Instruction: Generate impression based on findings.

Input: Female 8 years old with chronic ankle pain. TENDONS: The Achilles, posterior tibialis, flexor digitorum and flexor hallucis tendons and peroneus complex are intact. LIGAMENTS: The anterior and posterior tibiofibular ligaments, ATFL and deltoid ligaments are intact.ARTICULAR SURFACES AND BONE: Low T1 and high T2 signal is present in the cuboid bone, most in the prominent along the medial aspect, with mild postcontrast enhancement. The ankle mortise and talar dome are intact. There are no osteochondral defects. ADDITIONAL

Output: Findings can be seen in cuboid stress fracture, correlation with radiographs is recommended. Osteomyelitis is considered less likely given the lack of soft tissue edema and chronic course of symptoms however correlation with inflammatory markers is suggested.


Instruction: Generate impression based on findings.

Input: Known history of right vestibular schwannoma: Dizziness, Imbalance. The bilateral cranial nerve 7 and 8 complexes are intact. There is no evidence of mass lesions. The bilateral inner ear structures, including the cochlea, vestibule, endolymphatic duct, and semicircular canals, appear unremarkable. The bilateral mastoid air cells and middle ears also appear unremarkable.

Output: No evidence of retrocochlear or inner ear lesions.


Instruction: Generate impression based on findings.

Input: Diagnosis: Unspecified convulsions Malignant neoplasm of brain, unspecified Unspecified convulsions Malignant neoplasm of brain, unspecified MRI brain:There is a 12 x 23 mm axial dimension mass located at the medial aspect of the right temporal lobe which is homogeneously high signal on T2 and homogeneously low signal on T1. There is no associated contrast enhancement. It displaces the right posterior communicating artery medially and protrudes into the suprasellar cistern along its posterior aspect. It is within a millimeter of the infundibulum of the pituitary gland. It impresses upon the right cerebral peduncle and also displaces the basal vein of Rosenthal superiorly. It drapes over the tentorium. The right optic tract is displaced superiorly. Compared to the previous exam from 8/14/2015 and has not changedNormal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI pituitary:The pituitary gland is appropriate in overall height and morphology. The infundibulum of the pituitary gland is midline. No suprasellar or intrasellar mass is identified. The cavernous sinuses are intact bilaterally.

Output: There is redemonstration of a right medial temporal lobe mass which is stable compared to the prior exam and is known to represent an exophytic pilocytic astrocytoma. It is stable compared to the prior exam.


Instruction: Generate impression based on findings.

Input: Male 39 years old Reason: s/p ACL recon by Dr. Martin Leland. Check for ACL re-tear versus meniscus re-tear. History: knee pain and swelling. MENISCI: Again seen is vertically-oriented increased signal intensity within the peripheral fibers of the posterior horn of the medial meniscus indicating a longitudinal tear. The tear is less prominent on the current study than on the prior study and contains intermediate and low signal intensity suggesting prior repair and partial healing. However, there is a vertically oriented linear focus of higher signal intensity within the inferior aspect of the tear that is suspicious for a focal retear of the undersurface of the meniscus. Additionally, there is a small focus of increased signal intensity more anteriorly along the undersurface of the red/white zone of the posterior horn of the medial meniscus, likely representing a new undersurface tear. The anterior horn and body of medial meniscus appear intact.There is mild deformity of the root of the posterior horn of the lateral meniscus, likely representing repair of a tear at this location, but we see no findings to suggest retear or new tear of the posterior horn. There is, however, a new partial thickness radial/oblique tear of the anterior horn of lateral meniscus.ARTICULAR CARTILAGE AND BONE: There is focal loss of cartilage along the posterior aspect of the medial tibial plateau beneath the meniscal tear, with edema type signal in the underlying bone. There is also mild heterogeneity of the articular cartilage of the weight-bearing portion of the medial femoral condyle suggesting mild degeneration with mild edema type signal in the underlying bone. There is increased signal intensity within the articular cartilage of the lateral femoral condyle above the posterior horn of the lateral meniscus, likely representing focal degeneration, with a cyst in the underlying bone that is new when compared with the prior study. There is a full thickness cleft through the articular cartilage of the medial facet of the femoral trochlea, with degeneration of the articular cartilage. This appears slightly more extensive on the current study than on the prior study. There is mild edema within the medial tibial spine; this is nonspecific.LIGAMENTS: Patient is status post ACL reconstruction. The anterior cruciate ligament is heterogeneous in signal, perhaps due to "neo-ligamentization", but fibers can be traced from the femur to the tibia and we see no specific features of a retear. The posterior cruciate ligament is intact. The medial collateral ligament is abnormally thickened, indicating prior injury, but we see no fluid filled tear at this time. The lateral collateral ligament complex is intact. EXTENSOR MECHANISM: There are chronic enthesopathic changes within the distal quadriceps, but otherwise the extensor mechanism is intact.ADDITIONAL

Output: 1.ACL reconstruction as described above, with heterogeneous signal intensity of the graft that is favored to represent "neo-ligamentization" rather than tearing.2.Intermediate to low signal intensity tissue anterior to the graft may represent residual torn ACL fibers, but we cannot exclude the possibility of focal arthrofibrosis ("cyclops lesion").3.New radial tear of the anterior horn of the lateral meniscus.4.Findings suggestive of new and recurrent undersurface tears of the posterior horn of the medial meniscus.5.Cartilage abnormalities and other findings as described above.


Instruction: Generate impression based on findings.

Input: There is reversal normal upper cervical curvature. 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: Left facet appear to be causes mild left neural foraminal stenosis.C3/4: Posterior osteophyte disc complex and bilateral uncinate hypertrophy. There is moderate bilateral neural foraminal stenosis.C4/5: Posterior osteophyte disc complex, bilateral uncinate hypertrophy, and ligamentum flavum flavum thickening. There is mild central and moderate bilateral neural foraminal stenosis.C5/6: Posterior osteophyte disc complex, ligamentum flavum thickening, and right facet hypertrophy. There is mild central and moderate right neural foraminal stenosis.C6/7: Posterior osteophyte disc complex, bilateral uncinate hypertrophy, and ligamentum flavum thickening. There is mild to moderate central, moderate to severe left neural foraminal, and moderate right neural foraminal stenosis.C7/T1: Unremarkable

Output: 1.C2/3: Mild left neural foraminal stenosis.2.C3/4: Moderate bilateral neural foraminal stenosis.3.C4/5: Mild central and moderate bilateral neural foraminal stenosis.4.C5/6: Mild central and moderate right neural foraminal stenosis.5.C6/7: Mild to moderate central, moderate to severe left neural foraminal, and moderate right neural foraminal stenosis.


Instruction: Generate impression based on findings.

Input: 42-year-old male with persistent left knee pain unresponsive to conservative therapy. MENISCI: There is a complex but predominantly horizontal tear of the posterior horn of the medial meniscus with branching signal abnormality which extends to both the tibial and femoral articular surfaces. The signal within portions of the tear approaches that of fluid, suggesting a relatively large and potentially unstable tear. The body and anterior horn of the medial meniscus appear intact. There is a small undersurface tear of the free edge of the body of the lateral meniscus. Blunting of the undersurface of the free edge of the posterior horn may represent an additional tear.ARTICULAR CARTILAGE AND BONE: There is a vertical fracture through the lateral aspect of the patella with clefts in the overlying articular cartilage. There is an additional cleft in the articular cartilage just lateral to the median eminence of the patella as well as superficial fraying of the articular cartilage of the medial facet of the patella. There is degeneration of the articular cartilage of the lateral tibial plateau beneath the posterior horn of the lateral meniscus. The articular cartilage of the medial compartment appears intact.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Nondisplaced patellar fracture with adjacent soft tissue injury as described above.2. Medial and lateral meniscus tears.3. Cartilage defects/degeneration as described above.4. Moderate sized joint effusion.


Instruction: Generate impression based on findings.

Input: Male, 72 years old, with neck pain and radiculopathy radiating down the left arm. Mild reversal of the cervical lordosis is seen. Sagittal alignment is otherwise unremarkable.Mild degenerative loss of vertebral body height is noted. Degenerative endplate edema is seen at C3-4 and C6-7. No definite areas of marrow replacement are seen.The visualized spinal cord demonstrates normal signal intensity throughout. No epidural abnormalities are suspected.C2-3: Moderate right facet arthropathy. No spinal canal stenosis or neuroforaminal narrowing. C3-4: Mild right facet arthropathy. Posterior disc-osteophyte complex formation with loss of disc height. Mild effacement of the ventral thecal sac but no significant generalized spinal canal stenosis. Moderate bilateral foraminal narrowing.C4-5: Moderate right facet arthropathy with degenerative cyst formation. Posterior disc-osteophyte complex formation and ligamentum flavum thickening. Moderate generalized spinal canal stenosis with slight deformation of the spinal cord contour. Moderate bilateral foraminal narrowing.C5-6: Mild bilateral facet arthropathy. Mild posterior disc-osteophyte complex formation with loss of disc height. No significant generalized spinal canal stenosis. Mild right foraminal narrowing. C6-7: Mild bilateral facet arthropathy. Posterior disc-osteophyte complex formation. Mild effacement of the ventral thecal sac without significant spinal canal stenosis. Mild bilateral foraminal narrowing. C7-T1: Moderate bilateral facet arthropathy. Minimal posterior disc-osteophyte complex formation. Ligamentum flavum thickening. Mild generalized spinal canal stenosis. Mild bilateral foraminal narrowing.

