Instruction: Generate impression based on findings.

Input: Preoperative planning for meningioma. There is an enhancing mass with prominent flow voids that appears to arise from the anterior falx cerebri, which measures up to 64 mm. There is an associated peritumor cyst or trapped cerebrospinal fluid collection that measures up to 14 mm along the left aspect of the tumor, as well as a similar 4 mm wide focus along the right aspect of the tumor. There is considerable mass effect upon the adjacent brain, as well as vasogenic edema in the regional brain parenchyma, left greater than right. However, there may be superimposed mild ischemic changes in the medial left frontal lobe. There is also effacement of the bilateral lateral ventricle frontal horns, but dilatation of the more posterior portions of the right lateral ventricle. There is posterior and right lateral displacement of the bilateral anterior cerebral arteries. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: A large vascular mass that appears to arise from the anterior falx cerebri with associated peritumor cysts and mass effect upon the adjacent brain, as well as extensive vasogenic edema, is compatible with a meningioma. The posterior portions of the right lateral ventricle appear to contain entrapped cerebrospinal fluid.


Instruction: Generate impression based on findings.

Input: Persistent knee pain MENISCI: There is abnormal signal intensity within the posterior horn of the medial meniscus with extension to the tibial articular surface suggesting an undersurface tear, perhaps with an unstable horizontal flap component. This tear extends into the body of the meniscus where meniscal flounce is noted. The anterior horn of the medial meniscus is intact.There is mild intrasubstance degeneration of the lateral meniscus but no evidence of tear.ARTICULAR CARTILAGE AND BONE: There is partial-thickness degeneration of the articular cartilage of the patella. There is minimal degeneration of the articular cartilage of the medial and lateral compartments, commensurate with the patient's age. There is serpentine signal abnormality within the proximal tibial metaphysis consistent with a chronic bone infarct.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The quadriceps and patellar tendons are normal. There is edema within the quadriceps fat pad which is of uncertain clinical significance.ADDITIONAL

Output: Medial meniscal tear with other findings described above.


Instruction: Generate impression based on findings.

Input: Male 46 years old Reason: evaluate for severe chondromalacia, ligamentous injury History: severe left knee pain, patellofemoral pain, sensations of instability. MENISCI: Mild poorly defined intrasubstance signal within the posterior horn and body of the medial meniscus suggesting degeneration. We see no discrete meniscal tear. There is slight medial extrusion of the body of the medial meniscus. Lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is degeneration of the articular cartilage of the patella. There is full-thickness cartilage loss along the far lateral facet of the patella, similar to the prior exam. There is relatively mild-moderate degeneration affecting the remaining patellar cartilage. There is diffuse thinning of the articular cartilage along the weightbearing surface of the medial compartment with full-thickness degeneration along the medial femoral condyle above the posterior horn of the medial meniscus, progressed from the prior study. There is also osteophyte formation with overlying cartilage thinning along the medial femoral condyle anteriorly. Articular cartilage of the lateral compartment is relatively spared.There is poorly defined edema type signal within the intercondylar eminence posteriorly, anterior to the attachment of the PCL. This is likely degenerative in etiology and is new from the prior exam.LIGAMENTS: ACL is intact. The PCL is intact, although there is a small collection of fluid signal intensity within the ligament which may represent a small ganglion. The MCL and lateral collateral ligament complex are intact. EXTENSOR MECHANISM: Within the quadriceps tendon there is focal intermediate signal intensity which may represent tendinosis or an old tear, similar to the prior exam. The patellar tendon is intact.ADDITIONAL

Output: 1.Degeneration of the articular cartilage predominantly affecting the patellofemoral and medial compartments, which has progressed in the medial compartment.2.No findings to suggest acute knee injury.3.Joint effusion and other findings above.


Instruction: Generate impression based on findings.

Input: Chronic headache and intracranial hypertension. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is no partially empty sella. The brain parenchyma appears 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, mastoid air cells, and scalp soft tissues are grossly unremarkable. There is mucosal thickening and fluid in the right maxillary sinus.

Output: 1. No evidence of intracranial hemorrhage, mass, or ventriculomegaly. 2. Mucosal thickening and fluid in the right maxillary sinus may indicate acute sinusitis.


Instruction: Generate impression based on findings.

Input: 19 year with jaundice, bilirubin of 10 ABDOMEN:LIVER, BILIARY TRACT: Mild to moderate intrahepatic biliary ductal dilatation. There is layering sludge within the gallbladder. No choledocholithiasis. There is probable low insertion of the cystic duct although this is incompletely evaluated due to cyst pancreatic head lesion. The common bile duct is dilated, slightly increased when compared to most recent CT dated 11/14/2015. The distal common bile duct and ampulla are difficult to visualize due to mass effect from cystic pancreatic lesion.Hepatic steatosis is present.SPLEEN: No significant abnormality noted.PANCREAS: There is diminished intrinsic T1 signal of the pancreas suggestive of chronic pancreatitis. The main pancreatic duct and side branches are dilated measuring up to 8 mm. There is a new large cystic lesion in the head of the pancreas measuring 6.2 x 6.8 x 7.2 cm. There is mass effect on both the pancreatic and common bile duct. There is mass effect and displacement of the duodenum. There is no evidence of gastric outlet obstruction. There is no abnormal enhancement. No splenic vein thrombosis.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Prominent appearing unusually shaped periportal lymph node may be reactive. BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.New large cystic lesion head of the pancreas, likely reflecting a pseudocyst provided history of pancreatitis, with focal mass effect on adjacent structures including the common bile duct and pancreatic duct with slight interval increase in size of biliary dilatation could explain the patient's jaundice and increased bilirubin. An ERCP or US guided drainage of the cyst may be helpful.2.Mild restricted diffusion of the pancreas and diminished intrinsic T1 signal of the pancreas is suggestive of an acute on chronic pancreatitis.


Instruction: Generate impression based on findings.

Input: 85 year old with history of atrial fibrillation, hypertension and heart failure presenting for evaluation of etiology of heart failure. Left VentricleThe left ventricle is mildly dilated with mildly reduced systolic function. There is basal septal hypertrophy and concentric left ventricular hypertrophy. The overall LV ejection fraction is 45%, the LV end diastolic volume index is 95 ml/m2 (normal range: 65+/-11), the LVEDV is 157 ml (normal range 109+/-23), the LV end systolic volume index is 53 ml/m2 (normal range 18+/-5), the LVESV is 86 ml (normal range 31+/-10), the LV mass index is 60 g/m2 (normal range 67+/-11), and the LV mass is 99 g (normal range 114+/-24). The left ventricular systolic dysfunction is global.There is late gadolinium enhancement at the basal to mid septum (on right ventricular side), subendocardial basal lateral wall, subendocardial apical septum and transmural at the apex. The differential diagnosis includes prior myocarditis from inflammation or sarcoidosis. This distribution is atypical for amyloidosis. Although the majority of the enhancement is subendocardial, it does consistently follow a pattern for infarct. No intracardiac thrombus.Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is moderately dilated with moderately reduced systolic function. The overall RV ejection fraction is 31%, the RV end diastolic volume index is 114 ml/m2 (normal range 69+/-14), the RVEDV is 187 ml (normal range 110+/-24), the RV end systolic volume index is 78 ml/m2 (normal range 22+/-8), and the RVESV is 129 ml (normal range 35+/-13). No enhancement.Right AtriumThe right atrium is severely dilated. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is at least mild mitral regurgitation. There is mild thickening of anterior leaflet of the mitral valve. Pulmonic ValveThe pulmonic valve opens widely. There is mild pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is at least moderate tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC drain normally into the right atrium. PericardiumThere is no significant pericardial effusion.Extracardiac Findings:There is a trace right pleural effusion and small left pleural effusion.

