEASUREMENTS: 2 mmRIGHT LOBE: Again noted heterogeneous echotexture of the right lobe without any discrete nodules.LEFT LOBE: Heterogeneous echotexture of the left lobe. There is a 1.1 x 0.6 cm nodule in the upper pole of the left kidney, not significantly changed from previous study.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Benign-appearing level 2 lymph nodes.OTHER: No significant abnormality noted.

Output: Heterogeneous echotexture of the thyroid as noted previously. No significant change from previous study.


Instruction: Generate impression based on findings.

Input: Age: 15 years. Sex : Male. Indication: Reason: right hip pain with hgbSS, hx avascular necrosis, want to assess for septic hip, wanting imaging down to right knee History: pain, fever. 01/18/15 No fracture or dislocation is identified. There is deformity of the right femoral head. Decreased T1 and increased T2 signal within the right femoral head reflects avascular necrosis. There is a minimal amount of fluid within the right hip joint.There is a small area of abnormal signal intensity in the left femoral mid diaphysis. There is abnormal signal intensity throughout the right femoral diaphysis, mainly within the mid to distal diaphysis. There is approximately 3mm elevation of the medial periosteum with fluid extending along 16.7 cm total length of the right femur. There is adjacent soft tissue edema. Postcontrast sequences demonstrate enhancement of the mid to distal right femoral diaphysis and surrounding soft tissues. There is rim-like enhancement along the thin fluid collection.

Output: Extensive bone changes involving predominantly the mid and lower diaphysis of the right femur with a sliver of elongated fluid in the subperiosteal region and surrounding edema. Differential diagnosis includes acute bone infarct with reactive fluid and edema or osteomyelitis with a subperiosteal abscess.


Instruction: Generate impression based on findings.

Input: Reason: foot ankle erythema, edema Ankle:Subcutaneous edema along the medial and lateral aspects of the ankle and enhancing reticulation of the subcutaneous fat along the heel may reflect cellulitis. Although the ankle edema becomes confluent we see no discrete rim-enhancing fluid collections to suggest a drainable abscess. We see no intra/inter-muscular fluid collections. The ankle tendons are intact. The study was not protocoled for ligamentous evaluation, however we see no discrete ligamentous injury. Loss of striation of the fibers of the deltoid ligament may represent a prior strain. Mild osteoarthritis affects the ankle and midfoot. The bone marrow signal is unremarkable.Foot:A focus of abnormal signal in the medial aspect of the first metatarsal head demonstrates enhancement following gadolinium administration and likely represents a degenerative cyst or perhaps chronic erosion. Mild thickening/enhancement of the medial capsular structures are seen, however we see no underlying soft tissue defect to suggest infection. The signal intensity of the remaining bones of the forefoot appears normal. There is mild edema of the dorsal subcutaneous fat of the foot but otherwise the soft tissue is unremarkable. Mild osteoarthritis affects the first MTP joint.

Output: 1. Cellulitis of the heel and ankle.2. Osteoarthritis and possible chronic erosion of the first metatarsal head but no specific radiographic findings of osteomyelitis.


Instruction: Generate impression based on findings.

Input: 30-year-old female. Evaluate for biliary obstruction, acute pancreatitis, elevated LFTs. ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter T2 hyperintense signal of the hepatic parenchyma (series 5 image 15) could represent a cyst versus hemangioma and further evaluation is limited due to the lack of intravenous contrast. Cholelithiasis without evidence for acute cholecystitis. No intra or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: Diffuse thickening/edema of the pancreatic parenchyma with severe peripancreatic fluid collections. No definite evidence for parenchymal necrosis. No significant pancreatic ductal dilatation. There is some restricted diffusion compatible with acute pancreatitis.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Extensive fluid signal in the retroperitoneal and intraperitoneal compartments.BOWEL, MESENTERY: No bowel obstruction.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Edematous pancreatic parenchyma with extensive fluid in the retroperitoneal and intraperitoneal compartments. Findings compatible with acute pancreatitis.2.Cholelithiasis without evidence for acute cholecystitis. Normal bile ducts.


Instruction: Generate impression based on findings.

Input: Reason: lower abdominal cramps, ? Colonic or distal SI disease History: abdominal cramping pain. ABDOMEN:LIVER, BILIARY TRACT: Postsurgical changes of a cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No bowel wall thickening or hyperenhancement.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No abnormal fluid collections. PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

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


Instruction: Generate impression based on findings.

Input: Cryptogenic cirrhosis. Evaluate for hepatocellular carcinoma. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic morphology of the liver. Loss of signal intensity on in phase imaging, compatible with iron deposition. The portal vein is patent at the splenic/SMV confluence. There is occlusive thrombus within the extrahepatic portal vein just distal to the confluence and within the intrahepatic portal vein. No enhancing lesions are identified. Numerous portal systemic varices.SPLEEN: Splenomegaly, measuring 13.0 cm in the coronal plane.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right renal cyst. The left kidney is unremarkable. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No evidence of bowel obstruction or ileus. Moderate to large volume of abdominal pelvic ascites.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: New small bilateral pleural effusions, left greater than right.

Output: 1.Cirrhotic morphology of the liver, with no evidence of hepatocellular carcinoma.2.Occlusive thrombus of the extra hepatic and intrahepatic portal vein, just distal to the splenic/SMV confluence.3.Moderate to large volume of abdominal pelvic ascites, unchanged.4.New small bilateral pleural effusions, left greater than right.


Instruction: Generate impression based on findings.

Input: Male, 73 years old, history of multiple subdural hematomas status post evacuation complicated by empyema status postevacuation, now presenting with two weeks of lethargy and altered mental status. Findings are demonstrated compatible with prior left parietal craniectomy. The resultant contour abnormality of the scalp and calvarium appear similar to that seen on prior CT.The dura of the left cerebral hemisphere is diffusely thickened and enhancing, but this is improved relative to the prior MRI. No discrete or enhancing extracranial or intracranial fluid collections are seen.The underlying parenchyma the left frontal and parietal lobes is mildly compressed, likely due to a combination of dural thickening and prolapse of the soft tissues at the level of the craniectomy. Mild intravascular sulcal enhancement in this region probably represents slow flow or vascular engorgement due to the regional compression.Patchy T2 hyperintensity within the parenchyma underlying the craniectomy is not significantly changed the prior examination. Previously seen subarachnoid blood product at this location has resolved.Patchy periventricular T2 hyperintensity also remains elsewhere on both sides brain. Evidence of chronic bilateral lacunar infarcts is also seen in the basal ganglia. No restricted diffusion is evident.No definite pathologic enhancement is seen elsewhere in the brain. Areas of apparent enhancement along the medial left temporal lobe, and at the level of the left caudate head, seen only on the 3-D postcontrast sequence, are most likely artifactual, particularly as they are not confirmed on any other sequence.No new intracranial fluid collections are detected. The ventricular size and morphology are stable and within normal limits.

Output: Multiple sequelae of prior surgery are seen including craniectomy and associated skull deformity, diffuse left-sided dural thickening and enhancement, as well as scattered signal abnormality within the parenchyma subjacent to the craniectomy.No definite evidence of any new or significant intracranial or extracranial fluid collections are seen. No parenchymal edema is detected and there is no definite evidence of pathologic parenchymal enhancement.


Instruction: Generate impression based on findings.

Input: Male, 47 years old. Necrotic diabetic ulcer at base of R great toe w/ surrounding cellulitis. There is extensive ulceration of the great toe with edema and enhancement of the underlying soft tissues, particularly medially, indicating inflammation. There is abnormal signal intensity throughout the distal phalanx of the great toe which is hypointense on T1 and hyperintense on T2, compatible with osteomyelitis. There are cysts in the base of the proximal phalanx, but we see no marrow edema to suggest osteomyelitis of the proximal phalanx. The phalanges of the lesser toes appear normal. Aside from mild subchondral degenerative changes, signal intensity in the metatarsals is normal. There is a bipartite medial sesamoid bone. The marrow signal intensity of the medial sesamoid bone is low on T1-weighted images with small cysts noted within the proximal fragment on T2-weighted images. This could reflect osteonecrosis, but it appears chronic. Mild degenerative changes affect the Lisfranc joint. Mild edema within the medial cuneiform is nonspecific but may be degenerative in etiology. There is atrophy of the musculature of the forefoot. There is edema along the dorsum and within the medial soft tissues of the forefoot, but we see no focal fluid collection to suggest an abscess.

Output: Osteomyelitis of the distal phalanx of the great toe and other findings as described above.Findings were discussed via telephone with Dr. Vasishta at 1:35 PM on 05/13/2016.