Output: Multilevel disc degeneration is seen with scattered variable areas of facet arthropathy. At C4-5, these findings contribute to produce a moderate generalized spinal canal stenosis with slight deformation of the cord contour. Scattered mild to moderate foraminal narrowing is demonstrated as above.


Instruction: Generate impression based on findings.

Input: Male 42 years old Reason: thyroid nodule History: thyroid nodule, pls assess for changes RIGHT LOBE MEASUREMENTS: Right lobe measures 5.3 x 1.6 x 1.9 cmLEFT LOBE MEASUREMENTS: Left lobe measures 4.3 x 4.7 x 1 cmISTHMUS MEASUREMENTS: 3 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 suggestive of thyroiditis. No significant change from previous study.


Instruction: Generate impression based on findings.

Input: Small cell lung cancer: please evaluate for brain metastasis. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is unchanged predominantly periventricular white matter T2 hyperintensity. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No evidence of intracranial metastases.


Instruction: Generate impression based on findings.

Input: Persistent pain ROTATOR CUFF: There is tendinosis of the supraspinatus with partial thickness tearing. The supraspinous muscle is not retracted. There is tendinosis of the infraspinatus without fluid-filled tear evident.SUPRASPINATUS OUTLET: There is moderate to severe acromioclavicular joint osteoarthritis.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is globular signal in the superior labrum, compatible with degeneration.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: 1. Tendinosis of the supraspinatus with partial thickness tearing.2. Degenerative changes of the superior glenoid labrum.3. Moderate to severe acromial clavicular joint osteoarthritis.


Instruction: Generate impression based on findings.

Input: Female 25 years old; Reason: eval for ATFL tear; talar injury History: ankle sprain Oct, 2014 still pain with walking laterally and still in aircast with limp and weakness TENDONS: A small amount of fluid is noted in the flexor tendon sheaths, likely of no clinical significance. The peroneal tendons are intact. The extensor tendons are intact. Achilles tendon is normal.LIGAMENTS: Fibers of the anterior talofibular ligament can be traced from the fibula to the talus on T2 axial images. However, on other sequences, the ATFL appears thickened and indistinct, compatible with prior sprain. The calcaneofibular ligament is thickened, compatible with prior sprain. Lack of fluid within the peroneal tendon sheaths argues against complete tear of the calcaneofibular ligament. The posterior talofibular ligament is intact. The distal fibular syndesmotic complex is intact. Loss of the normal striations of the deep deltoid ligament may represent prior injury.ARTICULAR SURFACES AND BONE: The bone marrow signal is normal. Other than a small bone island, the talus is normal. No osteochondral defects are seen.ADDITIONAL

Output: Findings compatible with prior sprain of the anterior talofibular ligament and calcaneofibular ligament, without a fluid-filled tear of the ligaments seen. We see no injury to the talus.


Instruction: Generate impression based on findings.

Input: 19 female with cerebellar lesion Redemonstrated is a stable 15 x 15 mm axial dimension mass in the right cerebellar hemisphere at the junction of the right middle cerebellar peduncle which mildly extends to the fourth ventricle surface at its right posterolateral aspect. There is no associated contrast enhancement or susceptibility effect associated with this lesion.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma. There is no restricted diffusion to suggest the presence of acute ischemia. Expected vascular flow voids are demonstrated. There is pansinus opacification with superimposed air-fluid levels throughout several sinuses. The mastoid air cells are clear.

Output: 1.Stable right cerebellar mass.2.There is pansinus opacification with superimposed air-fluid levels throughout several sinuses. The mastoid air cells are clear.


Instruction: Generate impression based on findings.

Input: High risk low grade astrocytoma, evaluate for progression. Status post biopsy and RT/TMZ. Again seen is sequela of left frontal approach biopsy. Again seen is a nonenhancing T2 hyperintense mass involving the left thalamus measuring approximately 3.8x2.6x3.0 cm in the AP, transverse, and craniocaudal dimensions. The lesion has not significantly changed in size from prior exams. Also unchanged is T2 hyperintensity and thickening involving the left amygdala and medial temporal lobe which likely represents infiltrative tumor as well. Linear branching enhancement within the left thalamus appears vascular and more apparent perhaps due to treatment change.A few scattered foci of T2 hyperintensity are evident elsewhere in the cerebral white matter which are nonspecific and unchanged. No restricted diffusion is seen. No new lesions are detected. No evidence of intracranial hemorrhage is seen apart from minimal susceptibility along the biopsy tract. No pathologic fluid collections are detected. The ventricular system is stable in size and morphology including minimal effacement of the left lateral and third ventricles secondary to mass effect related to the tumor.

Output: Compared to 11/4/2014 and 8/27/2014, there is no significant interval change in the size of left thalamic tumor. Also unchanged is evidence of tumor extension into the medial aspect of the left anterior temporal lobe. There is linear branching enhancement within the posterior aspect of the left thalamic tumor, which is favored to be vascular.


Instruction: Generate impression based on findings.

Input: 19-year-old female with right thigh pain in a runner. Is there a stress fracture? Heterogeneous bone marrow likely represents residual islands of red marrow. No convincing stress reaction is identified. There is no linear signal abnormality to suggest a stress fracture. The remainder of the bone marrow signal is within normal limits. The imaged musculature of the right hip and femur is within normal limits. There is a small amount of fluid within the hips bilaterally, which is not necessarily of any clinical significance. Minimal peritrochanteric inflammatory changes are identified bilaterally which are also of questionable clinical significance.

Output: No evidence of stress reaction or stress fracture as clinically questioned. No findings to account for the patient's pain.


Instruction: Generate impression based on findings.

Input: Reason: pain History: pain Right shoulder:Lucent lesion with internal calcifications within the proximal humeral metaphysis may represent an enchondroma however, if pain localizes to this location than MRI could be considered. Mild osteoarthritis first glenohumeral and acromioclavicular joints. No acute fracture is evident.Right knee:Mild osteoarthritis affects the right knee. No acute fracture or malalignment. No joint effusion is evident.Left knee:Mild osteoarthritis affects the left knee. No acute fracture or malalignment. No large joint effusion is evident.Left great toe:Minimal osteoarthritis affects the first MTP joint. No acute fracture or malalignment.

Output: Osteoarthritis of the knees, left great toe, and right shoulder. Lucent lesion in the proximal humeral metaphysis may represent an enchondroma, however, if pain localizes to this location, MRI could be considered for further evaluation.


Instruction: Generate impression based on findings.

Input: Female, 40 years old, with cavernous malformation, evaluate for change. A bilobed heterogeneous lesion is again seen centered on the right basal ganglia. As before, the lesion is heterogeneously T2 hyperintense internally and contains scattered locules of T1 hyperintensity. On postcontrast imaging, the components of the lesion which are not intrinsically T1 hyperintense do show contrast fill-in. The lesion measures approximately 35 x 24 mm when measured similarly to the prior examination showing no significant interval change in size. There is a thin rim of surrounding susceptibility effect, but no significant edema in the adjacent parenchyma. The lesion causes local mass effect with perhaps partial effacement the right frontal horn and slight encroachment upon the third ventricle, similar to prior. The ventricular system is otherwise unremarkable. No additional intracranial lesions are seen. No other pathologic enhancement is identified. Scattered punctate foci of FLAIR hyperintensity elsewhere in the cerebral hemispheres are nonspecific and unchanged.

Output: No significant change in size or morphology of a presumed cavernous malformation centered on the right basal ganglia.


Instruction: Generate impression based on findings.

Input: 21-year-old woman with history of Chiari malformation and reported history of syrinx, now with worsening symptoms and back pain. The thoracic spine is in normal alignment. The vertebral body and disk heights are well-maintained. There is a subcentimeter T1 and T2 hyperintense lesion consistent with hemangioma involving the T8 vertebral body. A subcentimeter T2 hyper and T1 hypointense lesion in the T10 vertebral body is nonspecific but may represent an atypical hemangioma. The spinal cord is of normal caliber and signal. There is no significant disc disease, spinal canal, or neural foraminal stenosis. The paraspinous soft tissues are within normal limits. Low-lying cerebellar tonsils are partially imaged on the sagittal counting sequence.LUMBAR SPINE

Output: 1.No evidence of syrinx in the thoracic cord. 2.Borderline low position of the conus medullaris at L2/L3 without fatty filum or other lesions to suggest cord tethering. Prone images may be considered if clinically warranted.3.Mild central disc protrusion at L5/S1. No significant spinal canal or neural foraminal stenosis at any level.


Instruction: Generate impression based on findings.

Input: Paresthesias and back pain, rule out radiculopathy and myelopathy. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is some loss of lumbar lordosis and minimal retrolisthesis of L5 on S1. Alignment is otherwise normal. Bone marrow signal is benign. The conus medullaris is normal in position.Mild multilevel degenerative changes are seen with multilevel disc desiccation and mild height loss, relatively worse at the L5-S1 level. Individual levels as below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: Small extraforaminal disc protrusion which contacts the exiting left L2 nerve root. No spinal canal or neural foraminal stenosis. L3-L4: Small foraminal and extraforaminal disc protrusion which contacts and displaces the exiting left L3 nerve root in the foramen and extraforaminally. There is mild to moderate left-sided neural foraminal stenosis. No significant spinal canal or right neural foraminal stenosis. Mild facet arthropathy.L4-L5: Disc bulge and mild facet arthropathy. Mild to moderate left neural foraminal stenosis. There is mild right neural foraminal narrowing. No significant spinal canal stenosis.L5-S1: Disc bulge and mild bilateral facet arthropathy. No significant spinal canal stenosis. There is up to moderate right neural foraminal stenosis and mild to moderate left neural foraminal narrowing.Paraspinous soft tissues are within normal limits.