Output: 1. The left ventricle is mildly dilated with mildly reduced systolic function. The overall LV ejection fraction is 45%. Enhancement pattern that is suspicious for prior inflammation from myocarditis or infiltrative process such as sarcoidosis. It is atypical for amyloidosis or embolic infarcts.2. The right ventricle is moderately dilated with moderately reduced systolic function. The overall RV ejection fraction is 31%


Instruction: Generate impression based on findings.

Input: Chiari malformation, esotropia, vision changes. The cerebellar tonsils extend up to 8 mm inferior and display pointed morphologies. In addition, posterior cranial fossa capacity appears to be relatively small. However, there is flow of cerebrospinal fluid across the foramen magnum, albeit perhaps slightly reduced posteriorly. The spinal cord displays normal signal and morphology. The conus medullaris is located at the L1-L2 level. The vertebral column alignment is within normal limits, without evidence of retroflexion of the dens. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The paravertebral soft tissues are unremarkable.

Output: Findings suggestive of Chiari type 1 malformation, without associated syringohydromyelia.


Instruction: Generate impression based on findings.

Input: Diagnosis: Multiple sclerosisClinical question: please do on 3 T Dr Javed MS protocol compare to priorSigns and Symptoms: progression MS MRI brain:There is redemonstration of a moderate degree of periventricular and subcortical white matter signal hyperintense lesions on the FLAIR and T2-weighted images some which are perpendicularly oriented to the lateral ventricles and some are located in the corpus callosum. These tend to be hypointense on T1 and are stable and compared to the previous exam there is no associated contrast enhancement at these lesions.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 cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal enhancing lesions are identified in the cervical spine.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.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.Multiple periventricular subcortical white matter lesions are present as well as corpus callosum lesions which are stable since the prior exam and compatible with patient's clinical diagnosis of demyelinating disorder.2.There is no compromise to cervical spinal canal or exiting nerve roots and no lesions detected in the cervical spinal cord.


Instruction: Generate impression based on findings.

Input: 74 years, Female, lung cancer, evaluate for metastasis. Examination slightly motion degraded. There is no intracranial mass or abnormal parenchymal or meningeal enhancement to suggest metastatic disease. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. The ventricles are within normal limits in size and configuration. Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild chronic small vessel ischemic disease. Brain parenchyma is otherwise unremarkable for age. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: No evidence of intracranial metastatic disease


Instruction: Generate impression based on findings.

Input: Reason: eval prior OSH surgery, possible Dupuytren's excision with continued pain and stiffness History: finger and palmer hand pain Suboptimal evaluation secondary to inability to properly position patient due to the inability to flatten the patient's fingers, per the technologist note.TENDONS: The flexor and extensor tendons appear intact. There is a small amount of circumferential fluid within the tendon sheaths of the flexor digitorum tendons at the level of the third MCP joint of questionable clinical significance.BONES: No bone marrow signal abnormalities are identified. There is apparent negative ulnar variance.ADDITIONAL

Output: Linear decreased signal abnormality within the subcutaneous tissue along the volar aspect of the wrist and hand may reflect postsurgical scarring or fibrosis.


Instruction: Generate impression based on findings.

Input: 62 year-old female with altered mental status and history of multiple sclerosis. Evaluate for intracranial hemorrhage. There is no evidence of intracranial hemorrhage, mass or edema. Extensive white matter changes are stable when compared to previous examination. No evidence of cortical stroke. If there is clinical concern for acute ischemia an MRI may be considered. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Stable, extensive white matter changes. If there is clinical concern for acute ischemia an MRI may be considered.


Instruction: Generate impression based on findings.

Input: Acinic cell parotid cancer now with headache and nausea, evaluate for progression of skull base metastases. There are postsurgical findings related to prior right lateral temporal bone resection and parotidectomy. There is marrow replacement with corresponding patchy heterogeneous enhancement involving the right basiocciput, petrous ridge, condylar and squamous portions of the occipital bone, and the right lateral mass of C1, with a small soft tissue component in the upper carotid space, all appearing similar to prior examinations. There are no new skull base osseous lesions identified. Intracranially, no new or suspicious lesions are seen. There are a few unchanged punctate foci of enhancement within the right lateral cerebellum, immediately adjacent to the abnormal skull base, with surrounding T2 hyperintensity. Supratentorially, there are several scattered foci of nonspecific T2 hyperintensity, which appear unchanged. There are no new enhancing intracranial lesions. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles remain normal in size and morphology.

Output: Findings related to right lateral temporal bone resection and parotidectomy without significant change in the treated right skull base and right craniocervical junction tumor, as well as the abnormality in the right cerebellar hemisphere.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Pain. Four views of the left knee demonstrate tiny osteophytes along the undersurface of the patella. A large joint effusion is noted. The knee otherwise appears normal.

Output: Left knee joint effusion and tiny patellar osteophytes.


Instruction: Generate impression based on findings.

Input: A patient submitted outside study for review. Submitted for review are: 1. Diagnostic mammogram of both breast with tomo synthesis and right breast ultrasound dated 7/18/20162. Right breast biopsy with postprocedure mammogram dated 7/25/2016 performed at Christ Center for breast care, Oak lawn . For comparison,none are available. History of right lumpectomy 1996 for breast cancer. 1. Diagnostic mammogram of both breast with tomo synthesis and right breast ultrasound dated 7/18/2016: 2 standard views of both breasts and additional exaggerated CC lateral view of the left breast and spot magnification views of the left breast were submitted for review. Tomo synthesis images could not be uploaded for interpretation. The breast parenchyma is heterogeneously dense, distributes fairly symmetrically in both breasts. Postsurgical changes in the form of architectural distortion and scarring identified in the posterior central aspect of the right breast best seen on the CC view and exaggerated CC lateral view.There is a 15 mm partially visualized spiculated mass with highly suspicious calcifications with linear distribution in the right breast 10 to 11:00 position posterior depth best seen on the exaggerated CC lateral view. Suspicious calcifications are seen extending anteriorly in a discontinuous fashion approximately measuring 6 cm. This is best seen on the ML spot magnification view. Further evaluation with MRI would be helpful to assess extent of disease.Few hyalinizing fibroadenomas and benign calcifications are seen in the anterior depth. Focal asymmetry in the right retroareolar region is incompletely evaluated, this could represent asymmetric normal glandular tissue however special attention should be given to this area on MRI.No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in left breast. Ultrasound demonstrates an irregular hypoechoic mass that measures 1.4 x 1 x 1.5 cm with calcifications within it. This is located in the right breast 10:00 position, 11 cm from the nipple.Subsequent biopsy of the right breast was performed on 7/25/2016 and a clip was placed. Clip is identified within the mass on the exaggerated CC lateral view.Pathology revealed IDC grade 3 with DCIS which appears concordant.

Output: Biopsy-proven IDC grade 3 with DCIS in the right breast 10:00 position with clip placement.Extensive calcifications extend anteriorly from the mass approximately 6 cm. Further evaluation with MRI would be helpful to assess extent of disease. Focal asymmetry in the right retroareolar region appears indeterminate and can be evaluated on MRI.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: 76-year-old female with right lower extremity weakness and history of renal cell carcinoma metastases to the spine. There is abnormal bone marrow signal in the S1 and S2 segments of the sacrum, which corresponds to an ill-defined sclerotic and lytic lesion in the prior CT. There is an additional area of abnormal signal within the right posterior superior L5 vertebral body and right pedicle. Mild loss of vertebral height is noted at the S1 segment. The vertebral bodies are otherwise appropriate in the overall alignment and height. There is also abnormal signal in the L5-S1 intervertebral disc. The spinal cord has normal signal characteristics and overall morphology. There is no compromise of the spinal cord. Small posterior disc osteophyte complexes are present in the cervical spine, most conspicuous at C3-C4. Combined with mild ligamentum flavum hypertrophy/facet arthropathy, this results in mild spinal canal stenosis. There is no area of high-grade spinal canal stenosis in the spine. Moderate degenerative changes are noted in the lower lumbar spine with associated moderate to severe narrowing of the right L5-S1 neural foramen. No additional areas of high-grade neural foraminal stenosis are identified throughout the spine. Within the presacral region, there is increased STIR signal and low T1 signal, which is slightly heterogeneous and perhaps related to fluid, versus less likely mass given the relatively normal appearance of the presacral area on recent CT. Moderate bilateral pleural effusions are noted. There is a subcentimeter round focus of hyperintensity in the inferior pole of the left kidney.