Instruction: Generate impression based on findings.

Input: Seven month old female with a full and bulging anterior fontanelle There is no evidence of intracranial hemorrhage, mass or edema. There are prominent ventricles and subarachnoid spaces, unchanged since recent MRI dated 9/26/2008.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Prominent ventricles and subarachnoid spaces


Instruction: Generate impression based on findings.

Input: Clinical question, indeterminate age stroke. Signs and symptoms: Unsteady gait. Pre and post enhanced brain MRI:Negative diffusion weighted images.Examination demonstrate extensive periventricular and to a lesser degree subcortical patchy and confluent foci of FLAIR/T2 hyperintensity consistent with mild to moderate age-indeterminate small vessel ischemic strokes.Very minimal similar findings are noted in the bilateral basal ganglia and thalami and pons and with small foci of bilateral chronic cerebellar ischemic stroke. There is no associated susceptibility signal changes with the findings.Slight prominence of ventricular system and the cortical sulci likely representing ex vacuo dilatation is noted. Midline is maintained.There is no detectable abnormal enhancement of brain parenchyma or the meninges.Unremarkable calvarium and orbits without evidence of abnormal enhancement.All paranasal sinuses and bilateral mastoid air cells and middle ear cavities demonstrate normal pneumatization signal.

Output: 1.No acute intracranial process.2.Findings suggestive of moderate chronic nonhemorrhagic small vessel ischemic strokes and small bilateral cerebellar chronic ischemic strokes.3.No detectable abnormal parenchymal, leptomeningeal, calvarial or orbital enhancement.


Instruction: Generate impression based on findings.

Input: Cystic lesion deep to left SCM. There is a well-defined mass in the left neck deep to the sternocleidomastoid muscle that measures up to 5 cm. The lesion demonstrates high T1 and low T2 signal and has smooth, thin peripheral enhancement, perhaps arising from a lymph node. There are no flow voids or signs of phleboliths within the lesion. The cervical lymph nodes are not particularly enlarged. The thyroid and salivary glands are unremarkable. There is a left maxillary sinus retention cyst. The imaged intracranial structures and orbits are unremarkable. The osseous structures appear to be intact.

Output: A well-defined cystic lesion deep to the left sternocleidomastoid muscle inferior to the level of the mandibular angle, which measures up to 5 cm, may represent a lymphatic malformation versus a brachial cleft.


Instruction: Generate impression based on findings.

Input: Pain while branch passing, and question of left pectoralis tear. There is abnormal signal about 2 cm proximal to the insertional site at the muscular-tendinous junction of the left pectoralis musculature (series #1601, image 17) extending through the left lateral aspect of the pectoralis inferiorly. The insertional site of the pectoralis musculature on the left humerus appears intact. The pectoralis origin appears within normal limits. No other significant findings.

Output: Findings as above are most consistent with a partial tear at the muscular-tendinous junction of the left pectoralis musculature.


Instruction: Generate impression based on findings.

Input: Metastatic lung cancer. There are numerous, at least 40, new enhancing lesions with associated mild vasogenic edema in the brain and cerebellum, primarily distributed at the grey-white matter junctions. The largest lesion measures up to 25 mm in the right temporal stem and appears to be cystic or necrotic. Many of the lesions also demonstrate susceptibility effect. There is no evidence of acute infarct. There are unchanged mild nonspecific punctate foci of high T2 signal in the cerebral white matter. There is an unchanged arachnoid cyst in the anterior right posterior fossa that measures up to 12 mm in width with associated mild mass effect upon the right cerebellar hemisphere. The ventricles and basal cisterns are stable in size and configuration. There is no midline shift or herniation. There is a right maxillary sinus retention cyst. The skull appears to be intact.

Output: Numerous hemorrhagic intracranial metastases.


Instruction: Generate impression based on findings.

Input: MRI for preoperative planning of a sphenoid sinus mucocele/fluid filled lesion to sinus near artery with boney erosion. There is a globular T2 hyperintense and T1 hypointense lesion with thin peripheral mucosal enhancement that completely occupies the left sphenoid sinus and measures up to 25 mm. The wall of the left sphenoid sinus are diffusely thinned. The other paranasal sinuses and intracranial structures are unremarkable.

Output: Findings suggestive of left sphenoid sinus mucocele formation.


Instruction: Generate impression based on findings.

Input: 12 year-old male with hypotension and hypoxia. The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear.The patient is intubated. There are fluids in the paranasal sinuses and soft tissue emphysema in the neck, which may be procedure related.

Output: No acute intracranial abnormality.


Instruction: Generate impression based on findings.

Input: Clinical question: History of meningioma status post resection. Signs and symptoms: Surveillance study. Pre and post enhanced brain MRI:Examination demonstrates chronic expected postoperative changes of a large bilateral anterior frontal craniectomy for removal of tumor. Minimal residual fluid epidural thickening and enhancement is within expected postop changes as well. There are small patchy foci of T2 hyperintense signal changes along paramedian bilateral inferior frontal lobes (L>R) consistent with a small foci of encephalomalacia.Enhanced images demonstrate a tiny well-demarcated focus of enhancement in the right medial midline along cribriform plate measuring 9.5 x 7.4 mm and coronal reformatted series 1001 image 305. Finding is suspected of a tiny focus of residual tumor. Prior MRI exam was performed immediately post surgery and residual post surgical blood product in the surgical bed precludes precise assessment for residual tumor and cannot be compared properly with the current study.The anatomical morphology and the signal intensity of the brain is otherwise within normal on all MRI sequences and without detectable abnormal enhancement.

Output: 1.Expected chronic postoperative changes of a large bilateral anterior frontal craniotomy.2.Well-demarcated right paramedian focus of extra-axial enhancement along the right cribriform plate measuring at 9.5 x 7.4 mm coronal postinfusion series is suspected of a small focus of residual tumor. Please see above comments.3.Multiple small foci of encephalomalacia in the bilateral inferior frontal lobes (L>R) likely result of prior tumor and postoperative changes.4.Unremarkable exam otherwise.


Instruction: Generate impression based on findings.

Input: 40-year-old woman with recurrent tibialis anterior tendinitis, evaluate for anterior tibial syndrome. TENDONS: There is no abnormality in the appearance of the tibialis anterior origin from the tibia or its insertion on the medial and plantar surfaces of the medial cuneiform and the base of the first metatarsal along its medial and plantar surfaces. There is no abnormal enhancement of the tibialis anterior muscle belly. The other tendons of the right ankle also appear normal.LIGAMENTS: No significant abnormality noted.ARTICULAR SURFACES AND BONE: No significant abnormality noted. ADDITIONAL

Output: No evidence of anterior tibial syndrome.


Instruction: Generate impression based on findings.

Input: Cervical spine:There is a slight anterolisthesis of C5 relative to C6. There are degenerative endplate signal changes at C6/C7. There is no definite pathologic marrow replacement in the cervical spine. There are no cervical cord signal abnormalities. There is no evidence of epidural tumor in the cervical spine. Note is made of a 1 cm left level three lymph node.C2/3: No significant canal or neural foraminal stenosis.C3/4: There is minimal uncovertebral and facet hypertrophy without canal or neural foraminal stenosis.C4/5: There are advanced facet hypertrophic changes, right greater than left, and disc-osteophyte formation with mild spinal canal stenosis and moderate bilateral neural foraminal stenosis.C5/6: There is advanced right facet hypertrophy and disc-osteophyte formation with moderate spinal canal stenosis with slight impingement of the spinal cord but without underlying cord signal abnormality. There is severe bilateral neural foraminal narrowing.C6/7: There is facet hypertrophy and disc-osteophyte formation contributing to mild spinal canal stenosis. There is moderate left and mild right neuroforaminal stenosis.C7/T1: There is no significant spinal canal or neuroforaminal stenosis.Thoracic spine:There are areas of marrow replacement involving many of the thoracic vertebral body levels. The most conspicuously affected vertebral body is T5 where there is some loss of height centrally and epidural expansion with encroachment of the spinal canal. The canal is narrowed, but the spinal cord is not significantly compressed as there is still intervening CSF. The left neural foramina of T5/T6 is also infiltrated with tumor.There is also significant involvement of the T11 vertebral body with loss of height anteriorly, but no significant retropulsion or obvious epidural tumor spread.Alignment is overall anatomic. The vertebral body heights are otherwise preserved. There is no thoracic spinal cord edema.

Output: 1. Metastatic disease involving many of the thoracic vertebral bodies. The T5 level is most severely affected where there is some osseous expansion and epidural spread resulting in spinal canal narrowing.2. No definite evidence of metastatic disease in the cervical spine. Degenerative changes as described above.