Output: Multilevel degenerative changes in the lumbar spine. There is no significant spinal canal stenosis at any level. There is mild to moderate stenosis of the left neural neural foramina at the L3-L4, L4-L5, and L5-S1 levels. There is mild right L4-L5 and moderate right L5-S1 neural foraminal stenosis.


Instruction: Generate impression based on findings.

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

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


Instruction: Generate impression based on findings.

Input: Pial synangiosis in 2008 right side: surveillance. MRI: There are postoperative findings related to right pial synangiosis. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable.MRA: There is a patent right superficial temporal artery pial synangiosis. There is significant steno-occlusive disease involving the right distal internal carotid artery and proximal right anterior and middle cerebral artery branches. The left internal carotid artery and proximal right anterior and middle cerebral artery branches are grossly intact. There is apparent asymmetrically diminished left posterior cerebral artery flow-related enhancement. The rest of the posterior circulation appears to be intact. There is no evidence of cerebral aneurysms.

Output: 1. No evidence of acute intracranial hemorrhage, mass, or acute infarct.2. Findings compatible with moyamoya disease of the right anterior circulation. The left anterior cerebral circulation is intact. 3. Patent right superficial temporal artery pial synangiosis.4. Apparent asymmetrically diminished left posterior cerebral artery flow-related enhancement, which may be artifactual or due to steno-occlusive disease. The rest of the posterior circulation appears to be intact.


Instruction: Generate impression based on findings.

Input: Metastatic lung cancer. There is no evidence of acute intracranial hemorrhage or infarct. There are scattered areas of T2 hyperintensity in the cerebral white matter, which are nonspecific. There are multiple unchanged punctate foci of susceptibility effect in the bilateral cerebral hemispheres, without associated enhancement. There is no evidence of acute infarction. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable. There are bilateral lens implants.

Output: Post-treatment findings without evidence of recurrent intracranial metastatic disease.


Instruction: Generate impression based on findings.

Input: 79-year-old female with increased CRP and purulent wound, evaluate for osteomyelitis. Several series are limited by patient motion artifact. Evaluation of the knee is limited due to metallic susceptibility artifact from the patient's total knee arthroplasty device.There is diffuse thickening and enhancement of the skin with foci of skin irregularity suggesting ulceration with overlying packing material. There is reticulation of the subcutaneous fat with associated enhancement. These findings are compatible with the stated history of cellulitis. Although the subcutaneous edema becomes confluent, particularly laterally, we see no fluid collection to suggest abscess. There is fatty atrophy of the musculature of the leg. We see no intra- or intermuscular abscess. The bone marrow signal is within normal limits, without evidence of osteomyelitis. There is subcutaneous edema and fatty atrophy of the musculature of the right lower extremity as seen on the large field-of-view series.

Output: Limited study showing cellulitis, without evidence of osteomyelitis.


Instruction: Generate impression based on findings.

Input: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are no areas of abnormal parenchymal signal. There is no abnormal intracranial enhancement. There is a 6 mm presumed pineal cyst. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The midline structures and craniocervical junction are within normal limits without evidence of abnormal CSF flow dynamics at the level of the foramen magnum. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable. There is minimal fluid within the left mastoid air cells.

Output: 1.Normal brain MRI without evidence for Chiari malformation.2.Minimal nonspecific fluid within the left mastoid air cells.


Instruction: Generate impression based on findings.

Input: 9 year-old boy with history of intractable epilepsy. The hippocampi and parahippocampal gyri appear unremarkable. However, there is a subcetimeter focus of T2 hyperintensity and susceptibility effect in the posterior limb of left internal capsule. Additionally, there is a small curvilinear susceptibility artifact extending medially from this focus. There is no evidence of acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: A focus of signal abnormality in the left internal capsule may represent a small developmental venous anomaly that may be associated with a cavernous malforamtion. A contrast-enhanced MRI of the brain can be considered for further evaluation.


Instruction: Generate impression based on findings.

Input: Patient with marked shoulder pain with both active and passive movement. Low back pain. Motor vehicle accident 2 weeks ago Diffuse demineralization limits sensitivity. Near severe osteoarthritic changes of the shoulder largely involving the glenohumeral articulation with narrowing, bulky osteophytes and extensive subchondral cysts are observed. No discrete definite fracture or subacute osseous abnormality is observed. Mild downward sloping acromion without additional definite findings to suggest rotator cuff injury, however MRI would be otherwise needed.

Output: Near severe osteoarthritic changes without distinct definite acute or subacute abnormality.


Instruction: Generate impression based on findings.

Input: Possible Chiari malformation: vertigo and neck pain. There are unchanged mildly low lying cerebellar tonsils, up to 4 mm on the left and 5 mm on the right. However, the cerebellar tonsils display normal rounded morphologies and there is intact cerebrospinal fluid flow across the foramen magnum. The spinal cord appears unremarkable, without evidence of syringohydromyelia. There is degenerative spondylosis in the lower cervical spine, including a disc-osteophyte complexes at C5-6 and C6-7 associated with mild spinal canal and neural foraminal narrowing. There is a left T1-2 extraforaminal perineural cyst that measures up to 15 mm. There is a small eccentric right disc protrusion at L4-5 and a slight disc bulge at L5-S1, but no significant spinal canal or neural foramen stenosis at these levels. There is a partially imaged right adnexal cyst that measures approximately 4 mm in width, with what appears to be a small mural nodule.

Output: 1. Unchanged mildly low lying cerebellar tonsils, up to 4 mm on the left and 5 mm on the right. However, the cerebellar tonsils display normal rounded morphologies and there is intact cerebrospinal fluid flow across the foramen magnum. 2. No evidence of syrinx.3. Degenerative spondylosis in the lower cervical spine, including a disc-osteophyte complexes at C5-6 and C6-7 associated with mild spinal canal and neural foraminal narrowing. 4. Left T1-2 extraforaminal perineural cyst that measures up to 15 mm. 5. Partially imaged right adnexal cyst of indeterminate significance. A pelvic ultrasound may be useful for further evaluation.


Instruction: Generate impression based on findings.

Input: Painless left parotid mass. There is a well-defined, but bosselated T2 hyperintense and heterogeneously enhancing mass centered in the superficial portion of the left parotid gland, measuring up to 3 cm. The other salivary glands are unremarkable. There is no evidence of significant cervical lymphadenopathy. There are small probable retention cysts in the bilateral maxillary sinuses and left sphenoid sinuses, as well as mild scattered paranasal sinus mucosal thickening. The imaged intracranial structures and orbits are unremarkable. There is multilevel degenerative cervical spondylolysis.

Output: A left parotid mass that measures up to 3 cm displays features most suggestive of a pleomorphic adenoma.


Instruction: Generate impression based on findings.

Input: Ms. Miller is a 72 year old female with two areas of biopsy proven malignancy in the left breast. She presents for MRI evaluation for staging purposes. There is scattered fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.LEFT BREAST:In the left lateral breast, there are two irregular enhancing masses identified. The anterior mass measures 1.4 x 1.7 x 1.2 cm (AP x ML x SI). Seen immediately anterior to this mass is a 2.8 cm hematoma, of which contains susceptibility artifact from the biopsy marker clip. The posterior mass measures 1.3 x 1.5 x 1.3 cm, which contains a centrally located biopsy marker clip. The two masses span approximately 4.3 cm in the AP oblique dimension.There is no additional abnormal enhancement seen in the left breast. RIGHT BREAST:There is no abnormal enhancement seen in the right breast. AXILLA: There is a prominent left axillary lymph node present, which measures approximately 2.1 cm in maximal dimension. No abnormal axillary lymph nodes are identified in the right axillary region.

Output: (1) Two biopsy proven malignancies in the left lateral breast, spanning approximately 4.3 cm in the AP oblique dimension. Of note, the biopsy clip for the anterior mass is located slightly anteriorly within an adjacent hematoma.(2) Prominent left axillary lymph node. MR directed ultrasound is recommended for further evaluation.(3) No MRI evidence of malignancy in the right breast. BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: E - Additional Mammo/Ultrasound Workup Required.


Instruction: Generate impression based on findings.

Input: Diagnosis: Fibromyalgia CervicalgiaClinical question: cause for neck pain, pt with fibromyalgia and spine issuesSigns and Symptoms: neck pain The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. A T1 hyperintense focus along the superior aspect of the C7 vertebral body most likely represents a vertebral body hemangioma. It suppresses on the T2 STIR images.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina. There is a disc bulge present at this level which is associated with mild disc desiccation. There is mild ligamentum flavum hypertrophy present at this level.At C6-7 there is no significant compromise to the spinal canal or neural foramina. There is a disc bulge present at this level which is associated with mild disc desiccation. There is mild ligamentum flavum hypertrophy 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.

Output: 1.There are mild degenerative changes present in the cervical spine without significant compromise to the spinal canal or neural foramina.


Instruction: Generate impression based on findings.