Output: 1. Findings suggestive of metastatic lesions L5, S1, and S2. Loss of height at S1 suggestive of pathologic compression fracture.2. No spinal cord compression is identified. This is a limited exam specific for the exclusion of cord compression only and does not exclude more subtle lesions such as intrinsic cord abnormalities.3. Degenerative changes in the lower lumbar spine with associated moderate to severe narrowing of the right L5-S1 neural foramen. Correlation with patient symptoms is suggested.4. Bilateral pleural effusions are incidentally noted, new since prior CT.5. Abnormal signal in the presacral region may represent fluid. New presacral mass is felt to be less likely given the short time course since prior CT and presacral space appeared relatively normal.


Instruction: Generate impression based on findings.

Input: History of nasal BCC treated with resection and reconstruction. Yearly MRI to look for recurrence: Nasal deformity and irregularity. There are postoperative findings in the left nasal ala and nasolabial fold region, as well as in the left frontal scalp region. There is deformity of the left nasal ala and predominantly linear low T1 and T2 signal tissue in the surgical bed, which likely represents scar tissue, but no measurable enhancing tumor. There is no evidence of significant lymphadenopathy in the head and neck. The thyroid and salivary glands are unremarkable. The orbital contents and imaged intracranial structures are unremarkable.

Output: Postoperative findings related to left nasal skin tumor resection without evidence of locoregional tumor recurrence.


Instruction: Generate impression based on findings.

Input: Back pain, fever. Evaluate for compression. Examination is limited to sagittal sequences per cord compression protocol. There are postsurgical changes related to recent revision of spinal fusion with hardware extending from L4 to S1 with iliac screws. Mild L5-S1 anterolisthesis. There is a small fluid collection involving the posterior paraspinous soft tissues which given recent surgery may represent a seroma or perhaps a pseudomeningocele. Superimposed infection is not excluded. Degenerative changes are seen in the cervical spine particularly at C5-C6 and C6-C7 with mild kyphotic angulation. Minimal T2 hyperintensity at the C6-C7 disc is likely on a degenerative basis. STIR hyperintensity involving the posterior elements at the C7-T1 level is also nonspecific and may represent a mild interspinous bursitis.

Output: 1. No evidence of cord compression or high-grade stenosis within the cervical, thoracic, or lumbar spine. No obvious epidural collection.2. Postoperative changes of recent hardware revision with fluid collection involving the posterior paraspinous soft tissues dorsal to the L4-S1 levels. Given recent surgery, this fluid collection can be expected and may represent a seroma or pseudomeningocele, although infection cannot be excluded.3. Due to the screening nature of this protocol details are not as evident on imaging as dedicated protocols of the spine. If there is high suspicion for spinous/paraspinous infection, consider complete study with gadolinium.


Instruction: Generate impression based on findings.

Input: Right hip, low back pain, and right leg pain. There is disc space narrowing and bulging with superimposed eccentric left protrusion, as well as bilateral facet hypertrophy at L5-S1, with resultant compression of the descending nerve roots in the lateral recesses, left more than right. There is also mild right and mild to moderate left neural foraminal stenosis at this level. There is no significant spinal canal or neural foraminal stenosis at the other lumbar spine levels. The vertebral column alignment is within normal limits. The vertebral body heights are preserved. The vertebral bone marrow signal is unremarkable. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable. There is a hypointense mass in the uterus that measures up to 4.5 cm and several small probable Nabothian cysts and adnexal cysts.

Output: 1. Degenerative spondylosis at L5-S1 results in compression of the descending nerve roots in the lateral recesses, left more than right, as well as mild right and mild to moderate left neural foraminal stenosis at this level.2. Probable fibroid uterus and several small probable Nabothian cysts and adnexal cysts. Pelvic ultrasonography may be useful for further imaging.


Instruction: Generate impression based on findings.

Input: Left eye pain and vision changes, evaluate for optic neuritis. Per EPIC, pain OU after waking up 2 nights ago and egg/oval shaped spot in FOV (nasally about 9 o'clock) OD. Also has chorioretinal scar, right and bilateral ocular rosacea. There is mild asymmetric prominence of the cerebrospinal fluid surrounding the left optic nerve, which appears similar to prior examinations. The optic nerves themselves are symmetric and normal in size and signal intensity. The extraocular muscles are unremarkable. There is no intraorbital mass or abnormal enhancement. However, there appears to be mild diffuse thickening and enhancement of the bilateral eyelids. There is no optic chiasm mass or parasellar abnormality.

Output: 1.Mild unchanged asymmetric prominence of the cerebrospinal fluid surrounding the left optic nerve, which may be a normal variant, but no evidence of optic neuritis.2.The bilateral eyelids appear to be mildly swollen, which may correspond to the clinically reported blepharitis.


Instruction: Generate impression based on findings.

Input: 54 years Female (DOB:2/8/1962)Reason: Progressing numbness of L leg to groin, new-onset L leg weakness History: as abovePROVIDER/ATTENDING NAME: SHANNON K MARTIN AUDREY L. TANKSLEY Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall height. There is mild anterior subluxation of L4 and L5. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is loss of disc space height, disc desiccation and diffuse disc bulge associated with mild hypertrophy. There is partial effacement of the fat at the left lateral recess at this level with mild encroachment of nerve roots. There is narrowing of the neural foramina bilaterally at this level with some encroachment of the left-sided exiting nerve roots.At L4-5 there is loss of disc space height, disc desiccation and endplate reactive change. Endplate reactive changes dark on T1 and bright on T2 STIR. There is associated effacement of the fat at the lateral recess bilaterally at this level and crowding of the nerve roots with moderate to severe spinal stenosis resulting. There is also narrowing of the neural foramina due to disc material bilaterally with encroachment of exiting nerve roots bilaterally. There is mild anterior subluxation of L4 and L5. There is marked bilateral facet and ligamentum flavum hypertrophy at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is a disc bulge present at this level associated with mild ligamentum flavum hypertrophy.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.There is moderate to severe spinal stenosis associated bilateral encroachment of exiting nerve roots at L4-5 related to a combination of diffuse disc bulge, marked facet hypertrophy and subluxation.2.There are some mild to moderate encroachment of the nerve roots at the left lateral recess at L5-S1 and within the left neural foramen at L5-S1.


Instruction: Generate impression based on findings.

Input: The ventricles and sulci are within normal limits. The basal cisterns remain patent. There is no midline shift or mass effect. There are no areas of abnormal signal. There is no diffusion abnormality. Moderate amount of bilateral hemispheric extra-axial fluid collection likely represent subarachnoid fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. There is no abnormal enhancement. There is no intracranial mass.In the right frontal region of the calvarium there is a well-circumscribed lesion that may represent a sebaceous cyst versus epidermal inclusion cyst seen.

Output: No evidence of metastatic disease to the brain. There is moderate amount of bilateral hemispheric extra-axial fluid seen, most likely subarachnoid fluid.