Instruction: Generate impression based on findings.

Input: Subarachnoid hemorrhage, assess for extensiveness. Diffuse encephalopathy, LUE decorticate posturing. Again seen are numerous foci of microhemorrhage, increased from 3/28/2016 MRI, some of which demonstrate restricted diffusion, including in the left occipital lobe. Multiple new foci of FLAIR signal abnormality are seen in the bilateral occipital lobes, the bilateral inferior frontal lobes, the right anterior frontal lobe and the left anterior temporal lobe at least most of which clearly correspond to adjacent blood products. Some of these FLAIR foci demonstrate restricted diffusion.Increased FLAIR sulcal signal in the superior right parietal lobe, right frontal lobe, left occipital lobe and left temporal lobe representing subarachnoid hemorrhage. Small amount of intraventricular blood product appears similar to 4/18/2016 CT head. Ventricles and basal cisterns are unchanged. There is no mass effect or herniation. There is nonspecific opacification of the mastoid air cells and paranasal sinuses. Partially empty sella.

Output: Scattered areas of subarachnoid and intraventricular hemorrhage appear similar to 4/18/2016 CT head. However the numerous foci of microhemorrhage throughout the brain are significantly increased when compared to prior brain MRI from 3/28/2016. Some of these foci demonstrate restricted diffusion which may be related to the blood products themselves although small infarcts with hemorrhagic transformation are not entirely excluded. FLAIR hyperintensity surrounding these foci are compatible with foci of edema related to the hemorrhages. No findings to suggest acute large vascular territory infarct.The numerous foci of small intra and extra-axial hemorrhage may be related to vasculitis as noted previously although thrombocytopenia may also be contributing.


Instruction: Generate impression based on findings.

Input: 30-year-old male patient with jaundice, transaminitis. Concern for PSC, PBC, ascending cholangitis. ABDOMEN:LIVER, BILIARY TRACT: The liver is enlarged measuring up to 25 cm in the craniocaudal dimension. No focal hepatic lesion. No intra or extrahepatic biliary ductal dilatation. No CBD stone seen, image 48 series 8. No significant biliary wall thickening, enhancement or restricted diffusion identified. There is periportal edema. The gallbladder wall is thickened measuring up to 8 mm in thickness and is mildly contracted. No cholelithiasis. SPLEEN: No significant abnormality noted.PANCREAS: The main pancreatic duct is normal in diameter. There is mild peripancreatic edema. Additionally, there is increased diffusion abnormality within the head of the pancreas. No pancreatic mass is identified.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is mild increased wall enhancement of the duodenum.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Trace ascites and trace bilateral pleural effusions.

Output: 1.Hepatomegaly without intra- or extrahepatic biliary ductal dilatation. 2.Thickened gallbladder wall without distension or cholelithiasis; this is non-specific and could be secondary to various etiologies including hepatitis and hypoalbuminemia. 3.Mild peripancreatic edema, diffusion abnormality (primarily within the pancreatic head), and duodenal wall enhancement; these findings raise concern for acute pancreatitis, correlate with lipase and amylase levels and patient's clinical history/physical exam.


Instruction: Generate impression based on findings.

Input: Reason: s/p tumor resection. please do full brain MRI and 1mm stealth without fiducials History: meningioma Since the prior exam the patient has undergone frontal craniotomy for removal of a frontal lobe meningioma. There are some attendant postoperative changes present within the scalp tissues.There are foci of residual tumor present along the anterior cranial fossa at the floor in the midline measuring 53 x 34 mm in axial dimensions involving the cribriform plate and the adjacent intracranial fossa floor. Another residual component is present which is adjacent to the corpus callosum along the midline measuring 25 x 11 mm sagittal dimensions and 23 x 40 mm axial dimensions.There is elevated T2 and flair signal involving medial aspects of the frontal lobes bilaterally associated with some microhemorrhages. More prominently the portion of the frontal lobe brain parenchyma previously anterior to the contain some microhemorrhages and signal change and has a reexpanded into the tumor bed.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate opacification of the frontal sinuses and mucosal thickening ethmoid air cells and the maxillary sinuses as well as the sphenoid sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.The patient is status post bifrontal craniotomy for removal of large meningioma . The clear majority of the meningioma has been removed. There are a couple foci of residual tumor present along the floor of the intracranial fossa and cribriform plate as well as adjacent to the corpus callosum.2.There are attendant postoperative changes present as detailed above.The posterior wall of the frontal sinus is not clearly defined.


Instruction: Generate impression based on findings.

Input: History of retroperitoneal fibrosis. Evaluate for disease progression. ABDOMEN: Limited evaluation of the upper abdomen is unremarkable.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: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Small uterine fibroids.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Best seen on the delayed images (series 11 images 68 through 83) is partially circumferential enhancing soft tissue of the distal abdominal aortic bifurcation and proximal common iliac arteries, unchanged from the recent prior study.

Output: No significant interval change in gradually enhancing partially circumferential soft tissue of the aortobiiliac area.


Instruction: Generate impression based on findings.

Input: A T1/T2 hypointense, susceptibility-inducing lesion is redemonstrated in the left aspect of the pons. As before, there may be minimal peripheral enhancement around the lesion but this is unchanged. The lesion measures 8 x 8 mm, unchanged since the previous study.No new parenchymal lesions are seen. The ventricular size is normal. No midline shift. There is normal gray-white matter differentiation. No other abnormal lesion seen. No evidence of mass effect or edema.With the exception of a small mucous retention cyst in the left maxillary sinus, the paranasal sinuses and mastoid air cells are clear

Output: Stable left pontine lesion with imaging characteristics suggestive of a cavernous malformation. No new lesions are detected.


Instruction: Generate impression based on findings.

Input: Stage IIA2 Cervical Adenocarcinoma, s/p EBRT for image planning for tandem and ovoid brachytherapy History: vaginal bleeding PELVIS:UTERUS, ADNEXA: An ovoid and tandem device is present in the vagina and uterus. There is a 2.3 cm cystic lesion within the region of the right cervix which may reflect a nabothian cyst and appears similar to prior. There are several foci of abnormal signal within the region of the uterine cervix and its junction with the vagina compatible with known neoplasm, overall decreased in size compared to prior outside CT. For reference, a focus of abnormal signal at right cervical vaginal junction along lateral inferior aspect of cystic lesion (series 6, image 12) measuring 6 x 11 mm. Focus of abnormal signal at right cervix along inferior aspect of cystic lesion (series 6, image 11) measuring 7 x 22 mm. Focus of abnormal signal along left cervix (series 6, image 12) measuring 6 x 24 mm.BLADDER: A Foley catheter is present within the bladder.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is increased T2 signal and possible thickening involving portions of the partially visualized bowel which could be related to radiation therapy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Limited examination for pretreatment planning demonstrates findings compatible with known cervical cancer as described above.


Instruction: Generate impression based on findings.

Input: 19-year-old male presents with left shoulder pain. ROTATOR CUFF: The rotator cuff is normal.SUPRASPINATUS OUTLET: The acromioclavicular joint is normal. No fluid or gadolinium is present in the subacromial-subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: No gadolinium enters the superior labrum; however, there is intermediate signal intensity partially separating the superior labrum from the adjacent glenoid. While this is suspicious for a SLAP tear, it is possible that it could simply represent cartilage undercutting or a sublabral sulcus. There is a small cleft separating the posterior inferior labrum from the adjacent underlying articular cartilage, which may represent a small partial thickness tear, but this is also equivocal. The glenohumeral joint alignment is normal. The articular cartilage is normal.BICEPS TENDON: The tendon of the long head of the biceps is intact. ADDITIONAL

Output: 1. Small cleft partially separating the posterior labrum from the adjacent articular cartilage may represent a small partial thickness tear, but this is equivocal.2. Findings suspicious for a SLAP tear, as described above.


Instruction: Generate impression based on findings.