Input: For the purposes of numbering, there are 5 lumbar type vertebral bodies. There is mild levocurvature of the lumbar spine with apex at L2-3 and loss of lumbar lordosis. Alignment is otherwise within normal limits. There is severe disk space narrowing at L2-3 and L3-4 with degenerative marrow signal abnormality involving L3, L4, and L5 endplates. The imaged portions of the distal cord is unremarkable. The imaged paraspinal soft tissues are unremarkable. Other level specific findings are as follows:T12-L1: No significant degenerative disk disease, spinal canal narrowing, or neural foraminal narrowing.L1-L2: No significant degenerative disk disease, spinal canal narrowing, or neural foraminal narrowing.L2-L3: Degenerative disk disease and disk bulge with ligamentum flavum thickening and facet degenerative changes results in moderate to severe right neuroforaminal narrowing and minimal left neuroforaminal narrowing. Minimal spinal canal narrowing.L3-L4: Degenerative disk disease and disk bulge with ligamentum flavum thickening and facet hypertrophy results in moderate-severe right and severe left neuroforaminal narrowing. There is mild central canal stenosis. There is a small right facet joint effusion.L4-L5: Mild disk bulge and facet degenerative changes without significant central canal stenosis. There is mild bilateral, left worse than right, neuroforaminal narrowing.L5-S1: No significant degenerative disk disease, spinal canal narrowing, or neural foraminal narrowing.

Output: Severe degenerative disk disease affecting L2-L3 and L3-L4 with moderate to severe neuroforaminal stenosis at these levels as detailed above. No high grade spinal canal stenosis at any level.


Instruction: Generate impression based on findings.

Input: Benign neoplasm of cranial nerves [D33.3], Reason for Study: ^Reason: eval for tumor resection History: eval for tumor resection Previously seen large left middle cranial fossa mass appears to be removed with evidence of left fronto-temporal craniotomy.The surgical bed shows some susceptibility artifacts and extradural fluid collections which are postoperative changes. There is no evidence of mass effects from extra dural collections.There is MR evidence of minimal brain parenchymal edema or contusion at inferolateral aspect of the left temporal pole indicating postoperative changes.On post contrast images, there is thin dural enhancement around the surgical bed which indicate postoperative changes. No definitive evidence of residual mass on the surgical bed.There is no evidence of acute ischemic or hemorrhagic lesion on this scan.The left cerebral peduncle and upper pons still appear to be deformed but comparing to prior scan, the direct mass effects have been significantly relieved postoperatively.The ventricles, sulci and cisterns are symmetric and unremarkable. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Post total resection status of the middle cranial fossa extra axial mass with significant relief of mass effects toward adjacent brain parenchyme including left cerebral peduncle, upper pons and left mesial temporal lobe.2. Postoperative changes including some blood products at surgical bed, craniotomy site extradural fluid collections and subtle brain edema on the inferolateral aspect of the left temporal lobe pole and dural enhancement. 3. No evidence of residual tumor on this scan.4. No evidence of new ischemic or hemorrhagic lesion.


Instruction: Generate impression based on findings.

Input: 68 year old male with pain. Evaluate for infection. TENDONS: There is circumferential fluid signal intensity about the flexor hallucis longus tendon suggesting tenosynovitis.ARTICULAR SURFACES AND BONE: Degenerative changes affect the third tarsalmetatarsal joint. No bone marrow signal abnormality is identified to suggest osteomyelitis.ADDITIONAL

Output: 1. Soft tissue edema about the mid and forefoot as described above. Superimposed infection cannot be excluded. There is no evidence to suggest osteomyelitis. 2. Subcentimeter focus of nonenhancing fluid signal abnormality within the interspace of the first and second metatarsals may represent a mild bursitis. Other findings as described above.


Instruction: Generate impression based on findings.

Input: 54-year-old male with history of pancreatitis ABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy. No choledocholithiasis. Common bile duct is within normal limits.SPLEEN: No significant abnormality noted.PANCREAS: Normal response to secretin with normal morphology and conventional anatomy of the main pancreatic duct. The pancreatic parenchyma is within normal limits. No peripancreatic fluid or inflammation.ADRENAL GLANDS: Mild left adrenal adenoma.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No specific MR evidence of acute or chronic pancreatitis.2.Normal response to secretin with normal morphology and conventional anatomy of the main pancreatic duct. 3.Left adrenal gland adenoma.


Instruction: Generate impression based on findings.

Input: 47-year-old female with history of fall. MENISCI: There is mild intrasubstance degenerative signal within menisci compatible with degeneration, but we see no discrete meniscal tear.ARTICULAR CARTILAGE AND BONE: There is a fracture of the lateral tibial plateau with 1 mm of depression. The fracture fragment is situated beneath the body and posterior horn of the lateral meniscus and measures approximately 1.5 x 1.0 cm in cross-sectional area and 6 mm in depth. There is surrounding bone marrow edema. The fracture plane appears to disrupt the overlying articular cartilage.There is a full-thickness cleft of the articular cartilage along the weight-bearing portion of the medial femoral condyle. There is also a cyst within the intercondylar eminence of the tibia, likely degenerative in etiology. There are foci of full-thickness articular cartilage degeneration of the patella with underlying cyst formation. There are tricompartmental osteophytes.LIGAMENTS: The cruciate and collateral ligaments are intact.EXTENSOR MECHANISM: The extensor mechanism is unremarkable.ADDITIONAL

Output: 1.Tibial plateau fracture with large joint effusion as described above.2.Cartilage defects as described above.3.No evidence of patellar/quadriceps tendon tear. Other findings as above.


Instruction: Generate impression based on findings.

Input: There is loss of the cervical lordosis with mild cervical kyphosis. There is loss of height of the C4 vertebral body. The C45 intervertebral disc shows low signal intensity on T1 but high signal intensity on T2 and STIR images. In addition, the disc shows somewhat inhomogenous enhancement. However, the enhancement does not extend beyond the level of endplate. The STIR high signal intensity did not cross the endplate either. Above MR findings suggest possible discitis not extended beyond the inferior endplate of C4 and superior endplate of C5.At the level of C56, the intervertebral disc demonstrates high signal intensity on T1 as well on T2 weighted images and did not show MR evidence of enhancement. The constellation of findings suggest calcification of intervertebral disc.There is a focus of high signal in T1 and T2 which is suppressed in STIR in the anterior superior endplate of C3, consistent with hemangioma. Multilevel Schmorl's nodes are seen.C2-C3: Disc height is preserved. There is desiccation of the disc. No disc bulge. No spinal or neural foraminal compromise.C3-C4: No disc bulge. There is disc desiccation with preservation of disc height. No spinal bone marrow for minimal compromise.C4-C5: The intervertebral disc space is enhancing, most consistent with discitis. The corresponding endplates are not involved. There is a mild to moderate disc bulging with mild spinal stenosis. Mild narrowing of the neural foraminal canal bilaterally.C5-C6: Disc is decreased in height. T1 and T2 high signal is seen with no enhancement, representing calcification. No spinal stenosis or neural foraminal compromise.C6-C7: No evidence of bulge or spinal or spinal stenosis or neural foraminal compromise.C7-T1: No disc bulge or spinal stenosis. There is a minimal bilateral neural foraminal narrowing

Output: 1. Possible discitis at the level of the C4-C5 without involvement of the adjacent endplates. 2. There is mild to moderate disc bulge with mild spinal stenosis at C45 with mild narrowing of the neural foraminal canal bilaterally.3. Calcified disc with loss of height of the disc space C5-C6.


Instruction: Generate impression based on findings.

Input: Worsening headache with known white matter abnormality on previous MRI. A number of scattered punctate hyperintense T2/FLAIR lesions are somewhat better seen due to the 3 Tesla imaging technique, but these were all likely present on the previous exam, and do not appear to have significantly changed.No diffusion restriction is seen to suggest acute ischemia. No susceptibility weighted artifact is seen to suggest intracranial hemorrhage. The CSF spaces are appropriate for the patient's stated age with no midline shift. Normal vascular flow voids are present in the major intracranial vasculature. The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: No significant interval change in the size, number or distribution of numerous punctate nonspecific white matter lesions.


Instruction: Generate impression based on findings.

Input: There are postoperative findings related to left frontal lobe meningioma resection with unchanged regional encephalomalacia, and punctate susceptibility effect with no evidence of recurrent tumor. There is no acute infarct, suspicious intracranial enhancement elsewhere, or significant mass-effect. The ventricles and basal cisterns are unchanged. There is no midline shift or herniation. There is opacification of a left ethmoid air cell. The skull and extracranial soft tissues are otherwise unremarkable. There is unchanged diffuse low T1 osseous marrow signal without focal lesion in the visualized cervical vertebral bodies.

Output: Stable treatment related changes without recurrent tumor.


Instruction: Generate impression based on findings.

Input: Rotator cuff tear The exam is slightly limited by motion artifact.ROTATOR CUFF: Again seen are full-thickness tears of the supraspinatus and infraspinatus tendon with associated retraction to the level of the glenoid. Intermediate signal within the joint space may reflect a combination of scarring or debris. Mild fatty atrophy of the supraspinatus and infraspinatus muscles is again noted. The subscapularis and teres minor tendons and muscles are intact.SUPRASPINATUS OUTLET: A small cystic focus is noted within the supraspinatus muscle which may represent an small intramuscular ganglion. There is otherwise no significant fluid within the subacromial subdeltoid bursa. GLENOHUMERAL JOINT AND GLENOID LABRUM: The humeral head is slightly high riding. The glenoid labrum otherwise appears intact.BICEPS TENDON: A trace amount of fluid surrounds the biceps tendon which is otherwise intact. ADDITIONAL

Output: Redemonstration of complete and retracted tears of the supraspinatus and infraspinatus tendons appearing similar to the prior exam. Additional chronic findings are described above.