Instruction: Generate impression based on findings.

Input: Preoperative planning for a cystic lesion in the left cerebellar pontine angle. There is a cystic lesion in the left cerebellopontine angle cistern that measures up to approximately 25 mm. There is associated posterior deviation of the left cranial nerve 7 and 8 complex and mass effect upon the brainstem, left middle cerebellar peduncle, and left cerebellar hemisphere. There is a small developmental venous anomaly in the right inferior frontal gyrus. There is scattered mild mucosal thickening in the paranasal sinuses. There is a small amount of fluid signal in the right mastoid air cells. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Left cerebellopontine angle cistern arachnoid cyst that measures up to approximately 25 mm with associated posterior deviation of the left cranial nerve 7 and 8 complex and mass effect upon the brainstem, left middle cerebellar peduncle, and left cerebellar hemisphere.


Instruction: Generate impression based on findings.

Input: Male 81 years old Reason: History of metastatic prostate cancer to bones, lymph nodes with lower abdominal pain History: pelvic pain, prostate cancer ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter T2 hyper intensities are too small characterize but may represent cysts. The common duct is dilated measuring 1.1 cm. No filling defect is identified.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: The kidneys are bilaterally atrophic; right greater than left. No hydronephrosis. Bilateral mild hydroureter and ureteric wall thickening not significantly changed compared to prior studies. Nephroureteric stents in situ.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Multiple sclerotic lesions identified throughout the osseous skeleton consistent with metastatic disease. Evaluation of disease extent and activity is better assessed with nuclear medicine bone scan.OTHER: No significant abnormality noted.

Output: 1.Diffuse osseous metastatic disease. Disease extent and activity is better assessed on nuclear medicine bone scan.2.Denervation edema of the right gluteal muscles.


Instruction: Generate impression based on findings.

Input: 19 year-old male with abdominal pain, asses for Crohn's disease. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is no bowel wall thickening, signal abnormality, or abnormal enhancement to suggest active inflammation. No dilated loops of bowel to suggest obstruction. No focal fluid collection is identified to suggest abscess formation. No fistula formation is seen. There is a moderate amount of stool noted throughout the colon.

Output: Moderate amount of stool noted throughout the colon without evidence of active inflammatory bowel disease, as clinically questioned.


Instruction: Generate impression based on findings.

Input: 35-year-old female with numbness in hands result. Slurred speech resolved. One hour ago. No evidence of hemorrhage, edema, mass-effect, midline shift or hydrocephalus. Cortical sulci, ventricular system and all CSF cisterns remain within normal range for patient's stated age. Slight crowding at the level of the foramen magnum is concerning for ectopic cerebellar tonsils. This can be further evaluated with a dedicated MRI examination.Calvarium, paranasal sinuses and mastoid air cells are also unremarkable.

Output: 1.No evidence of acute findings.2.Minimal crowding at the level foramen magnum is concerning for a slightly ectopic cerebellar tonsils.


Instruction: Generate impression based on findings.

Input: There is trace grade 1 retrolisthesis of C3 on C4 and C6 and C7, as well as anterolisthesis of C4 on C5. There is straightening of the normal cervical lordosis. The vertebral body heights are well-maintained. There is multilevel disc narrowing and desiccation, up to moderate-severe degree at C6-C7. Is a small focus of T1 hypointensity and T2/STIR hyperintensity with enhancement along the inferior endplate of C3 which may represent a small metastatic lesion. The spinal cord is of normal caliber and signal. There is no pathological enhancement.At C2-C3, there is no significant disk pathology or stenosis.At C3-C4, there is uncovering of the disc with a mild diffuse posterior osteophyte disk complex. There is also bilateral facet arthropathy and ligamentum flavum thickening resulting in overall mild to moderate central spinal canal stenosis and moderate left foraminal narrowing.At C4-C5, there is trace uncovering of the disc with mild-moderate right foraminal narrowing.At C5-C6, there is a mild diffuse posterior osteophyte disk complex with slight left paracentral prominence. There is significant bilateral uncovertebral hypertrophy resulting in moderate left and mild-moderate right foraminal narrowing. There is overall mild to moderate central spinal canal stenosis.At C6-C7, there is uncovering of the disc with mild diffuse posterior osteophyte disk complex resulting in up to moderate central spinal canal stenosis. Severe bilateral uncovertebral hypertrophy results in moderate right and moderate-severe left foraminal narrowing.At C7-T1, there is minimal central disc protrusion without stenosis.THORACIC SPINE

Output: 1.Diffuse osseous metastatic disease, with several levels of more confluent abnormality. One of these is noted at T10 where there is additional epidural spread of tumor resulting in moderate-severe central spinal canal stenosis, deformity of the cord, and abnormal cord signal suggestive of cord compression. Severe left and moderate-severe right foraminal narrowing at T10-T11.2.Scattered multilevel spondylotic changes as detailed above.Dr. Purakal discussed these findings over the telephone with Dr. Andrew Bokarius on 1/25/2016 20:20 hours.


Instruction: Generate impression based on findings.

Input: 41-year-old female with loose stools and joint pain. History of stricturing ileal Crohn's disease on Humira and MTX. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Mild tethering of the small bowel to adjacent sigmoid colon is unchanged and compatible with chronic inflammatory bowel disease (coronal series 10 image 22). The terminal/distal ileum is denuded without evidence for stricture, wall thickening, or abnormal enhancement. Fibrofatty proliferation most evident in the right lower quadrant. No wall thickening or abnormal enhancement to suggest active disease. No evidence for fistula or abscess formation. No bowel obstruction.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Status post hysterectomy.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Chronic findings of Crohn's disease as described above. No evidence for acute inflammation.


Instruction: Generate impression based on findings.

Input: 33-year-old male with history of seizures. There no areas of restricted diffusion to suggest acute ischemia. There is no evidence of acute intracranial hemorrhage. No mass or mass effect. No areas of parenchymal edema. The ventricles and sulci are symmetric. Specifically the medial temporal lobes are unremarkable. Normal flow voids are appreciated in the major intracranial vessels. There are mucous retention cysts in bilateral maxillary sinuses, left larger than right. There is a small amount of fluid in the left petrous bone which likely represents trapped fluid. The mastoid air cells are clear. The orbits are unremarkable.

Output: No evidence of mass or clear etiology of seizures.


Instruction: Generate impression based on findings.

Input: During the study, the patient became agitated and did not wish to continue. Best attempts were made at obtaining diagnostic images.Redemonstrated are bilateral partially calcified subdural hematomas (right larger than left), which due to their calcific component are better demonstrated on prior head CT. As before, there is significant associated regional right hemispheric mass effect causing approximately 8 mm right to left midline shift, although this is stable in appearance. There is confluent white matter T2 hyperintensity, primarily in a periventricular distribution, without associated restricted diffusion or mass effect, matching the diffuse hypodensity noted on the prior head CT. As before, a ventriculostomy catheter is noted entering via a left frontal approach with its tip near the leftward foramen of Monroe, unchanged in position. A second ventriculostomy catheter is again noted via a right parietal approach, with its tip in the left frontal horn, unchanged in position. A focus of susceptibility hypointensity at the tip of this second catheter is consistent with the previous small focus of hemorrhage at the catheter tip identified on prior head CT. Ventricular sizes are stable. Intraventricular air has resolved. Susceptibility hypointensity along the shunt is consistent with hemorrhagic products as noted on the prior head CT. Smooth dural enhancement with minimal thickening is noted adjacent to the subdural collections. There is no abnormal parenchymal enhancement. There is a prominent CSF collection extending from the suprasellar region to the pineal region causing flattening of the tectal plate, better demonstrated by multiplanar MRI, which has not significantly changed. Diffuse calvarial thickening is again noted. Expected vascular flow voids are demonstrated. The cerebellar tonsils are in an appropriate position. The pituitary is unremarkable in appearance.