Input: Mild cognitive impairment, so stated [G31.84], Reason for Study: ^Reason: Cognitive decline - please assess for lobar atrophy History: executive dysfunction and visuospatial difficulty 78 years Female (DOB:4/4/1938)Reason: Cognitive decline - please assess for lobar atrophy History: executive dysfunction and visuospatial difficultyPROVIDER/ATTENDING NAME: JAMES A. MASTRIANNI JAMES A. MASTRIANNI There is no evidence of acute ischemic or hemorrhagic lesion.Scattered T2/FLAIR high signal intensity periventricular white matter and subcortical white matter are seen, these lesions represent most likely nonspecific small vessel ischemic disease.The CSF spaces are appropriate for the patient's stated age with no midline shift. 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: 1.No evidence of acute ischemic or hemorrhagic lesion.2. Nonspecific small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: CERVICAL SPINE: There is moderate degenerative changes throughout the cervical spine with multilevel disc desiccation, loss of disc height, severe endplate degenerative changes, and reversal of the normal cervical lordosis. The spinal cord displays normal signal. The paravertebral soft tissues are unremarkable.C2-C3: There is no significant spinal canal or neural foraminal stenosis.C3-C4: There is a mild disc osteophyte complex asymmetric to the right and bilateral uncovertebral joint arthropathy, right greater than left, resulting in mild spinal canal stenosis and moderate to severe right neural foramen stenosis.C4-C5: There is a posterior disc osteophyte complex and bilateral facet and uncovertebral arthropathy, right greater than left. These findings result in mild spinal canal stenosis, mild left, and moderate to severe right neural foramen stenosis. C5-C6: There is mild bilateral uncovertebral joint arthropathy with mild bilateral neural foramen stenosis but without significant spinal canal stenosis. C6-C7: There is a mild disc osteophyte complex and mild bilateral uncovertebral arthropathy with moderate bilateral neural foramen stenosis but without significant spinal canal.C7-T1: There is no significant spinal canal or neural foraminal stenosis.THORACIC SPINE: The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. There is a small left paracentral disc protrusion at T3-T4 that mildly indents the thecal sac without significant spinal canal or neural foramen stenosis. The paravertebral soft tissues are unremarkable.

Output: 1.No evidence of spinal cord lesion.2.Moderate cervical spine degenerative changes as detailed above.3.Mild thoracic spine degenerative changes without significant spinal canal or neural foramen stenosis.


Instruction: Generate impression based on findings.

Input: History of hypertension and seizure disorder. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are a few scattered cerebral white matter T2 hyperintense foci. There are subcentimeter foci of susceptibility effect in the left posterior cingulate gyrus and left superior parietal lobule. There is no abnormal intracranial enhancement. The ventricles and sulci are mildly prominent diffusely. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is mild scattered paranasal sinus mucosal thickening.

Output: 1. Subcentimeter foci of susceptibility effect in the left posterior cingulate gyrus and left superior parietal lobule may represent chronic microhemorrhages related to hypertension or amyloid angiopathy versus cavernous malformations, for example. 2. No evidence of acute infarct.3. A few cerebral white matter T2 hyperintense foci may represent chronic small vessel ischemic disease.4. Mild diffuse cerebral volume loss.


Instruction: Generate impression based on findings.

Input: Left orbit lesion. Orbit: There is an enhancing tubular lesion with low diffusivity in the superonasal aspect of the left orbit that appears that appears to envelope part of the adjacent extraocular muscles. The lesion measures up to approximately 20 mm. The left globe and optic nerve are intact. The right orbit is unremarkable. The orbital walls are intact. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is a right parotid nodule with high T2 signal and heterogeneous enhancement that measures up to 12 mm.

Output: 1. An enhancing tubular lesion with low diffusivity in the superonasal aspect of the left orbit that appears that appears to envelope part of the adjacent extraocular muscles may represent a lymphoproliferative process or metastatic lesion, for example. 2. A right parotid nodule with high T2 signal and heterogeneous enhancement that measures up to 12 mm may represent a primary salivary gland neoplasm or metastasis.3. No evidence of intracranial lesions.


Instruction: Generate impression based on findings.

Input: Reason: assess for cervical myelopathy and radiculopathy History: abnormal sensation in LUE The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal enhancing lesions are identified in the cervical spine.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina. There is a mild disk bulge present at this level.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. The right vertebral artery is small. On the postcontrast sagittal T1 images appears to be some misregistration artifact which overlies the anterior aspect of the spinal cord at the C6-7 level

Output: There are mild degenerative changes present in the cervical spine without significant compromise of spinal canal or neural foramina. No abnormal mass lesions are appreciated in the cervical spine.


Instruction: Generate impression based on findings.

Input: Female, 34 years old, with history of a suprasellar lesion, surveillance examination Again seen is a lobular, heterogeneous, T1 and T2 hyperintense mass with both intrasellar and suprasellar components. The overall size and morphology of the lesion are not significantly changed. As before, the suprasellar portion of the lesion encroaches upon the third ventricle as well as the interpeduncular cistern. The lesion splays the optic tracts laterally, and the optic chiasm is not well seen and is likely impinged. The partially visualized brain parenchyma is unremarkable. A retention cyst is again seen in the left maxillary sinus.

Output: No significant interval change in the size or morphology of a large sellar and suprasellar mass.


Instruction: Generate impression based on findings.

Input: 50 year-old female with generalized abdominal pain. History of ulcerative colitis. Evaluate for inflammatory bowel disease. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Right adrenal mass measures 2 x 3 cm in axial image 30/14 series 3. This is incompletely evaluated on the postcontrast study. Further evaluation with dedicated adrenal CT or MRI examination may be helpful for further characterization, if indicated.KIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The colon is ahaustral and the descending colon contains small amount of fluid within mucosal enhancement. The appearance is consistent with history of ulcerative colitis. Normal appendix in the right lower quadrant. The terminal ileum appears normal.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXAE: There is a central pelvic uniloculated fluid density cystic lesion which measures 7 x 8 cm in axial image 120/154 of series 3. This is most likely of adnexal origin. Bilateral adnexal cysts, larger on the left measuring more than 5 cm in diameter. If clinically indicated, transvaginal ultrasound examination may be helpful for further evaluation.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: Ahaustral colon compatible with history of ulcerative colitis. No small bowel abnormality was identified. Central pelvic cystic lesion, probably adnexal measures 7 x 8 cm. Additional cystic lesions in the adnexae. Right adrenal mass.


Instruction: Generate impression based on findings.

Input: 51-year-old female with desmoid tumor. Evaluate for progression. Exam is limited due to the lack of intravenous contrast and respiratory motion artifact. Contrast extravasation as described above. Patient refused repeat contrast infusion.ABDOMEN:LIVER, BILIARY TRACT: The previously described small enhancing lesion in hepatic segment 7 is incompletely evaluated on this noncontrast exam. Similar size and appearance are noted on the T2 sequence (series 1601 image 51).SPLEEN: No significant abnormality noted.PANCREAS: Subcentimeter cystic foci of the pancreas are too small to completely characterize and could represent sidebranch IPMNs. The largest of these measures 6 mm and is located in the pancreatic tail (series 1501 image 28). No significant interval change.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Stable T2 hypointense mesenteric lesion measuring 6.3 x 4 cm (series 801 image 29) (prior 6.1 x 4 cm). The lack of intravenous contrast limits evaluation of the relationship to the SMA and SMV, which was seen to encase these vessels on the prior study. No bowel obstruction or ascites.BONES, SOFT TISSUES: Broad-based ventral hernias in the central and right abdominal wall containing loops of small bowel. No evidence for acute complication.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Enlarged uterus with a lobulated contour again noted. Multiple nabothian cysts are again seen. Stable mild thickening of the of the endometrial canal. Stable appearance of the T2 hyperintense and restricted diffusion mass (series 504 image 396) of the right aspect of the fundus measuring 5.7 x 3.5 cm (series 201 image 46) (prior 6.9 x 3.6 cm).BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Mild endplate degenerative changes of the lumbosacral junction.OTHER: No significant abnormality noted.

Output: 1.Stable appearance of the known small bowel mesenteric mass. The lesion was previously described to encase the SMA and SMV, however this evaluation is limited due to the lack of intravenous contrast.2.Contrast extravasation as described above.


Instruction: Generate impression based on findings.

Input: There is straightening of the upper cervical spine. There are no fractures or subluxations. The marrow signal is benign. The cervical and upper thoracic cord are normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.C2/3: Unremarkable and unchangedC3/4: Posterior osteophyte disc complex and bilateral uncinate hypertrophy. There is mild to moderate left neural foraminal and moderate right neural foraminal stenosis. Neuroforaminal stenoses have progressed.C4/5: Posterior osteophyte disc complex, bilateral uncinate hypertrophy, right facet hypertrophy. There is moderate bilateral neural foraminal stenosis. Neural foraminal stenosis or progressed.C5/6: Posterior osteophyte disc complex and bilateral uncinate hypertrophy (left greater than right). There is severe left and mild right neural foraminal stenosis. These findings are unchanged.C6/7: Posterior osteophyte disc complex and bilateral uncinate hypertrophy. There is mild to moderate bilateral neural foraminal stenosis. These findings are unchanged.C7/T1: Left facet hypertrophy causes new mild left neural foraminal stenosis.