Instruction: Generate impression based on findings.

Input: The exam is degraded by motion artifact.BRAIN: Foci of restricted diffusion are noted in the right dorsal putamen and right parietal periventricular white matter, consistent with acute infarction. Multiple chronic lacunar infarcts are again noted in the bilateral cerebellar hemispheres. FLAIR signal abnormality in the periventricular and subcortical white matter in addition to the pons is consistent with moderate chronic small vessel ischemic disease. Global parenchymal volume loss appears commensurate for the patient's age. There is a small extra-axial mass along the posterior surface of the petrous temporal bone, which has shown gradual growth since 2009 and most likely reflects a meningioma. There is no evidence of intracranial hemorrhage. There is no midline shift or herniation. The major cerebral flow voids are intact. There is a chronic left lamina papyracea fracture. The skull and scalp soft tissues are unremarkable. There is partial opacification of the paranasal sinuses and right mastoid.MRA HEAD: There is no evidence of flow-limiting stenosis or aneurysm within the limitations of motion artifact. The left vertebral artery and A1 segment of the left anterior cerebral artery are diminutive. The left internal carotid artery is slightly smaller than the right. The middle cerebral arteries are unremarkable. The basilar artery is normal in course and caliber. There is a fetal origin of the right posterior cerebral artery.

Output: 1. Small foci of restricted diffusion in the right dorsal putamen and right parietal periventricular white matter are consistent with acute infarction. 2. No significant stenosis in the major intracranial vasculature.3. Note examination is moderately motion degraded.


Instruction: Generate impression based on findings.

Input: Clinical question: h/o intractible epilepsy; planning for depth electrode placement. Signs and Symptoms: preop planning Pre and postcontrast enhanced fusion brain MRI:This limited examination is performed utilizing surgical planning protocol and is not a true diagnostic exam.There is no acute intracranial process.There is mild prominence of the cortical sulci for the stated age of 21 year. The ventricles and the CSF spaces remain within normal.There is no abnormal parenchymal of leptomeningeal enhancement. Calvarium, orbits and the paranasal sinuses are unremarkable.

Output: Unremarkable surgical planning brain MRI as detailed above.


Instruction: Generate impression based on findings.

Input: Reason: Preop planning for 6/27 surgery. Study patient. Craniotomy for tumor History: none- preop Limited exam for surgical planning purposes was obtained. There is redemonstration of postoperative changes from previous right temporal parietal craniotomy, with a stable cystic-appearing resection cavity in the right posterior temporal region. There is persistent irregular enhancement along the posterior margin of the cavity, with redemonstration of T1 hypointense and T2 hyperintense discrete oval satellite lesions surrounding the resection cavity. The overall size of these cystic lesions is not significantly changed, although with slight increased convexity of the margins of the most superior lesion which now measures 13 x 15 mm. A thin extra axial collection underlying the craniotomy flap persists, measuring 7 mm in greatest thickness with mild mass effect.There is a similar pattern of confluent T2 hyperintensity within the surrounding right posterior cerebral white matter, including extension to the right internal and external capsules posteriorly. Abnormal T2 hyperintensity is also seen in the splenium of the corpus callosum. There is stable age-related volume loss diffusely, with a small area of linear T2 hyperintensity within the right frontal subcortical and deep white matter.

Output: 1.Redemonstration of multiple peripherally enhancing lesions surrounding the right posterior temporal resection cavity margins, as previously described, with slight increased convexity of the margins of the most superior lesion.2.Similar extent of T2 abnormality within the surrounding white matter which is nonspecific and may represent accommodation of post treatment changes, vasogenic edema, and/or nonenhancing tumor.


Instruction: Generate impression based on findings.

Input: Female 28 years old; Reason: s/p knee dislocation and reduction, assess ligamentous injury MENISCI: There is vertical signal abnormality within the peripheral fibers of the posterior horn of the medial meniscus extending to the tibial articular surface, which may represent a short partial-thickness undersurface tear of the red zone, however this is equivocal. Mildly increased signal intensity is seen in the body of the medial meniscus, without discrete tear. Globular mildly increased signal intensity is seen at the inner fibers of the body of the lateral meniscus, without discrete tear. ARTICULAR CARTILAGE AND BONE: Small foci of bone marrow edema are present at the anteromedial aspect of the medial femoral condyle. We see no discrete cartilage defects. LIGAMENTS/TENDONS: There is a complete tear of the anterior cruciate ligament, likely through its mid substance. There is a complete (or near-complete) tear of the posterior cruciate ligament at its femoral attachment. The superficial band of the MCL is intact. Overlying edema may represent a sprain. The meniscofemoral coronary ligament is not seen, and we cannot exclude the possibility of a tear. Edema in the soft tissues immediately anterior to the MCL may reflect partial disruption of the medial retinaculum; a 7-mm linear focus of low signal intensity along the anteromedial aspect of the medial femoral condyle with mild underlying edema within the bone may represent a medial retinacular/capsular avulsion fracture. The LCL is indistinct, compatible with a full thickness tear. The distal fibers of the biceps femoris tendon are also indistinct, suggestive of at least a high grade partial thickness tear. The IT band is intact. There is extensive edema along the lateral retinaculum beneath the joint line. There is edema between the biceps femoris muscle and underlying femur as well as between the gastrocnemius heads. The popliteus tendon can be traced to its femoral attachment, though appears attenuated at its femoral attachment, suggestive of a partial tear.EXTENSOR MECHANISM: No significant abnormality noted. The extensor mechanism is intact. ADDITIONAL

Output: 1. Tears of the ACL, PCL, and LCL, as described above.2. Possible medial retinaculum injury and medial meniscus tear, as described above.3. Findings suggestive of at least a partial tear of the biceps femoris tendon and possibly of the popliteus tendon.4. Other findings, as described above.


Instruction: Generate impression based on findings.

Input: Stage IV melanoma: restaging. There is a subcentimeter of high T2 signal in the left corona radiata. 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 orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: A subcentimeter of high T2 signal in the left corona radiata may represent a chronic lacunar infarct. Otherwise, no evidence of intracranial metastases.


Instruction: Generate impression based on findings.

Input: Jaw mass There is sclerosis of the right hemimandible with bony enlargement particularly of the mandibular body with protuberance inferiorly. This correlates with the signal abnormality seen on the MRI of 2012. Of note, prior CT also showed multifocal involvement of this process affecting the bones of the skull. We see no focal bony destruction or other aggressive features. There are multiple absent teeth and dental fillings. Please note the right coronoid process of the mandible was not fully included.

Output: Sclerosis and deformity of the right hemimandible which is compatible with fibrous dysplasia. We see no aggressive features to suggest malignancy; however if there has been recent growth or development of a mass, further evaluation with CT is recommended.


Instruction: Generate impression based on findings.

Input: Female; 22 years old. Reason: PSC, IBD, eval for cholangiocarcinoma History: PSC, IBD ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. No suspicious hepatic lesions. The portal and hepatic veins are patent.Mild beading of the left and right intrahepatic central ducts is similar similar to prior. However, there is increased narrowing of the confluence of the intrahepatic ducts and the common hepatic duct, which demonstrates new concentric biliary wall thickening. No associated increased enhancement or focal mass.Mild common bile duct dilation is slightly increased and now measures up to 10 mm, previously 8 mm, without evidence of obstructing mass.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 ascites.

Output: Increased narrowing of the biliary ducts at Klatskin point, particularly of the common hepatic duct, with new concentrate biliary wall thickening. Considering the patient's young age, cholangiocarcinoma is a possibility, and correlation with ERCP is recommended.


Instruction: Generate impression based on findings.

Input: Clinical question: Assess for intracranial hemorrhage. Signs and symptoms: Found down. Nonenhanced head CT:There is no detectable acute intracranial process.CT is insensitive for early detection of acute ischemic strokes.Excessive premature a subcortical low attenuation white matter is nonspecific caliber considering patients age likely representing small vessel ischemic strokes of indeterminate age.Mild expansion of right temporal horn secondary to minimal right anterior temporal tip encephalomalacia.Calvarium and soft tissues of the scalp are unremarkable.Limited images through the paranasal sinuses are unremarkable.Limited images through the orbits are unremarkable.There is evidence of a C1 fracture involving both the anterior and posterior arch on the right. There is mild compromise of the spinal canal at this level. This finding is not associated with any associated surrounding soft tissue abnormality and likely to present a chronic fracture. Recommend dedicated CT of cervical spine and/or MRI for further assessment.Findings on this exam were discussed on the phone with Dr. Juan Rojas # 3577at the time of review of the study.

Output: 1.Small muscle ischemic stroke of indeterminate age. CT is insensitive for the detection of nonhemorrhagic acute strokes.2.No acute intracranial process.3.Right anterior temporal tip encephalomalacia and resultant ex vacuo dilatation of right temporal horn.4.Fracture of C1 anterior and posterior arch without any associated surrounding soft tissue abnormality. The finding is highly suspect a chronic fracture. Recommend follow-up with dedicated CT and or MRI for better assessment.


Instruction: Generate impression based on findings.