Output: 1.Redemonstrated are bilateral partially calcified subdural hematomas (right larger than left), with significant associated regional right hemispheric mass effect causing approximately 8 mm right to left midline shift which is stable in appearance. 2.There is confluent white matter T2 hyperintensity, primarily in a periventricular distribution, without associated restricted diffusion or mass effect, matching the diffuse hypodensity noted on the prior head CT.3.Unchanged left frontal and right parietal ventriculostomy catheters.4.Stable ventricular sizes.5.There is no abnormal parenchymal enhancement. 6.There is a prominent CSF collection extending from the suprasellar region to the pineal region causing flattening of the tectal plate, better demonstrated by multiplanar MRI, which has not significantly changed.


Instruction: Generate impression based on findings.

Input: metastatic NCSLC initially treated with CRT (carbo/taxol), SRT to brain lesion followed by 2 cycles of carbo/taxol consolidation. F/u scans showed progression of disease. Received WBRT. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is unchanged confluent cerebral 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 unremarkable.

Output: Post-treatment findings in the brain without evidence of recurrent brain metastatic disease.


Instruction: Generate impression based on findings.

Input: Elevated PSA. History of prostate cancer. 3/15/2011 biopsy showed 3+3 mm 20% right medial base, 3+ 3 2-mm 10% right lateral base and 3+ 3 1-mm 10% right lateral mid. PELVIS:PROSTATE:Prostate Size: 3.6 x 6.3 x 5.3 cm.Peripheral Zone: No significant intrinsic T1 weighted signal hyperintensity. In the right paramedial base there is a 1.2 x 8 mm focus of T2 weighted hypointensity (series 801/17) associated with restricted diffusion (series 1004/324) and asymmetric early enhancement (series 1 701/1 935) which may correspond to the patient's known site of prostatic adenocarcinoma. There is some adjacent low T2-weighted signal intensity which crosses the midline which likely predominantly represents the central zone, unchanged in appearance from the prior.1.5 x 0.9 cm nodule adjacent to the left base anterior surgical capsule (peripheral zone/central gland junction) demonstrates very low T2-weighted signal intensity (series 801/18), restricted diffusion (series 1004/344) and early arterial enhancement (series 1701/2095). This is increased in size from the prior study.Additional punctate T2 weighted hyperintense foci in the peripheral zone measuring less than 3 to 4 mm.Central Gland: Changes of benign prostatic hyperplasia.Seminal Vesicles: The right base lesion signal abnormality may extend into the right seminal vesicle (series 601/15).Extracapsular Extension: No evidence of extra capsular extension.BLADDER: Partially distended urinary bladder.LYMPH NODES: No enlarged pelvic lymphadenopathy.BONES, SOFT TISSUES: Probable mild focal synovitis adjacent to the right superolateral posterior hip joint. No arterially enhancing bone lesion.OTHER: No significant abnormality noted.

Output: 1.1.2 cm right paramedial base lesion is suspicious for prostatic adenocarcinoma with findings suspicious for extension into the right seminal vesicle.2.Left anterior base 1.5 cm lesion is suspicious for prostatic adenocarcinoma, increased from the prior study.


Instruction: Generate impression based on findings.

Input: 38 year old male pre op planning for L cerebellar cavernoma resection. Limited sequences are provided for the purpose of surgical planning. Redemonstrated is a heterogeneous intermediate to high T1 signal and mixed low and high T2 signal lesion centered in the left middle cerebellar peduncle with diffuse central and peripheral susceptibility effect, which measures up to 20 mm. There is surrounding vasogenic edema. There is partial effacement of the fourth ventricle, but the third and lateral ventricles are not particularly enlarged. There is no evidence of acute infarct. There is peripheral enhancement of the left cerebellar peduncle lesion which could represent inflammation or lack of a intact blood brain barrier in this region. There is no midline shift or herniation. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is a retention cyst in the left maxillary sinus.

Output: Findings remain suggestive of a recently hemorrhagic left middle cerebellar peduncle cavernous malformation with associated developmental venous anomaly.


Instruction: Generate impression based on findings.

Input: Reason: cutaneous SCC of L cheek with PNI s/p radiation History: surveillance Again seen are post-treatment changes in the left cheek including thinning and reticulation of the subcutaneous fat. No discrete mass is evident. There is also no significant cervical lymphadenopathy.Again seen is asymmetric increased T2 signal diffusely within the left parotid gland, which is consistent with posttreatment change. Remainder of the salivary glands and thyroid gland are grossly unremarkable. The major cervical flow voids are grossly intact. There are mild multilevel degenerative changes in the cervical spine without suspicious osseous lesions. The partially imaged orbits and brain parenchyma are grossly unremarkable. There is mild left maxillary sinus mucosal thickening similar to prior. There is persistent fluid within the left mastoid air cells and middle ear.

Output: 1. No evidence of local tumor recurrence within the limits of noncontrast study.2. No significant cervical lymphadenopathy.3. Persistent fluid in the left middle ear cavity and mastoid air cells which may reflect posttreatment-related otomastoiditis.


Instruction: Generate impression based on findings.

Input: 81-year-old female with history of renal cell cancer, status post left radical nephrectomy. Abdominal pain, vomiting and diarrhea. Rule out obstruction. This examination is limited by the absence of intravenous contrast.ABDOMEN:LUNG BASES: Mild bibasilar atelectatic changes. Small pericardial effusion.LIVER, BILIARY TRACT: The gallstone seen on the prior MRI examination is no longer present in the gallbladder. The gallbladder contains a small amount of air seen on coronal image 73/118 and axial image 41/153 of series 3. A minimal amount of perihepatic free fluid is present. There is a punctate calcification in the left lateral hepatic segment, probably due to old granulomatous disease.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Status post left radical nephrectomy. Large simple cyst at the right inferior pole. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The stomach is moderately dilated with fluid and retained food. There is partial small bowel obstruction. A 2.7-cm diameter gallstone with peripheral calcifications is present in the distal jejunum at axial image 102/153 of series 3. This is the apparent source of obstruction. The small bowel proximal to the gallstone obstruction is mildly dilated and the wall is thickened, probably due to edema.BONES, SOFT TISSUES: Degenerative changes in the spine.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Atrophic or absent. BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Degenerative changes in the lumbosacral spine and pelvis.OTHER: No significant abnormality noted

Output: Gallstone ileus.


Instruction: Generate impression based on findings.

Input: BRAIN: There postoperative findings related to suboccipital craniectomy for Chiari I malformation. There is bilateral inferior cerebellar tenting towards the overlying dura. There is intact biphasic flow across the neo-foramen magnum, although there appears to be mild flow turbulence posteriorly along the inferior cerebellum. There is unchanged flexion of the brainstem configuration. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles are unchanged in size and configuration. The major cerebral flow voids appear to be intact. The clivus is hypoplastic and associated with platybasia. SPINE: The holocord syringohydromyelia has decreased in caliber, measuring up to 3 x 7 mm in cross section, previously 7 x 12 mm. There is more pronounced thoracolumbar scoliosis and straightening of the vertebral column in the sagittal plane. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis.