Output: 1.C3/4: Mild to moderate left neural foraminal and moderate right neural foraminal stenosis. Neuroforaminal stenoses have progressed.2.C4/5: Moderate bilateral neural foraminal stenosis. Neural foraminal stenosis or progressed.3.C5/6: Severe left and mild right neural foraminal stenosis. These findings are unchanged.4.C6/7: Mild to moderate bilateral neural foraminal stenosis. These findings are unchanged.5.C7/T1: New mild left neural foraminal stenosis.


Instruction: Generate impression based on findings.

Input: MRI brain: There is no evidence of discernible mass in the visualized portions of the nasopharynx. There is redemonstration of heterogeneous marrow signal involving the central skull base including clivus with ill-defined enhancement which extends along bilateral left more than the right expanded pterygopalatine fossa, unchanged from the prior exam. There is mild diffuse enhancement extending to the right more than the left masticator space, grossly similar to prior exam. There is no new enhancement in the nasopharynx.There are scattered patchy foci of T2/FLAIR signal throughout the cerebral white matter which are nonspecific, most likely representing mild chronic small vessel disease, unchanged. There is a small focus of T2/FLAIR hyperintense lesion involving the left cingulate gyrus with associated punctate focus of susceptibility which may represent prior ischemic injury and associated chronic hemosiderin deposition, unchanged.There is an ill-defined apparent focus of enhancement along the right paramedian genu of the corpus callosum seen only on the coronal post contrast images of the brain (series 20, image 19), which was also suggested on coronal post-contrast images on the prior exam, however, not demonstrated on any other post-contrast sequences including post axial 3-D T1 weighted imaging and coronal postcontrast images through the orbits (although these are not as delayed). Hence this focus of enhancement is favored to be artifactual. Otherwise, there is no evidence of parenchymal enhancement or meningeal enhancement.The ventricles and sulci are within normal limits. The cisterns remain patent. There is no midline shift or mass effect. There is no diffusion abnormality. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. There is unchanged opacification of the anterior and posterior ethmoid air cells as well as mucosal thickening in the bilateral maxillary sinuses, similar to the prior exam. There are stable diffuse opacification of the bilateral mastoid air cells, similar to prior.MRI ORBITS: There is mild nonspecific non-mass-like enhancement in the right orbital apex corresponding to the site of previous tumor, unchanged from prior. Previously demonstrated intraorbital extension of tumor with mass effect on the medial rectus and right optic canal is completely resolved. No definite abnormal mass or abnormal enhancement is seen in the intraconal or extraconal compartment. No abnormal enhancement along the foramen rotundum or inferior orbital fissure. The optic nerves are normal in size and signal intensity, and are symmetric bilaterally. No retrobulbar mass, chiasmatic mass, or parasellar abnormality is seen. Extraocular muscles are unremarkable.

Output: 1. Stable posttreatment changes related to treated nasopharyngeal carcinoma with ill-defined enhancement involving the base of skull as well as pterygopalatine fossa extending to the right more than the left maxillary space without significant interval change compared to the prior exam. No evidence of tumor recurrence.2. Ill-defined apparent punctate focus of enhancement along the right paramedian genu of corpus callosum, which was not present on any other sequences, with similar focus of enhancement present on same sequence on the previous exam is felt to be artifactual. Attention on follow-up exam.3. No evidence of intraorbital mass or tumor extension.4. Scattered cerebral white matter T2/FLAIR hyperintense foci, may relate to chronic small vessel ischemic changes, similar to prior.5. Stable extensive opacification of the bilateral ethmoid air cells and bilateral maxillary sinuses as well as opacification of the bilateral mastoid air cells.


Instruction: Generate impression based on findings.

Input: Reason: Rotator cuff tear History: Shoulder pain ROTATOR CUFF: T2 hyperintense signal and thickening of the supraspinatus tendon indicates moderate tendinopathy with intact fibers. Globular T2 hyperintense signal and thickening is also seen at the attachment of the infraspinatus tendon, indicating mild tendinopathy.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is globular hyperintense signal within the superior and inferior aspects of the glenoid labrum. Otherwise no gross abnormality is seen on this noncontrast exam.BICEPS TENDON: There is mild increased signal in the horizontal component of the biceps tendon. ADDITIONAL

Output: 1. Moderate tendinopathy of the supraspinatus tendon with intact fibers.2. Mild tendinopathy of the infraspinatus tendon.3. Degenerative changes of the glenohumeral and acromioclavicular joints as described above.


Instruction: Generate impression based on findings.

Input: Pain in the right arm and shoulder. PT thinks it may be from c-spine. Brachial neuritis. The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina. There are small right sided uncovertebral osteophytes at this level with mild narrowing of the right neural foramen but with out nerve root compromise. At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.There is no significant compromise to the cervical spinal canal or exiting nerve roots to explain the patient's radiculitis.


Instruction: Generate impression based on findings.

Input: 29 years Female (DOB:3/9/1987)Reason: perr patient, diagnosed with small mass to the brain x 10-15yrs/ago History: severe headaches QODPROVIDER/ATTENDING NAME: PATRICIA CHAPMAN-KELLY PATRICIA CHAPMAN-KELLY There is opacification of the sphenoid sinus associated with the T1 and FLAIR signal hyperintensity and deformity of the sphenoid bone and superior aspect of the clivus. This does not appear to involve the cavernous sinuses or pituitary gland. It does appear to narrow the right pterygomaxillary fissure. There is a CT scan from 1/23/2013 which indicates this is also present at this time. In general it has not changed substantially in size since the prior exam. Their imaging studies dating back to 2/24/2004 and 10/8/2002 which demonstrated the same lesion. Signal characteristics and changed somewhat since the 12/11/2008 examThe cerebellar tonsils extend 6 mm below the level of the foramen magnum.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.There is diffuse marrow replacement present within the visualized calvarium and upper cervical spine

Output: 1.There is fibrous dysplasia involving the sphenoid bone appears stable in overall size but has changed in signal characteristics compared to prior exams.2.Marrow replacement is compatible patient's clinical diagnosis of sickle cell.3.Low-lying cerebellar tonsils are present. This compatible with Chiari I malformation. There is no evidence for ventriculomegaly.


Instruction: Generate impression based on findings.

Input: Diagnosis: Unspecified cerebral artery occlusion with cerebral infarction Unspecified cerebral artery occlusion with cerebral infarctionClinical question: evaluate for new strokeSigns and Symptoms: L sided hemiparesis and sensory loss The CSF spaces are appropriate for the patient's stated age with no midline shift. Incidental note is made of cavum septum pellucidum and cavum vergae.There is encephalomalacia involving the right cuneus. There is no associated focus of diffusion restriction on the current exam. On the prior exam from March there was a diffusion restriction in this location.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.Since the prior examination the patient has developed several subcutaneous nodules adjacent to the left parietal bone and left lambdoid suture. The largest one measures 10 mm in size. They are high signal on T2 and low signal on T1 imaging. They are not associated with diffusion restriction.Images were acquired using fast imaging techniques. More subtle abnormalities may be overlooked as a result.

Output: 1.There is continued evolution of a cerebral infarction involving the right cuneus which is now in the chronic stage.2.There is no evidence for acute ischemic cerebral infarction.3.Heterogeneous nodules along the left parietal scalp soft tissues near the lambdoid suture most likely represent sebaceous cysts but are nonspecific. Please correlate with clinical findings on physical exam.4.Images were acquired using fast imaging techniques. More subtle abnormalities may be overlooked as a result.


Instruction: Generate impression based on findings.

Input: Evaluate orbits for signs of inflammation or abnormal neurological anatomy: Pendular nystagmus. Born at 36 week GA. Brain: There is myelination in the bilateral posterior limbs of the internal capsules, occipital lobes, and perirolandic regions, well as most of the brainstem and cerebellum. However, there is no evidence of myelination in the anterior limbs of the internal capsules bilaterally. There is no evidence of 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 or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Orbits: The bilateral globes and ocular adnexa are unremarkable. There is no evidence of abnormal intraorbital enhancement or mass lesions.

Output: 1. Findings suggestive of delayed myelination. No evidence of intracranial hemorrhage, mass, or acute infarct. 2. No evidence of orbital lesions.


Instruction: Generate impression based on findings.