Input: 54-year-old male patient with severe back pain after fall. Pelvis: Three parallel pins affix the left proximal femur in near anatomic alignment. Osteoarthritis affects both hips with osteophyte formation and subchondral sclerosis. No acute fracture is evident.Lumbar spine: There is compression deformity of the L1 vertebral body with anterior wedging, which was not present on prior MRI from 6/4/2015. The remaining vertebral body heights are preserved. Mild degenerative changes affect the lumbar spine with small anterior osteophytes and facet joint osteoarthritis.

Output: Age indeterminate compression deformity of the L1 vertebral body, which was not present on prior MRI from 6/4/2015.


Instruction: Generate impression based on findings.

Input: Chronic hepatitis C. Cirrhosis. ABDOMEN:LIVER, BILIARY TRACT: The liver is nodular in contour with prominent fissure, compatible with cirrhotic morphology. Within the hepatic dome, there is a T2 hyperintense lesion measuring 1.1 x 1.0 cm lesion (series 7, image 17), with contrast enhancement but no washout on delayed imaging. An additional lesion is identified within segment 7 (series 11, image 48) measures 1.1 x 0.9cm, is isointense on T2, enhances on arterial phase, with no washout on delayed imaging, probable perfusion defect.SPLEEN: There is mild splenomegaly. Splenic varices are present.PANCREAS: There is atrophy of the pancreas with dilatation of the main pancreatic duct measuring to 1.3 cm and side branch ectasia, unchanged from prior. There are multiple cysts within the pancreatic head and body, the largest measures 2.2 x 1.6 cm (series 7, image 27), which is similar in size to prior study but increased in size since April 2015. This lesion communicates with the main pancreatic duct, probably combined-type IPMN. There is a filling defect within this lesion on T2 imaging, that minimally enhances (series 11, image 109).ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is a large hiatal hernia. The bowel loops are otherwise normal in appearance. There is a small volume of perihepatic ascites.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Stable T2 hyperintense hepatic dome lesion, without washout on delayed imaging, in a cirrhotic liver. This lesion remains suspicious for HCC. Follow-up recommended.2.Cystic lesion within the pancreas communicating with the main pancreatic duct is unchanged since recent MRI, but increased in size since April 2015, probably combined-type IPMN.3.Additional enhancing lesion within hepatic segment 7, probable perfusion defect.


Instruction: Generate impression based on findings.

Input: 42-year-old male with nonspecific lesion on recent CT scan ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: T2 hyperintense nonenhancing lesion in the interpolar right kidney with internal thin septation formation, lesion measures 1.6 x 1.3 cm. Renal stones seen on CT are not well visualized on MR. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Thin septation-containing cyst containing simple fluid in the right kidney.


Instruction: Generate impression based on findings.

Input: Osmophobia, headaches, and vomiting. 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. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is mild mucosal thickening in the maxillary sinuses.

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


Instruction: Generate impression based on findings.

Input: Breast cancer, evidence of brain metastasis, follow-up No evidence of acute ischemic or hemorrhage lesion.There are evidences of left frontal craniotomy including left frontal resection site with encephalomalacia and extra axial enhancement.Previously noted left inferior and superior frontal gyrus enhancing lesions appear to be slightly smaller than prior study, however, grossly no significant interval change in terms of MR characteristics and size.Multiple susceptibility artifacts on the left thalamus and right parietal lobe bilateral frontal lobe do not show any significant interval change since prior study.The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Post left frontal craniotomy with resection of tumor, no change since prior scan.2. Previously identified two enhancing nodules on the left frontal lobe superior and inferior gyri, do not show interval change in terms of size and MR characteristics since prior scan.3. No evidence of new ischemic or hemorrhagic lesion. No new abnormal enhancement.


Instruction: Generate impression based on findings.

Input: 52 year-old female with medial distal tibia pain There is bone marrow edema within the distal tibial diaphysis without discrete fracture line. The cortex appears intact. The remaining marrow signal is within normal limits. There is mild soft tissue swelling along the anterior distal tibia with the soft tissues otherwise appearing unremarkable.

Output: Bone marrow edema within the distal tibia which may represent a stress reaction without fracture evident.


Instruction: Generate impression based on findings.

Input: Cervical spine:T2 hyperintensity with enhancement is noted within C2, C3, C4 and C7. This signal abnormality is confined to osseous structures without breaching the cortices.Alignment is normal. The cervical cord is normal in signal without abnormal enhancement. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. Adenopathy is noted throughout bilateral neck compartments as well as in subcutaneous locations. Fluid is present within left mastoid air cells.C2/3: UnremarkableC3/4: Disc bulge causes slight anterior cord flattening without significant resulting stenosis.C4/5: Disc bulge causes minimal anterior cord flattening without significant resulting stenosis.C5/6: UnremarkableC6/7: UnremarkableC7/T1: UnremarkableThoracic spine:T2 hyperintensity with enhancement is noted within T1, T2, T6, T11, and T12. This signal abnormality is confined to osseous structures without breaching the cortices.There is a smooth, physiologic thoracic kyphotic curve. The vertebral body heights and disc spaces are maintained. The spinal cord is normal in signal without enhancement. There are no masses.T1/2 demonstrates no significant disc bulge or cord encroachment.T2/3 demonstrates no significant disc bulge or cord encroachment. T3/4 demonstrates no significant disc bulge or cord encroachment. T4/5 demonstrates no significant disc bulge or cord encroachment. T5/6 demonstrates a central disc protrusion causing anterior cord flattening without significant resulting stenosis.T6/7 demonstrates no significant disc bulge or cord encroachment. T7/8 demonstrates no significant disc bulge or cord encroachment. T8/9 demonstrates no significant disc bulge or cord encroachment. T9/10 demonstrates no significant disc bulge or cord encroachment.T10/11 demonstrates no significant disc bulge or cord encroachment. T11/12 demonstrates no significant disc bulge or cord encroachment. T12/L1 demonstrates no significant disc bulge or cord encroachment. Lumbar spine:T2 hyperintensity with enhancement is noted within L1, L2, L3, L4, L5, S1, S2, S3, as well as within the sacrum and iliac bones. This signal abnormality is confined to osseous structures without breaching the cortices.Alignment is anatomic. There are no fractures or subluxations. The conus is normal in signal and morphology and terminates at an appropriate level, without abnormal enhancement. The visualized intra-abdominal and paraspinal contents are unremarkable.L1/2: UnremarkableL2/3: UnremarkableL3/4: Mild disc bulge without stenosis.L4/5: Mild disc bulge without stenosis.L5/S1: Broad-based right paracentral disc protrusion causing flattening of the right S1 nerve root sheath origin.

Output: 1.Abnormal signal and enhancement is noted throughout multiple osseous structures from the cervical spine extending inferiorly into the visualized pelvic bones. This signal abnormality is confined to osseous structures without breaching the cortices. The findings are nonspecific, and is most likely related to infectious or neoplastic processes.2.The spinal cord is normal in signal without signal abnormality or enhancement.3.Adenopathy is noted throughout bilateral neck compartments as well as in subcutaneous locations. 4.Fluid is present within left mastoid air cells.5.T5/6 demonstrates a central disc protrusion causing anterior cord flattening without significant resulting stenosis.6.L5/S1: Broad-based right paracentral disc protrusion causing flattening of the right S1 nerve root sheath origin.


Instruction: Generate impression based on findings.

Input: Clinical question: Follow-up for polyradiculopathy and nerve root enhancement. Signs and symptoms: Neuropathic pain in lower extremities. Pre-and post-enhanced lumbar MRI:Examination redemonstrates uniformly mild thickening of cauda equina without convincing evidence of change since prior exam. There is however noticeable interval decrease enhancement of the cauda equina since prior examination. Trace residual enhancement however is noted.There is normal signal intensity and alignment the vertebral column without any appreciable degenerative changes. There is no evidence of central spinal stenosis or neural foraminal compromise.Unremarkable perispinal soft tissues.

Output: 1.Uniform mild thickening of cauda equina without significant change since prior exam however the enhancement of cauda equina is significantly less conspicuous.2.Unremarkable pre-and post enhanced lumbar MRI otherwise.


Instruction: Generate impression based on findings.

Input: Clinical question: Status post stroke, rule out hemorrhagic transformation. Signs and symptoms: Aphagia. Nonenhanced CT of brain:A subacute nonhemorrhagic right frontal lobe cortical stroke with subtle associated mass effect on the adjacent cortical sulci is identified. This finding was poorly visible on prior CT study, however it was well identified on prior MRI.Subacute left posterior temporal -- occipital nonhemorrhagic cortical stroke is again identified and with no appreciable change. Extensive findings of small vessel disease. No evidence of any new foci of cortical stroke, hemorrhage, mass-effect is identified. Prominence of cortical sulci and ventricular system as well as in the folia of the cerebellum and vermis are again identified and with no change. Old lacunar infarct of pons is again identified.

Output: 1.Redemonstration of right frontal and left posterior temporal -- occipital nonhemorrhagic subacute cortical stroke.2.Advanced small vessel disease of indeterminate age.3.No evidence of acute new findings and in particular no evidence of breakthrough hemorrhage of above described subacute cortical strokes.


Instruction: Generate impression based on findings.