Output: 1. Postoperative findings related to Chiari decompression with evidence of adhesion formation between the inferior cerebellum and overlying dura in the surgical bed and persistent craniocervical junction malformation manifesting with platybasia.2. Interval decrease in caliber of the holocord syringohydromyelia.3. More pronounced thoracolumbar scoliosis, perhaps attributable to the absence of a brace during the scan.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Reason: evaluate status of HCC - had marginal HCC recurrence on 4/7 MRI - s/p RFA on 4/16 - needs follow up imaging History: cirrhosis, HCC ABDOMEN:LIVER, BILIARY TRACT: Nodular cirrhosis with widening of the fissures. Hepatic steatosis and areas of fibrosis. Patent hepatic vasculature. No biliary dilatation. Status post cholecystectomy.Mildly increased size of segment 1 ablation cavity due to interval re-ablation with the cavity measuring up to 4 x 3.4 cm, previously 2.8 x 2.1 cm (series 11/40). Intrinsic high T1 signal within the cavity due to hemorrhage. There is mild heterogeneous signal surrounding this ablation cavity, but there is no enhancement or lesion suspicious for residual or recurrent tumor.Slightly decreased size of segment 8 ablation cavity measuring up to 0.9 x 0.9 cm, previously 1.1 x 1.0 cm (series 12/31). No evidence of residual or recurrent tumor.SPLEEN: Splenomegaly. PANCREAS: Stable small, nonspecific cystic lesion in the uncinate process, may be a sidebranch type IPMN.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable bilateral subcentimeter T2 hyperintensities, likely cysts.RETROPERITONEUM, LYMPH NODES: No pathologically enlarged lymph nodes by size criteria.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Midline incisional changes with small amount of fluid signal.OTHER: Moderate right pleural effusion, partially visualized.

Output: 1.Right hepatic lobe ablation cavities without evidence of residual or recurrent tumor.2.Stable nonspecific cystic lesion in the uncinate process, may be an IPMN.3.Moderate right pleural effusion, partially visualized.


Instruction: Generate impression based on findings.

Input: Reason: left knee pain for 1 year, minimal response to prior injections, eval for meniscal/tendon pathology; +medial McMurray History: as above. MENISCI: Extrusion of the medial meniscus into the medial gutter. Fraying on the undersurface of the anterior horn of the medial meniscus. Irregularity and small size of the posterior horn of the medial meniscus compatible with degenerative tearing. The lateral meniscus is intact. ARTICULAR CARTILAGE AND BONE: Severe osteoarthritis of the medial tibiofemoral compartment with marked thinning of the cartilage, near bone on bone apposition, osteophyte formation, and subchondral edema. Moderate osteoarthritis of the lateral tibiofemoral compartment with mild cartilage thinning. Severe osteoarthritis of the patellar compartment with complete cartilage loss along the lateral facet of the patella and marked thinning along the medial facet of the patella and osteophyte formation. No acute fracture or malalignment.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1.Degenerative tearing of the posterior horn of the medial meniscus. Extrusion of the medial meniscus into the medial gutter. 2.Severe tricompartmental osteoarthritis with complete cartilage loss involving the medial tibiofemoral and patellar compartments.3.Moderate size joint effusion.


Instruction: Generate impression based on findings.

Input: Clinical question: 62-year-old female with SLL, history of subdural bleed with midline shift, now with hypertension and bradycardia, concern for elevated intracranial pressure. Signs and symptoms: Bradycardia, hypertension Non-infused CT of brain:Redemonstration of periventricular low attenuation in bifrontal lobes. In comparison to the prior examination there is suggestion of interval increase of this finding.Also new since prior examination is large area of low attenuation involving the left occipital lobe surrounding the occipital horn of left lateral ventricle. Also note is made of interval increase in the size of the supratentorial ventricles. There is no evidence of hemorrhage. I believe the above findings may represent transependymal exudate secondary to gradually increasing hydrocephalus. Further evaluation with an MRI is recommended to exclude other possibilities. There is no evidence of residual subdural. Small calcified meningioma along the left petroclinoid ligament is again identified.Images through posterior fossa suggests interval increase in the size of fourth ventricle as well.

Output: 1.Increased in size of all ventricular system since prior exam. 2.Increased in periventricular low attenuation is concerning for hydrocephalus and periventricular exudate of CSF.3.correlate with clinical history and if concerned an MRI is recommended.


Instruction: Generate impression based on findings.

Input: Patient is a 53-year-old man with end-stage hepatitis B liver cirrhosis and portal hypertension who presented with altered mental status, acute respiratory and renal failure and hypotension now with multiorgan failure status post intubation with unclear neurological prognosis. Please evaluate for ischemia, cerebral edema, and encephalopathic changes. There is no evidence of intracranial hemorrhage, mass or edema. There are no CT findings of stroke, however if stroke is of clinical concern recommend MRI.The ventricles and basal cisterns are normal in size and configuration. There are no CT findings of cerebral edema.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Normal brain CT.


Instruction: Generate impression based on findings.

Input: Headache, dizziness, history of migraine and subarachnoid hemorrhage No evidence of acute ischemic or hemorrhagic lesion.On the first enhancement T1 axial scan (series #1001, image #7) shows intramedullary junction right posterior aspect subtle increased signal intensity. However, this lesion was not shown on 3-D postcontrast T1 imaging. In addition, there is no other imaging sequence which show any abnormal findings on this on this area.Therefore, this subtle increased signal intensity is most likely artifactual.There is no evidence of abnormal enhancement on the scan.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: No evidence of acute ischemic or hemorrhagic lesion.No evidence of abnormal enhancement.


Instruction: Generate impression based on findings.

Input: Secondary malignant neoplasm of skin [C79.2], Reason for Study: ^Reason: leptomeningeal spread History: metastatic breast CA Re-demonstration of multiple extra axial enhancing metastatic lesions involving skull and leptomeninges. Overall the enhancing lesions show a bit smaller than prior scan. In particular, the left parietal and midline occipital adjacent to torcular show significant decrease in size since prior scan. Leptomeningeal enhancement is again demonstrated without any significant interval change since prior scan.Previously seen left parietal lobe lesion, does not show any significant interval changes since prior scan. There is no other intra axial lesion on this scan.There is no evidence of acute ischemic or hemorrhagic lesion. The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Overall decrease in size of multifocal extra-axial (skull and scalp) metastatic enhancing nodule since prior scan, especially significant decrease in size of left parietal and midline occipital lesions.2. No significant interval change of leptomeningeal and enhancement since prior scan.3. No MR evidence of intra-axial metastatic lesion.


Instruction: Generate impression based on findings.

Input: 30-year-old female with diabetes and end-stage renal disease with severe callus over third metatarsal head. Concern for osteomyelitis on recent radiographs. There is soft tissue ulceration along the plantar aspect of the third MTP joint which extends dorsally to the level of the third metatarsal head. There is increased signal abnormality on fluid sensitive sequences with decreased signal abnormality on T1-weighted images within the head of the third metatarsal extending proximally to the mid diaphysis consistent with osteomyelitis. There is erosion about the first and second MTP joints particularly involving the lateral aspect of the first metatarsal head, which may reflect the sequela of chronic osteomyelitis. There is deformity about the base of the second metatarsal with signal abnormality in the surrounding area likely representing a healing fracture through the base of the second metatarsal with exuberant callus formation. There are also fracture deformities through the proximal aspect of the fourth and fifth metatarsals with slight medial angulation of the distal fracture fragments. The patient is status post amputation through the PIP joint of fifth digit of the right foot. No focal fluid collection is identified to suggest abscess formation. There is nonspecific increased signal abnormality within the calcaneus and cuboid as well as the remainder of the tarsal bones on fluid sensitive sequences which may represent a combination of reactive osteitis and degenerative change.

Output: 1. Findings consistent with acute osteomyelitis of the third metatarsal as described above. Erosions about the first and second MTP joints may represent the sequela of chronic osteomyelitis. 2. Fracture deformity of the second, fourth, and fifth metatarsals as described above. Other findings as described above.


Instruction: Generate impression based on findings.