Input: Evaluate for obstructive mass. Patient found to have duodenal obstruction at D2/D3 on upper GI study 1/21/2016. Metastatic urothelial bladder cancer with retroperitoneal lymph nodes. ABDOMEN:LIVER, BILIARY TRACT: Numerous bilobar subcentimeter T2 hyperintense lesion, too small to characterize, similar to prior.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral percutaneous nephroureterostomy stents are in place, terminating in the urinary bladder, unchanged from prior. No hydronephrosis. Left lower pole simple cyst, unchanged.RETROPERITONEUM, LYMPH NODES: Paraduodenal lymph node measures 1.0 x 0.8 cm (Series 1104, image 80). Additional small retroperitoneal lymph nodes are present.BOWEL, MESENTERY: Enteric tube terminates within the stomach. There is severe narrowing/obstruction of the second/third portion of the duodenum (series 4, image 31), compatible with prior site of obstruction on upper GI series January 21, 2016, and probably progressed from prior CT January 20, 2016. These findings may represent a high-grade stricture, anterior paraduodenal hernia or less likely mass. Status post left lower quadrant colostomy. There is unchanged colonic wall and perirectal thickening.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Severe narrowing/obstruction of the second/third portion of the duodenum, may represent a high-grade stricture, paraduodenal hernia or less likely mass. Upper endoscopy is recommended. 2.Unchanged colonic and bladder wall thickening.Findings were discussed by Dr. Stephen Thomas with the surgical team January 25, 2016.


Instruction: Generate impression based on findings.

Input: Unspecified convulsions [R56.9], Reason for Study: ^Reason: r/o structural lesion History: seizures There is no evidence of acute ischemic or hemorrhagic lesion on this scan.There is no mass lesion either.About 3mm caudal descent of cerebellar tonsil is seen.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: About 3mm caudal descent of cerebellar tonsil otherwise unremarkable brain MRI.


Instruction: Generate impression based on findings.

Input: Reason: multifocal AA. s/p RT/TMZ+TMZ. History: AA. Expansile and infiltrative T2 hyperintense lesion involving the left pons, midbrain and thalamus without enhancement or diffusion restriction is unchanged in size and distribution. Extension into the left medial temporal lobe with mass effect on the left hippocampus is similar to the prior exam. Increased T2 signal along the left lateral cerebellar hemisphere is also unchanged. There are 2 small T2 hyperintense cysts along the medial margin of the center lesion at the approximate imaging level of the hippocampus, measuring up to 3 mm (series 11, images 19 and 20) which are increased in size since the prior exam, and not definitely visualized on the baseline exam.Postsurgical changes including right cerebellar tissue loss appear similar to the prior exam. Several scattered foci of susceptibility, particularly along the right cerebellar hemisphere appear similar to the prior exam. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Nonenhancing mass involving the left pons, midbrain and thalamus is unchanged in size, however there are tiny 3 mm cysts at the margins of the lesion which have emerged and are minimally increasing in size, of uncertain clinical significance. Close attention is recommended on follow-up.


Instruction: Generate impression based on findings.

Input: There are scattered patchy T2/FLAIR hyperintensities in the periventricular and subcortical white matter, in the pons, and in the left cerebellum, suggestive of chronic small vessel ischemic findings, stable since previous study. There is no diffusion abnormality. A punctate dark susceptibility signal is seen in the right basal ganglia suggestive of previous microhemorrhage, stable since previous study. Ventricular size is normal with no midline shift. Basal cisterns are again. No abnormal enhancement.

Output: No evidence of intracranial metastatic lesions.


Instruction: Generate impression based on findings.

Input: Unspecified fever [780.60] Motion artifact degraded image quality.In addition, FLAIR imaging was not completed specifically, the FLAIR imaging on the covered skull base to the level of midbrain. Therefore, if indicated, the study should be repeated without additional charge.On covered imaging, there is no evidence of acute ischemic or hemorrhagic lesion.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. 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: Examination can be repeated without additional charge due to incomplete examination with the motion artifacts as described above.No evidence of acute ischemic or hemorrhagic lesion.No remarkable finding otherwise.


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: Reason: 49yo M with h/o ETOH/HCV cirrhosis s/p OLT 2014 c/b rouxeny limb obstruction syndrome and cholangitis. Here w/fever, RUQ pain. Needs further eval History: fevers, RUQ, ABDOMEN:LIVER, BILIARY TRACT:Postsurgical changes of liver transplant. The biliary enteric anastomosis is is patent. No intrahepatic biliary ductal dilatation. The remnant common bile duct is unremarkable. Artifact in the portal vein may be related to air.SPLEEN: Significant splenomegaly measuring 18.3 cm in craniocaudal dimension.PANCREAS: 3 mm T2 hyperintensity in the pancreatic head which communicates with a nondilated pancreatic duct likely represents a sidebranch IPMN.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right mid pole T2 hyperintensity is nonspecific without intravenous contrast.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postsurgical changes of Roux-en-Y jejunojejunostomy. No evidence of obstruction of the Roux limb. There are a few mildly dilated mid abdominal bowel loops not significantly changed from the prior CT.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Status post liver transplant with normal appearing biliary enteric anastomosis and no evidence of obstruction. Please note that evaluation of cholangitis is limited due to lack of intravenous contrast.2.No evidence of obstruction of the afferent limb.3.Small cyst in the pancreatic head measuring up to 3 mm likely represents a sidebranch IPMN.


Instruction: Generate impression based on findings.

Input: Left trapezius pain. Concern for neural foraminal stenosis. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained. Bone marrow signal is within normal limits. The cervical spinal cord has normal signal characteristics and overall morphology.Mild degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: No significant compromise to the spinal canal or neural foramina.C4-5: No significant compromise to the spinal canal or neural foramina.C5-6: Small right paracentral disc osteophyte complex and ligamentum flavum thickening. No significant compromise to the spinal canal or neural foramina.C6-7: Small left paracentral disc osteophyte complex and ligamentum flavum thickening. No significant compromise to the spinal canal or neural foramina.C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: Mild degenerative changes in the cervical spine. No significant spinal canal stenosis or neural foraminal stenosis at any level.


Instruction: Generate impression based on findings.

Input: 18-year-old male with intermittent left elbow swelling. There is mild increased signal intensity and enhancement in the distal triceps tendon at its insertion on the olecranon with perhaps minimal signal abnormality in the underlying bone suggestive of a mild enthesitis. The bone marrow signal intensity is otherwise unremarkable. We see no evidence of an osteochondral defect. The remaining tendons are unremarkable. Ligaments are unremarkable.There is a small elbow joint effusion. There is mild synovial enhancement suggesting mild synovitis, but the degree of synovial inflammation is decreased when compared to the prior study from 2013. We see no evidence of erosions.There are small foci of signal void within the elbow joint and adjacent soft tissues which may reflect prior intervention.

Output: 1. Small joint effusion with interval decrease in synovial inflammation when compared to the prior study.2. There is perhaps a mild enthesitis of the triceps at its insertion on the olecranon.


Instruction: Generate impression based on findings.

Input: Epilepsy, unspecified, not intractable, without status epilepticus [G40.909], Reason for Study: ^Reason: evaluate for seizure. pt has EEG small sharp spikes over L \T\ R temporal areas History: she reported 3 convulsive episodes over 2015-2016 \T\ staring No evidence of acute ischemic or hemorrhagic lesion on the scan.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: Normal brain MRI.


Instruction: Generate impression based on findings.

Input: Evaluate any change in size of the cranial bone lesion. Immediately preop. Nonenhanced head CT:A lytic bony lesion of the right parietal lobe along its inferior aspect measuring 12.8 times 6-mm in size. This lesion is similar to prior study in measurement. There is significant thinning of the inner table of the skull however the outer table of the skull is still in tact. There is no epidural soft tissue thickening at this site. Further evaluation with an enhanced MRI or CT is recommended to exclude epidural spread of tumor. The calvarium is otherwise intact. There is no evidence of intracranial hemorrhage, edema, mass effect, midline shift or hydrocephalus.The cortical sulci, ventricular system, CSF cisterns and gray -- white matter differentiations are within normal.

Output: 1.Stable small lytic right parietal bone lesion since prior study.2.Negative none diffuse head CT otherwise. A


Instruction: Generate impression based on findings.