Input: Temporal lobe seizures. Recent video-EEG study showed right temporal lobe interictal spikes and he had five seizures originated from right temporal lobe. There is suggestion of mild gyriform T2 hyperintensity in the inferior right temporal lobe. The hippocampi are unremarkable. There is no evidence of intracranial hemorrhage, discrete mass, or acute infarct. There are a few scattered punctate foci of nonspecific T2 hyperintensity in the white matter. 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: Suggestion of mild gyriform T2 hyperintensity in the inferior right temporal lobe, which may represent an underlying cortical dysplasia, perhaps with superimposed edema related to seizure activity. A neoplastic process is less likely. Nevertheless, further evaluation via an MRI with contrast may be useful.


Instruction: Generate impression based on findings.

Input: Cerebral infarction, unspecified [I63.9], Reason for Study: ^Reason: r/o stroke History: slurred speech Brain MRIThere is no evidence of acute ischemic lesion on this scan.Susceptibility lesions are seen on the right inferior parietal lobule and right middle frontal gyrus with associated encephalomalacia indicating chronic infarction with hemorrhagic transformations.Gliotic changes are seen at right frontal, parietal and occipital lobes.Patchy FLAIR/T2 high signal intensity lesions are seen on bilateral periventricular white matter indicating non specific small vessel ischemic disease.The ventricles, sulci and cisterns are unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. The paranasal sinuses are clear. Opacifications of the left mastoid air cell are seen. Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate more than 50% of luminal stenosis at the mid to distal left MCA M1 segment. In addition, there are multifocal tandem intracranial luminal stenosis involving right MCA distal, right PCA, left vertebrobasilar junction as well as basilar artery indicating intracranial atherosclerosis.Neck MRA3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate segmental signal loss at the right extracranial ICA just above the bifurcation. The signal loss length is measured about 36.4mm. This finding is consistent with post carotid artery stenting, clinical correlation is recommended. Otherwise, right brachiocephalic, left common carotid, and left subclavian arteries do not show any evidence of luminal stenosis. The vertebral artery origins are normal.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. More than 50% luminal stenosis of the right MCA M1 segment.3. About 36.4mm length signal loss on the right extracranial ICA on Neck MRA likely representing post carotid stenting status. Otherwise unremarkable.


Instruction: Generate impression based on findings.

Input: There is mild motion artifact degrading image quality. There is no suspicious intracranial enhancement, acute infarct, mass effect, or cerebral edema. There is minimal nonspecific T2 signal abnormality at in the periventricular white matter, likely vascular related. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There is trace bilateral maxillary, and scattered ethmoid mucosal thickening. The skull and extracranial soft tissues are unremarkable.

Output: No intracranial mass or mass effect.


Instruction: Generate impression based on findings.

Input: 41-year-old female with a history of bilateral cerebral peduncle cavernomas and acute bleed seen on MRI examination at an outside hospital. Ill defined hyperdensities are noted within the cerebral peduncles bilaterally, the left lesion being located nearer to the thalamus. These lesions are in identical location to the cavernomas characterized by MRI in 2004, at which time there was edema and larger size of the left-sided lesions suggestive of recent hemorrhage.There is no visible edema surrounding cerebral peduncle lesions, nor is there mass effect in this location or elsewhere in the brain. Findings are therefore most consistent with chronic cavernomas, and it is doubtful that there has been any recent change. If there is a high degree of concern regarding this finding, MRI could be obtained or the outside MRI could be compared with the prior from 2004. Outside of the cerebral peduncle lesions, the appearance of the brain is normal with preserved gray-white matter differentiation and no additional lesions identified. There is no midline shift or basal cistern effacement. Ventricles and sulci have normal size and configuration. No abnormal fluid collections.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized. Orbits unremarkable

Output: Ill-defined hyperdense lesions within the cerebral peduncles, corresponding to cavernomas in these locations previously characterized by MRI in 2004. There is interval reduction size of the left sided lesion since 2004, and there is no convincing evidence of edema or mass effect from either of the lesions based on CT. Therefore, it is felt to be unlikely that there has been recent hemorrhage in this location. MRI examination could be considered for further evaluation if there is a high degree of concern regarding change in symptoms or hemorrhage--it can more sensitively detect edema and would allow same modality comparison with prior study. The outside MRI can be compared to the UC prior if it is available.


Instruction: Generate impression based on findings.

Input: Multiple sclerosis.Question: MS, follow-up progression. Signs and symptoms: Paresthesias. There is redemonstration of several scattered cerebral T2 hyperintense lesions mostly in the periventricular and subcortical white matter, callosal septal interface, pons, left inferior cerebellar peduncle and right superior cerebellar hemisphere. There are 2 new small T2 hyperintense foci in the right parietal subcortical white matter. Several of this lesions demonstrate corresponding T1 hypointensity. There is no evidence of intracranial hemorrhage, mass or acute infarct. 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 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: Multiple scattered T2 hyperintense lesions predominantly in the bilateral cerebral periventricular and subcortical white matter as well as callosal septal interface suggestive of demyelinating disease with 2 small new foci in the right parietal subcortical white matter.


Instruction: Generate impression based on findings.

Input: Female, 12 years old, with history of Chiari malformation, no surgery done, yearly follow-up examination. The cerebellar tonsils remain pointed and descend 10 to 11 mm below the level of the foramen magnum, similar to the prior exam. On cine flow imaging, biphasic CSF flow is seen along the ventral brainstem and spinal cord. Mild flow related signal is seen along the dorsal spinal cord at the level of the cerebellar tonsils. Again, findings are similar to prior.A small prominence of the CSF space posterior to the cerebellum is partially imaged on this examination appearing overall similar to the prior study. The visualized spinal cord demonstrates normal signal intensity and morphology throughout. No evidence of syrinx is seen.There is a mild reversal of the normal cervical lordosis. Alignment is otherwise unremarkable. Vertebral body heights are preserved and marrow signal characteristics are unremarkable. No evidence of spinal canal or foraminal narrowing is seen.

Output: 1.Findings compatible with Chiari malformation appearing similar to the prior examination.2.Partially visualized is a small prominence of the CSF space posterior to the cerebellum which may represent a small arachnoid cyst or focal prominence of the cistern.3.Appearance of the spinal cord remains within normal limits.


Instruction: Generate impression based on findings.

Input: Repeat evaluation of pituitary: multiple myeloma with possible pituitary abnormality on MR. There is a persistent mild heterogeneous enhancement of the pituitary. Otherwise, there no evidence of a discrete pituitary mass or enlargement of the gland. The pituitary infundibulum is intact. The optic apparatus and cavernous sinuses are intact.

Output: Persistent nonspecific mild heterogeneous appearance of the pituitary.


Instruction: Generate impression based on findings.

Input: New diagnosis of metastatic non-small cell lung cancer and history of leukemia. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are mild nonspecific scattered foci of cerebral white matter T2 hyperintensity. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There are several mildly enlarged lymph nodes in the partially-imaged neck.

Output: 1. No evidence of intracranial metastases.2. Several mildly enlarged lymph nodes in the partially-imaged neck are likely related to leukemia.


Instruction: Generate impression based on findings.

Input: . Reason: Patient with sepsis and diabetes with foot ulcer History: fever, chills, pain Abnormal signal at the base of the third, fourth, and fifth metatarsals representing osteomyelitis. Blooming artifact along the osteotomies likely due to small bone fragments from amputation. Also abnormal signal in the cuboid and lateral aspect of the lateral cuneiform, incompletely imaged. Surrounding soft tissue swelling and inflammatory changes representing cellulitis. No definite abscess collection.

Output: Osteomyelitis of the base of the third, fourth, and fifth metatarsals. Also osteomyelitis of the cuboid and lateral aspect of the lateral cuneiform, incompletely imaged. Surrounding cellulitis without definite abscess.


Instruction: Generate impression based on findings.

Input: Optic nerve meningioma. There is no significant interval change in the well-defined right orbital mass that surrounds the optic nerve and results in marked proptosis, although the mass has gradually increased in size over several years. The right optic nerve is engulfed by the mass and there is remodeling of the orbital vault. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are a few unchanged scattered foci of nonspecific T2 hyperintensity in the cerebral white matter. 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.

Output: No significant interval change in the well-defined right optic nerve sheath meningioma, although the mass has gradually increased in size over several years.


Instruction: Generate impression based on findings.

Input: The risks (including, but not limited to, those of bleeding, infection, allergic reaction, pain and inability to access the joint) and benefits of the procedure were explained to the patient, and informed written consent was obtained. A pre-procedural “time-out” form was completed.The patient was placed supine on the fluoroscopy table. The left elbow was localized fluoroscopically, and a spot radiograph was obtained. The skin was cleansed and covered with a sterile drape. The skin and subcutaneous tissues were anesthetized with 1% lidocaine using 25-gauge and 22-gauge needles.Under fluoroscopic guidance, a 22 gauge needle was advanced into the joint using a posterior approach. Attempted aspiration yielded no fluid. Access to the joint was difficult to obtain and the initial injection demonstrated contrast material pooling along the posterior aspect of the olecranon fossa as well as within the posterior soft tissue of the elbow and triceps tendon. The needle was repositioned more inferiorly. Next, 8 mL of a 50/50 mixture of Omnipaque 240 (to confirm the intra-articular position of the needle) and dilute Multihance (0.1 cc in a 10 cc vial of saline, for subsequent MR imaging) were injected into the joint. Contrast opacified the joint in the expected manner. A spot radiograph was obtained for documentation. The needle was withdrawn. Blood loss was negligible (<1cc), and the patient tolerated the procedure well without immediate complication. An adhesive bandage was placed on the patient’s skin. Routine post procedure instructions were communicated to the patient. The patient was escorted to the MRI suite for further imaging in stable condition. Please refer to the subsequent MRI report for further information.Exposure time: 2 minutes and 59 seconds.