Input: The cervical and upper thoracic cord are normal in caliber and signal. The cervicomedullary junction is normal. Vertebral body heights and alignment are preserved. There is no evidence of fractures or subluxations. The bone marrow signal is benign. The visualized paraspinal structures are normal.C1/2: The atlantoaxial articulation appears normal.C2/3: There is no significant spinal canal or neural foraminal stenosis.C3/4: There is no significant spinal canal or neural foraminal stenosis.C4/5: There is mild disc bulge with minimal effacement of the anterior subarachnoid space. There is mild right uncovertebral hypertrophy with mild right neural foraminal narrowing.C5/6: There is a right paramedian disc protrusion with moderate narrowing of the spinal canal and severe narrowing of bilateral neural foramina.C6/7: There is a mild disc bulge with mild narrowing of the spinal canal. There is also mild bilateral uncovertebral and facet hypertrophy causing mild narrowing of the bilateral neural foramina.C7/T1: There is no significant spinal canal or neural foraminal stenosis.

Output: 1.Normal signal of the cervical cord without foci of demyelinating disease.2.Degenerative disease as described above with multilevel neural foraminal stenosis and moderate spinal canal stenosis, worst at C5/C6.


Instruction: Generate impression based on findings.

Input: History of right parapharyngeal schwannoma status post resection. Evaluate for recurrence. Redemonstration of subtle postsurgical findings in the right parapharyngeal space. No definite residual tumor is identified. Stable prominence of the left tonsil. Probable surgical resection of the right palatine tonsil. The aerodigestive tract is otherwise within normal limits. There is no significant lymphadenopathy in the neck. Thyroid gland and salivary glands are unremarkable. The major cervical flow voids are intact. The osseous structures are normal in appearance. The cervical spine is unremarkable. The orbits and paranasal sinuses are unremarkable. The cervical spine is unremarkable. The visualized intracranial contents are unremarkable without mass, mass effect, midline shift, or abnormal enhancement.

Output: Stable postoperative changes in the right parapharyngeal space without evidence of residual or recurrent tumor.


Instruction: Generate impression based on findings.

Input: 50-year-old female with abdominal pain and history of pancreatic cysts, likely IPM and. Now with worsening pain and evidence of pancreatitis. The lack of intravenous contrast limits complete evaluation of the solid parenchymal organs and of the cystic lesions in the liver, pancreas, and kidneys described below.ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. No anatomic evidence of cirrhosis.Numerous cystic structures following the intrahepatic biliary ducts are again noted. The known largest central cyst measuring 3.3 x 3.5 cm (axial series 5 image 26) has slightly increased in size (prior 2.8 x 3 cm on 1/29/2016) and again compresses the central ducts (coronal series 9 image 85) with mild intrahepatic biliary ductal dilatation. On the MRCP sequences, some cysts show a possible communication with the biliary ducts. No definite extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: There is thickening of the pancreatic body and tail with loss of the normal parenchymal architecture, and restricted diffusion is also noted. These findings are suspicious of pancreatitis, and autoimmune pancreatitis is in the differential.Multiple pancreatic cystic lesions are again seen. The largest cystic lesion within the pancreatic tail measuring 2.5 cm (axial series 5 image 21) has increased in size (prior 1.3 cm on 1/29/2016). Other cystic lesions have also slightly increased in size, including a septated cyst of the uncinate process (axial series 5 image 17, coronal series 9 image 62). The lack of intravenous contrast limits evaluation for enhancement of a nodular focus. No definite connection with the main pancreatic duct is identified. ADRENAL GLANDS: Stable nodular appearance of the bilateral adrenal glands. No dominant nodule identified.KIDNEYS, URETERS: Multiple bilateral renal cysts, some of which are too small to fully characterize. Each kidney contains greater than 5 cysts. A few T1 hyperintense cysts are again noted bilaterally, predominantly on the right. No suspicious features. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Cardiomegaly.

Output: 1. Multiple pancreatic cystic lesions have slightly increased in size as described above. On MRCP, no definite connection with the main pancreatic duct is identified. The differential includes side-branch IPMNs versus mucinous cystic neoplasms versus parenchymal cysts.2. Multiple central hepatic cystic structures, some of which have also increased in size, and again cause mild intrahepatic biliary ductal dilatation. These structures could represent peribiliary cysts versus choledochal cysts. Possible ductal communication with some of these cysts is noted, which would suggest choledochal cysts - this can be confirmed with ERCP. If these are peribiliary cysts, given the absence of cirrhosis, another etiology can be syndromes such as polycystic kidney disease (in which this patient also has greater than 5 cysts in each kidney).


Instruction: Generate impression based on findings.

Input: Ms. Simeran is a 52-year-old female with known left breast cancer with positive lymph nodes status post neoadjuvant chemotherapy. She presents today for imaging evaluation to assess for treatment response. There is heterogeneous amount of fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally. Bilateral prepectoral silicone implants are identified. There has been an interval increase in size of all previously measured left breast reference lesions:-Interval increase in size of index malignancy in the left retroareolar breast, now measuring 3.7 x 2.6 x 2.8 cm (AP x ML x SI), previously measuring 2.6 x 1.9 x 2.5 cm. This mass now invades and includes the entire left nipple.-Interval increase in size of mass located postero-inferior to the index malignancy, at site of mammographically detected asymmetry with calcifications, now measuring 0.9 x 0.6 x 0.9 cm, previously measuring 0.5 x 0.7 x 0.4 cm.-Interval increase in size of left intramammary lymph node, now measuring 0.9 x 0.7 cm, previously measuring 0.6 x 0.6 cm.-In addition, there are two new enhancing foci seen lateral to the left retroareolar index malignancy, suspicious for additional disease.-The total span of enhancement (index malignancy + postero-inferior mass + two new enhancing foci) measures approximately 3.6 x 4.0 cm (AP x ML).In the axillary regions, reference measurements are as follows:-Interval increase in size of previously identified left axillary lymph node, now measuring 5.0 x 3.0 cm, previously measuring 3.0 x 2.2 cm. This node is now centrally necrotic.-Interval increase in size of previously identified right axillary lymph node, now measuring 1.9 x 0.9 cm, previously measuring 1.4 x 0.9 cm. Of note, there are multiple additional enlarged right axillary lymph nodes, some of which are new/progressed since last exam.No abnormal enhancement is seen in the right breast.

Output: Interval progression of disease in the left breast and bilateral axillary regions. Continued surgical consultation is recommended for further evaluation at this time. All results and recommendations were discussed with the patient.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Dizziness and giddiness [R42], Reason for Study: ^Reason: stroke History: stroke 59 years Female (DOB:11/14/1957)Reason: stroke History: strokePROVIDER/ATTENDING NAME: JAMES AHN DAVID G. BEISER Brain MRIThere is well enhancing mass located at the left jugular foramen with irregular margin and associated with adjacent bony erosion. The mass is measured about (32.5 mm x 34.6 mm x 22 mm) with the branching patterned signal void within the lesion indicating hypervascular nature. There is also separate about 8 mm sized round enhancing nodular lesion of the left with the left middle cerebellar peduncle which shows nearly circular thin peripheral T2 low signal intensity. This lesion is associated with the surrounding brain edema.Constellation of above findings indicate hypervascular mass such as glomus jugulare located on the left jugular foramen. Differential diagnosis of the separated enhancing lesion on the left middle cerebellar peduncle include thrombosed vascular structure including arterial aneurysm and acute hemorrhagic lesion.There is evidence of previous left mastoidectomy as well as suboccipital craniectomy with scattered susceptibility lesions surrounding the enhancing mass indicating postoperative status of the enhancing mass lesion.No other abnormal enhancing lesion is seen.There is no evidence of acute ischemic lesion.Scattered T2/FLAIR high signal intensity lesions indicating nonspecific small vessel ischemic disease.The ventricles, sulci and cisterns are unremarkable. The paranasal sinuses and right mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal.There are multiple branching patterned in flow enhancement is seen on the left skull base indicating hypervascularity of the left the jugular foramen lesion.Neck MRA3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The vertebral artery origins are normal. There is normal flow enhancement through the bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries. Left the subclavian artery midportion shows focal signal loss which is likely indicate artifactual.Brain MRV3D MRV brain post-gadolinium with maximum intensity projections of the superficial/deep intracranial venous drainage demonstrate hypoplastic left transverse sinus with nonvisualization of left sigmoid sinus indicating possible occlusion due to enhancing jugular foramen mass. Otherwise, normal flow enhancement in the superior sagittal sinus, right transverse sinuses, right sigmoid sinuses, internal cerebral veins, vein of Galen and straight sinus.