Input: 55 year ol woman with history of heart failure with preserved LVEF, referred for vasodilator stress testing as part of research trial.MEDICATIONS: amlodipine, ASA, lipitor, coreg, enalapril, lasix, aldactone. First Pass PerfusionDuring hyperemia, no perfusion defects were present.Viability/ Myocardial ScarThere is a borderline region of late gadolinium enhancement involving the basal inferior and inferolateral wall. The pattern is atypical for prior myocardial infarction and suggests the presence of underlying myocardial fibrosis, inflammation, or infiltration. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 67%, the LV end diastolic volume index is 97 ml/m2 (normal range: 65+/-11), the LVEDV is 168 ml (normal range 109+/-23), the LV end systolic volume index is 32 ml/m2 (normal range 18+/-5), the LVESV is 55 ml (normal range 31+/-10), the LV mass index is 80 g/m2, and the LV mass is 140 g. There is moderate concentric left ventricular hypertrophy (IVS 13mm). There are no regional wall motion abnormalities present. The native myocardial T1 time is 1205ms, which is significantly elevated. The extracellular volume fraction is 36% (normal 20-30%). Both of these findings also support the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 63%, the RV end diastolic volume index is 72 ml/m2 (normal range 69+/-14), the RVEDV is 124 ml (normal range 110+/-24), the RV end systolic volume index is 27 ml/m2 (normal range 22+/-8), and the RVESV is 46 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a "psuedo-bovine" brachiocephalic branching pattern (normal variant). Mild atherosclerosis is noted in the descending aorta. Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThyroid enlargement is noted. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. No perfusion defects/ "ischemia" present during hyperemia.2. There is a borderline region of late gadolinium enhancement involving the basal inferior and inferolateral wall. The pattern is atypical for prior myocardial infarction and suggests the presence of underlying myocardial fibrosis, inflammation, or infiltration. The native myocardial T1 time is 1205ms, which is significantly elevated. The extracellular volume fraction is 36% (normal 20-30%). Both of these findings also support the presence of an underlying fibrosing, infiltrative, or inflammatory process.3. Normal LV size and systolic function (LVEF 67%). There is moderate concentric left ventricular hypertrophy.4. Normal RV size and systolic function (RVEF 63%).5. Mild atherosclerosis is noted in the descending aorta.6. Thyroid enlargement is noted. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Female, 71 years old, with remote history of squamous cell carcinoma of the supraglottic larynx, and more recent history of lung adenocarcinoma, with focus of abnormal uptake seen within L5 on prior PET scanning. Assess for metastatic disease. On a background of heterogeneous marrow, there are numerous focal areas of pathologic marrow replacement within the osseous structures of the lumbar spine. A lesion is indeed seen within the right aspect of the L5 vertebral body correlating to an area of abnormal PET hypermetabolism. However, multiple additional foci are seen in nearly every other vertebral body as well. No evidence of extraosseous or epidural disease extension is seen.Spinal alignment is anatomic. Vertebral body heights are preserved. There is a transitional morphology of the L5 vertebral body. The visualized distal spinal cord, conus and nerve roots of the cauda equina demonstrate normal signal characteristics. No epidural abnormalities are suspected.L1-2: Unremarkable. L2-3: Unremarkable. L3-4: Mild loss of disc height and mild disc bulging. Mild to moderate generalized spinal canal narrowing. Mild bilateral foraminal narrowing. L4-5: Mild facet hypertrophy and ligamentum flavum thickening. Mild bulging disc with a small superimposed central protrusion. Moderate generalized spinal canal stenosis. Mild right foraminal narrowing. L5-S1: Moderate left and mild right facet hypertrophy. Very small central annular disc fissure. No significant spinal canal stenosis. No foraminal narrowing.

Output: 1.Numerous foci of pathologic marrow replacement are seen within nearly every vertebral body level of the visualized lumbar spine. Given the history, these are highly suspicious for metastatic deposits. No evidence of any significant extraosseous or epidural disease extension is seen.2.Multilevel degenerative findings are noted as above. Specifically, there is a mild to moderate spinal canal stenosis at L3-4, and a moderate spinal canal stenosis at L4-5.


Instruction: Generate impression based on findings.

Input: Ms. Broughton is a 68-year-old female with a personal history of right breast lumpectomy for IDC/DCIS along with personal history of LCIS/ALH in right breast and focal ALH/UDH in left breast in 2007. She has no current breast related complaints. There is heterogeneous amount of fibroglandular tissue in both breasts. Mild background parenchymal enhancement is noted bilaterally.Susceptibility artifact is seen in the upper right breast, corresponding to the surgical clips from patient's prior lumpectomy. There is no abnormal enhancement seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.

Output: Stable postsurgical changes of the right breast. No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: Glioblastoma status post surgery and radiation therapy. There has been interval evolution postsurgical changes related to left frontotemporal craniotomy with mild enhancement along the margins of the insular lobe resection cavity and susceptibility effect within the resection cavity. Otherwise, there is no significant change in the extent of the confluent T2 hyperintensity in the remaining portions of the left insula and anterior left temporal lobe. There is no evidence of acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable.

Output: Interval evolution postsurgical changes with mild nonspecific enhancement along the margins of the insular lobe resection cavity. Otherwise, no significant change in the residual T2 hyperintense portions of the tumor in the left insula and anterior left temporal lobe.


Instruction: Generate impression based on findings.

Input: Brain MRI:A punctate focus of susceptibility weighted artifact is again seen in the posterior right putamen without blooming artifact. The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. Brain MRA:There is antegrade flow within the distal bilateral vertebral arteries, within the basilar artery, distal bilateral internal carotid arteries and carotid siphons and bilateral anterior, middle and posterior cerebral arteries. The circle of Willis is intact without arterial stenoses, occlusions or aneurysms. The right vertebral artery is hypoplastic with a dominant left vertebral artery, a normal variation. No arteriovenous malformations are identified and there is no evidence for cerebral vasculitis.

Output: 1.Stable focus of susceptibility artifact in the right putamen of questionable clinical significance. This is likely a focus of microhemmorhage, calcification, or very small cavernoma.2.No significant abnormality of the intracranial arteries.


Instruction: Generate impression based on findings.

Input: Ms. Hoyer-Lareau is a 53 year old female with a personal history of right lateral breast excisional biopsy in 7/2015 for intraductal papilloma with FEA/ADH and additional benign biopsy of the right medial breast for intraductal papilloma. Family history of breast cancer in mother, diagnosed at the age of 55. She presents today for MRI evaluation for screening purposes. There is heterogeneous amount of fibroglandular tissuein both breasts. Mild background parenchymal enhancement is noted bilaterally.Stable enhancing mass is seen in the right central breast, unchanged in appearance since MRI from 2007. Scattered benign simple cysts are seen bilaterally. No abnormal enhancement is seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Chronic history of thumb pain. Possible MCP ulnar collateral ligament versus radial collateral ligament injury. The majority of the ulnar collateral ligament proper can be followed from the head of the metacarpal to the base of the proximal phalanx. However, there is edema-type signal within the soft tissues adjacent to the dorsal and ulnar aspect of the base of the proximal phalanx and therefore I suspect that there is a partial thickness tear of the ulnar collateral ligament proper at its attachment to the proximal phalanx. The ligament is not displaced, and there is no Stener lesion. There is intermediate signal intensity within the radial collateral ligament proper that may either reflect degeneration or a prior sprain, but I see no frank disruption of the ligament. I see no findings to suggest disruption of the accessory collateral ligaments, and the sesamoid bones appear normal. Mild osteoarthritis affects the metacarpophalangeal joint. The collateral ligaments of the interphalangeal joint of the thumb appear normal. The flexor and extensor tendons of the thumb appear normal. Bone marrow signal intensity is normal.

Output: Mild edema along the dorsal and ulnar aspect of the base of the proximal phalanx of the thumb suggests a partial thickness tear of the ulnar collateral ligament proper. Other findings as above.


Instruction: Generate impression based on findings.

Input: History of hepatitis C. Renal mass seen on ultrasound. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology, size and signal intensity. There are numerous simple and minimally complex bilobar cysts. No focal suspicious lesion. Normal distended gallbladder. No biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: Approximately 5 mm distal pancreatic body cystic lesion likely communicates with the main pancreatic duct, compatible with a sidebranch IPMN without suspicious imaging features. Additional punctate cystic foci, likely small IPMNs.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral cysts. In the right interpolar region there is a 5.9 x 6.0 x 5.4 cm mass demonstrating heterogeneous T2-weighted signal predominantly isointense with the renal parenchyma and a hypointense capsule. The lesion demonstrates mild enhancement. It extends into the perirenal fat but not beyond the pararenal fascia. No locoregional lymphadenopathy, significant extension into the collecting system or renal vein involvement.There are several punctate subcentimeter intrinsically T1 weighted hyperintense foci in the left kidney likely representing proteinaceous/hemorrhagic cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 6 cm right interpolar mildly enhancing mass is suspicious for a renal cell carcinoma specifically a papillary subtype given its relatively low T2-weighted signal intensity and hypoenhancement. No evidence of renal vein invasion or locoregional lymphadenopathy. Bilateral hepatic and renal simple/minimally complex cysts.