Output: Successful fluoroscopic-guided injection of dilute gadolinium into the left elbow for subsequent MRI arthrogram examination.


Instruction: Generate impression based on findings.

Input: Ms. Jenkins is a 51 year old female with known left breast cancer (IDC grade III). She presents for MRI staging preoperatively. There is scattered fibroglandular tissue in both breasts. Minimal parenchymal enhancement is noted bilaterally.In the left lower inner breast, approximately 7:00 location, there is patchy enhancement identified measuring approximately 1.6 cm in maximal dimension. Susceptibility artifact from biopsy marker clip is seen in the central aspect of this enhancement, compatible with biopsy-proven malignancy. There is no additional abnormal enhancement seen in the left breast.In the right breast, there is no abnormal enhancement seen. Specifically, there is no abnormal enhancement in the area of the loosely scattered calcifications in the right upper outer breast, as identified on the outside mammogram. No abnormal axillary lymph nodes are identified in either axillary region.

Output: (1) Unifocal malignancy in the left lower inner breast. If breast conservation therapy is desired, biopsy marker clip can be used for targeting.(2) No MR evidence of malignancy in the right breast. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Clinical question: 36 year old lady with a history of UC who has left lower extremity weakness. Signs and symptoms: Left lower extremity weakness. Complete spine MRI:There is normal anatomical alignment of the entire spine.There is normal signal intensity of vertebral column.There is normal signal intensity and caliber of the cervical and thoracic cord. There is no convincing evidence of abnormality of the cauda equina.There is no evidence of the spinal canal or neural foramina compromise or stenosis at any level.Unremarkable visualized paraspinal soft tissues.

Output: Unremarkable nonenhanced total spine MRI utilizing cord compression protocol.


Instruction: Generate impression based on findings.

Input: 59-year-old male patient with left shoulder pain, has known arthritis, not responsive to injections. Evaluate left shoulder for rotator cuff tear. ROTATOR CUFF: Linear high signal intensity within the supraspinatus extending from the myotendinous junction into the distal fibers of the tendon is compatible with intrasubstance tearing. There is additional high signal intensity within the substance of the tendon at its insertion on the humerus consistent with concealed insertional tearing. No full-thickness tear is identified. The supraspinatus muscle appears normal. There is insertional tearing of the posterior fibers of the infraspinatus tendon without full-thickness tear. The infraspinatus muscle appears normal. The teres minor muscle and tendon are intact. There is interstitial tearing of the inferior fibers of the subscapularis tendon without full-thickness tear. The subscapularis muscle otherwise appears normal.SUPRASPINATUS OUTLET: Marked osteoarthritis affects the acromioclavicular joint with large osteophytes inferiorly causing impression on the supraspinatus. No significant fluid is identified within the subdeltoid/subacromial bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: There are large osteophytes along the inferior aspect of the humeral head. There is severe glenohumeral joint space narrowing with bone on bone apposition and total loss of the articular cartilage of the lower half of the glenoid. Subchondral cyst formation is noted within the glenoid. There is probable degenerative tearing of the posterior labrum. Degenerative cysts are noted within the humeral head at the supraspinatus and infraspinatus insertions.BICEPS TENDON: The long head of the biceps tendon appears intact. ADDITIONAL

Output: 1. Marked osteoarthritis of the glenohumeral and acromioclavicular joints.2.Tearing of the supraspinatus, infraspinatus, and subscapularis tendons without full thickness rotator cuff tear.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for CVA. Signs and symptoms: Left-sided weakness, slurred speech. Non-infused head CT: Examination demonstrate multiple foci of low-attenuation in the periventricular white matter of bilateral cerebral hemispheres. These are highly suspected for areas of encephalomalacia and likely result of small vessel ischemic stroke of indeterminate age. They produce no mass effect and they are not associated with any hemorrhage. There is no detectable acute cortical stroke on this exam. There is no evidence of hemorrhage, midline shift or hydrocephalus. Please correlate with history and if clinically desired an MRI examination is recommended.

Output: Small vessel disease of indeterminate age.


Instruction: Generate impression based on findings.

Input: Ms. Bosby is a 33 year old with proven left breast cancer presents for research MRI (I-SPY #4). There is extreme amount of fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.LEFT BREAST: The known left breast cancer shows a minimal interval decrease in size, now measuring 57 x 59 x 93 mm (AP x LR x CC, previously 57 x 61 x 98 mm). Although only measuring mildly smaller when compared to the prior exam, the overall enhancement pattern of this tumor has now markedly decreased. Compared to solid heterogenous enhancement of the tumor, there are now multiple diffuse masses/foci evident, compatible with treatment-related changes. Diffuse edema and skin thickening is similar to the prior exam. A Hydromark clip is again identified at the anterior 12 o'clock position within the tumor in the left breast.A known metastatic left axillary lymph node with Hydromark clip now measures 1.1 cm in maximum diameter (previously 1.4 cm). RIGHT BREAST: There is no abnormal enhancement seen in the right breast. Multiple small cysts are present in the right breast. No abnormal axillary lymph nodes are identified in the right axillary region.

Output: (1) Mild interval decrease in size of known left breast cancer with overall marked decrease in previously seen solid/heterogenous enhancement pattern, compatible with treatment-related response. (2) Interval decrease in size of metastatic left axillary lymph node.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Clinical question: Bleed. Signs and symptoms: Acute change in mental status. Nonenhanced head CT:There is no evidence of intracranial hemorrhage, edema, mass-effect, midline shift or hydrocephalus. Cortical sulci, ventricular system and gray -- white matter differentiation is preserved and unremarkable. On sagittal reformatted images there is suggestion of slight ectopia of cerebellar tonsils. Please correlate with history and follow-up with an MRI examination.Calvarium is intact. Visualized paranasal sinuses, middle ear cavities and mastoid air cells are unremarkable

Output: 1.No evidence of acute intracranial findings. 2.Minimally ectopic cerebellar tonsils which may require further follow-up with an MRI.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate brain tumor resection. Signs and symptoms: Same. Pre- and post enhanced brain MRI:Examination demonstrates postoperative changes of a recent right posterior temporal-parietal craniotomy. There is revisualization of a necrotic thick/irregular rim enhancing tumor at this site measuring at least at 15 x 21 mm in transaxial dimensions compared to prior study measurements of 17.5 x 22.5 mm indicating subtle interval decreased size. Surrounding FLAIR hyperintensity consistent with edema and postoperative changes. There is resultant regional mass effect and without deviation of midline. The surgical path is immediately superior and lateral to the enhancing tumor and extent inferiorly to the trigone of right lateral ventricle. It demonstrates internal mixed-signal intensity and layering consistent with hemorrhage within the cavity. It measures approximately 25 mm in transaxial dimensions and approximately 45 mm in cranial cephalad axis.There is expected postoperative changes of epidural collection of approximately 6 mm thick confined to the inner table of craniotomy flap with subtle mass effect on the adjacent parenchyma. Also noted is 8 mm thick subgaleal collection along the outer table of the craniotomy flap. Expected subtle dural thickening and enhancement in the dysphagia craniotomy is also noted.

Output: 1.Examination is status post right posterior temporal-parietal craniotomy with expected postoperative changes as detailed.2.A round necrotic tumor with thick irregular rim enhancing measuring at 15 x 21 mm in size compared to prior study measurement of 17.5 x 22.5 mm.3.The surgical path projects posterior to the tumor and extends inferiorly to the trigone of right lateral ventricle and without detectable continuity with the tumor as detailed/measured above.


Instruction: Generate impression based on findings.

Input: History of uterine fibroids. PELVIS:UTERUS, ADNEXA: The uterus is lobular in contour and enlarged due to multiple intramural, and subserosal pedunculated fibroids. One fibroid appears to have a small submucosal component. The uterus measures 13.3 x 10.1 cm in the sagittal plane. The endometrial cavity is distorted and displaced by the fibroids but appears normal in thickness.The inner myometrium/junctional zone is difficult to visualize. At the fundus it is normal in thickness measuring 5 mm in thickness.The largest fibroid is in the left fundal subserosal/pedunculated position measuring 6.9 x 5.4 cm. The fibroids demonstrate moderate to avid gradual postcontrast enhancement.The cervical stroma, parametrial soft tissues, and vaginal canal are unremarkable.The left ovary is displaced superiorly and is normal in morphology and size with several physiologic follicles. The right ovary is unremarkable. Trace pelvic fluid is within physiologic limits. Normal caliber appendix and unremarkable terminal ileum is partially imaged.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: Multiple intramural and subserosal pedunculated uterine fibroids as above within a lobular enlarged uterus demonstrating moderate to avid postcontrast enhancement.


Instruction: Generate impression based on findings.

Input: Ms. Morgan is a 44-year-old female with a personal history of right skin sparing simple mastectomy in 2011 for invasive breast cancer. Currently on tamoxifen. Family history of breast cancer in paternal grandmother, two paternal aunts, and a first cousin. She has no current breast related complaints. There is scattered fibroglandular tissue in both breasts. Minimal background parenchymal enhancement is noted bilaterally.Patient is status post right skin sparing simple mastectomy with tissue based reconstruction. No abnormal enhancement is seen in the right reconstructed breast or chest wall.No abnormal enhancement is seen in the left 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.