Instruction: Generate impression based on findings.

Input: Ms. Nichols is a 47-year-old female with history of right breast cancer status post mastectomy in 2008, implants 2009. History of chemotherapy and hormonal therapy. History of benign MRI-biopsy of the left breast in 2009. No current breast complaints. Three standard views and two implant displaced views of the left breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density(BiRads Density Category B), unchanged in pattern and distribution. There are no new masses, suspicious microcalcifications or areas of architectural distortion in the left breast. A biopsy clip is present in the left breast from prior benign MRI biopsy. An asymmetry in the left upper inner breast is not significantly changed since 2012.

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


Instruction: Generate impression based on findings.

Input: Female 77 years old; Reason: chronic R knee pain Due to the patient's body habitus and knee swelling, the high-definition MRI coil was not able to be used. An alternate coil was used, resulting in suboptimal image quality.MENISCI: There is horizontally oriented signal abnormality within the posterior horn of the medial meniscus extending to the femoral articular surface, indicating a horizontal tear. Globular signal abnormality replaces much of the body of the medial meniscus, compatible with mucoid degeneration, and extends to the femoral articular surface suggesting additional degenerative tearing. The anterior horn of the medial meniscus is relatively intact.The anterior horn of the lateral meniscus is not visualized, likely secondary to extensive degeneration and tearing. There is deformity and signal abnormality of the body of the lateral meniscus, particularly anteriorly, indicating extensive tearing. The body of the lateral meniscus is extruded laterally. The posterior horn of the lateral meniscus is relatively intact.ARTICULAR CARTILAGE AND BONE: Moderate-to-severe tricompartmental osteoarthritis affects the knee, with areas of full-thickness cartilage loss in all 3 compartments. Multiple foci of degenerative edema-type signal and subchondral cysts are seen in the underlying bone. Tricompartmental osteophytes are noted.LIGAMENTS: The ACL is intact, though with increased signal intensity, indicating mucoid degeneration. The PCL is intact. Linear increased signal within the proximal fibers of the MCL may represent an old tear, however, we see no adjacent edema to suggest acute injury. The LCL complex is intact.EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Osteoarthritis, meniscal tears, and joint effusion, as described above.


Instruction: Generate impression based on findings.

Input: Basilar invagination status post suboccipital craniectomy and C1 laminectomy for decompression of brainstem. There are recent postoperative findings related to suboccipital craniectomy and C1 laminectomy for decompression of brainstem, with a small amount of fluid and emphysema along the surgical approach. There is a dysmorphic clivus, a prominent dens, and basilar invagination with persistent indentation upon the medulla by the dens, although the degree of spinal canal stenosis at the level of the dens has diminished. There is also considerable interval decrease in the extent of T2 hyperintensity within the spinal cord at the level of the dens, perhaps now with mild volume loss of the spinal cord at this location. There is long-segment fine linear T2 hyperintensity that extends inferiorly from this lesion along the left aspect of the spinal cord. The vertebral bone marrow signal is unremarkable and the aliment of the cervical spine is anatomic, beyond the region of the craniocervical junction. There are right thyroid nodules, which measure at least up to 15 mm. There is mild mucosal thickening in the maxillary sinuses.

Output: 1. Recent postoperative findings related to suboccipital craniectomy and C1 laminectomy for decompression of brainstem in the setting of basilar invagination, with persistent indentation upon the medulla by the prominent dens, but decreased spinal canal stenosis and spinal cord edema at the level of the dens, with what may represent the development of myelomalacia and associated right Wallerian degeneration.2. Right thyroid nodules. A thyroid ultrasound may be useful for further evaluation.


Instruction: Generate impression based on findings.

Input: Shoulder pain and weakness ROTATOR CUFF: There is no evidence of rotator cuff tear. Mild increased signal in the distal fibers of the supraspinatus are noted reflecting tendinosis.SUPRASPINATUS OUTLET: There is a mild amount of subacromial subdeltoid fluid. No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is age-related degeneration of the superior labrum but without detachment. Otherwise no significant abnormality noted.BICEPS TENDON: A mild amount of fluid surrounds the biceps tendon. Otherwise no significant abnormality noted. ADDITIONAL

Output: Mild supraspinatus tendinosis without evidence of rotator cuff tear.


Instruction: Generate impression based on findings.

Input: 73-year-old female with right facial numbness. Evaluate for ischemia. There is no evidence of intracranial hemorrhage, mass or edema. Focus of decreased attenuation is present in a wedge-shaped distribution in the right posterior cerebellum reflecting prior infarct in a posterior inferior cerebellar artery distribution. There are multifocal regions of low attenuation throughout the subcortical and deep white matter periventricular distribution, nonspecific, however most likely representing small vessel ischemic disease, age indeterminate. If there is clinical concern for acute ischemia, an MRI may be considered.No areas of acute cortical ischemia identified.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. There is near complete opacification of the left maxillary sinus which represents a retention cyst, unchanged. The remaining visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. No evidence of acute cortical ischemia.2. Multifocal regions of low attenuation white matter which most likely represent small vessel ischemic disease, age indeterminate. If there is clinical concern for acute ischemia, an MRI may be considered.


Instruction: Generate impression based on findings.

Input: 28-year-old male with Crohn's disease flare. Abdominal pain. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: The liver is diffusely enlarged with a craniocaudal dimension of 20.7 cm.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Findings consistent with Crohn's disease identified throughout the colon including attenuated caliber, post-inflammatory polyps and global loss of haustration. Distal ileum and cecum and descending colon wall thickening are best demonstrated on coronal image 50/71. The wall thickening is most pronounced at the splenic flexure seen best at the splenic flexure on axial image 45/147 of series 3 and coronal image 27/71.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No free or loculated fluid.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: There is a small collection of air in the right perianal region with fluid density and may represent a fissure and tract seen best on axial image 128/147 and coronal image 22/71. This may be further evaluated with an MRI examination if indicated.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Diffuse changes in the colon compatible with long-standing Crohn's disease. Wall thickening is most pronounced at the distal ileum, cecum, ascending colon, and splenic flexure. Probable right sided perianal fissure and tract. See above.


Instruction: Generate impression based on findings.

Input: Male 16 years old Reason: Change in pelvic mass s/p 4 cycles of consolidation History: 15 year old with metastatic Ewing's sarcoma The mass around the left iliac bone is slightly decreased in size. When using a similar measuring technique, the medial component of the mass now measures 5.5 x 1.0 x 7.0 cm, previously 6.6 x 1.1 x 8.1 cm, and the lateral component measures 6.3 x 1.0 x 6.0 cm, previously 7.7 x 1.0 x 6.9 cm. The mass again demonstrates avid enhancement and increased T2 signal.Innumerable nearly confluent osseous metastases are again seen within the lower lumbar spine, pelvis and femurs, without substantial interval change. New small volume ascites is noted.

Output: 1.Mass around iliac bone, slightly decreased in size compared to the prior examination.2.Innumerable confluent osseous metastatic lesions, without substantial change.3.New small volume ascites.


Instruction: Generate impression based on findings.

Input: Female 55 years old Reason: evaluation for pelvic pain in this renal transplant patient with history of nephrectomy, transplant and recurrent infections History: pain in the pelvic area radiating down her legs PELVIS:UTERUS, ADNEXA: Uterus appears atrophic.BLADDER: Bladder is suboptimally distendedLYMPH NODES: No pelvic lymphadenopathyBOWEL, MESENTERY: Distended cecum with a fluid/fluid levelBONES, SOFT TISSUES: Right lower quadrant renal allograft without perinephric collections. No hydronephrosis. There are small parenchymal cysts.Pelvic laxity.OTHER: Linear T2 hyperintense tract seen on the axial T2-weighted images extends from the anus at the 6:00 position suspicious for a small perianal fistula.

Output: 1.Findings suspicious for a small perianal fistula at the 6 o clock position which is only partially imaged.


Instruction: Generate impression based on findings.

Input: History of L2 kyphoplasty, with back pain. Evaluate for stability, bone anatomy. Again seen is an anteriorly wedged L3 compression fracture, appearing similar to the prior MRI. There is diffuse sclerosis of the L2 vertebral body, consistent with known kyphoplasty. There are severe degenerative changes affecting the remainder of the lumbar spine with loss of normal lordosis. No evidence of instability across the flexion, neutral, and extension views.

Output: Chronic L3 compression fracture with severe degenerative changes of the lumbar spine, without evidence of instability.