Output: 1. Hypervascular left jugular foramen area lesion with the significant signal void within the mass associated with evidence of left mastoidectomy indicate postoperative status of left glomus jugulare or other hypervascular mass.2. Separated enhancing lesion within the left middle cerebellar peduncle likely represent thrombosed vascular structure such as thrombosed aneurysm or vein, or possible focal hemorrhage. CTA can be considered for further imaging evaluation.2. Non specific small vessel ischemic disease.3. Normal brain MRA with evidence of hypervascular tumor on the left jugular foramen.4. Normal neck MRA with again visualized hypervascular mass on the left jugular foramen area.5. Occlusion of the left sigmoid sinus likely due to the left jugular foramen area mass, otherwise unremarkable brain MRV.


Instruction: Generate impression based on findings.

Input: 16-year-old male. Lateral pain. Evaluate for lateral meniscus tear. MENISCI: Horizontal signal abnormality predominately within the posterior horn and body of the lateral meniscus extending to the free edge of the meniscus and the femoral articular surface indicating a horizontal tear. There is small intrameniscal cyst formation particularly within the periphery of the posterior horn and the contents of the tear also decompress laterally into a multiloculated para-meniscal cyst located between the lateral capsular structures and the meniscal body. This cyst measures approximately 2 cm in AP dimension, 1.5 cm in CC dimension, and 5 mm in mediolateral dimension with adjacent edema type signal. The body of the lateral meniscus itself appears slightly prominent, suggesting a partial discoid morphology. The medial meniscus is intact.ARTICULAR CARTILAGE AND BONE: Bone marrow signal intensity is normal without evidence of contusion. The tibiofemoral and patellofemoral compartment cartilage is intact with no focal defect.LIGAMENTS: The cruciate and collateral ligaments are intact.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1. Horizontal tear of the lateral meniscus with para-meniscal cyst formation, as described above. Prominence of the body of the lateral meniscus suggests a partial discoid morphology.2. Approximately 1 cm disc shaped focus of intermediate to low signal intensity within the patellofemoral joint, as described above, may simply represent a peculiar synovial fold/plica but we cannot entirely exclude the possibility of a loose cartilaginous fragment. We see no cartilage defects.


Instruction: Generate impression based on findings.

Input: Dense aphasia, right arm/leg ataxia. There are multiple areas of cortical encephalomalacia in the bilateral cerebral hemispheres and patchy areas of white matter T2 hyperintensity. There is also encephalomalacia in the bilateral cerebellar hemispheres, right more than left. There are a few unchanged scattered punctate foci of susceptibility effect in the bilateral posterior cerebral hemispheres. There is no evidence of acute intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is mild mucosal thickening in the bilateral maxillary sinuses.

Output: Multiple chronic infarcts in multiple cerebral territories and in the bilateral cerebellar hemispheres, but no evidence of acute infarct.


Instruction: Generate impression based on findings.

Input: 58 years Male (DOB:8/3/1958)Reason: AA. s/p resection in 2013, then RT/TMZ. History: AA.PROVIDER/ATTENDING NAME: RIMAS V. LUKAS RIMAS V. LUKAS The patient is status post right frontal lobe surgery for tumor removal. There is local gliosis and volume loss at the right frontal lobe surgical site which involves superior frontal gyrus and to lesser degree middle frontal gyrus. There is no interval change relative to the previous exam. No abnormal enhancement is appreciated at the surgical site. Cerebral blood volume is low in the tumor bed. There are some susceptibility effect within the surgical site.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate a minor opacity in the left maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: There is no evidence for local recurrence of the patient's right frontal lobe neoplasm on the current exam.


Instruction: Generate impression based on findings.

Input: Reason: evaluate for progression of fasciitis History: eosinophilic fasciitis Right femur:There has been further interval decrease in the previously seen fascial enhancement. Currently, there is perhaps minimal thickening and enhancement of the peripheral deep fascia along the anterolateral margin of the quadriceps as well as along the posterior aspect of the upper hamstrings, but this is equivocal. There is no intermuscular enhancement nor do we see any muscle edema. There is mild enhancement of the knee joint suggesting a very mild synovitis as well as a small joint effusion appearing similar to the prior study. The signal intensity of the bone marrow is normal. No muscle atrophy is identified. There is a possible anterior paralabral cyst which appears slightly smaller when compared to the prior study.Left femur:We see no fascial enhancement. There is no muscle atrophy. There is no muscular edema. The bone marrow signal intensity is normal. There is a mild synovitis of the left knee joint with a small amount of fluid extending posteromedially into a Baker's cyst.

Output: Near complete resolution of fascial inflammation with equivocal fascial enhancement on the right as described above. Other findings as described above.


Instruction: Generate impression based on findings.

Input: CT head 9/10/2015 and 9/10/2013. MRA BRAIN: There is a saccular aneurysm arising from the anterior communicating artery that is inferiorly-directed and measures 9 mm in length, 7 mm in width, and a neck that measures approximately 5 mm in width. There appears to be mild mass-effect upon the prechiasmatic optic nerves. There is no evidence of significant steno-occlusive lesions. The left vertebral artery terminates are the PICA, which is an anatomic variant.MRI BRAIN: There is no evidence of intracranial hemorrhage or acute infarct. There are scattered subcortical and confluent periventricular hyperintensities, which may be nonspecific most likely related to chronic small vessel ischemic changes. The ventricles are unchanged. There is no midline shift or herniation. There are left orbital floor fracture and lamina papyracea blow out fractures associated with enophthalmos. The left maxillary sinus contains mucosal thickening and is smaller in size compared to the right. There is torus palatinus. There is a large lipoma overlying the right occipital scalp, grossly unchanged from previous.

Output: 1. A saccular aneurysm arising from the anterior communicating artery measures up to 9 mm.2. No evidence of acute intracranial hemorrhage or acute infarct.3. Moderate periventricular white matter hyperintensities likely related to chronic small vessel ischemic disease.4. Chronic eft orbital floor fracture and lamina papyracea blow out fractures associated with enophthalmos.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Uterine fibroids, abdominal pain PELVIS:UTERUS, ADNEXA: Multiple subserosal and intramural enhancing masses in the uterus some compatible with fibroids. The largest fibroid at the fundus measures 9.9 x 9.6 x 9.6 cm (AP x TR x CC; series 10, image 33). A fibroid in the posterior fundus demonstrates a region of nonenhancement compatible with necrosis (series 12, image 26).The ovaries are normal.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small amount of pelvic free fluid.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1.Uterine fibroids as described above.2.Small amount of pelvic free fluid; likely physiologic.


Instruction: Generate impression based on findings.

Input: 55 year-old female with fall, head trauma and possible seizure. BRAIN: There is no evidence of intracranial hemorrhage, mass or edema. Multifocal regions of patchy hypoattenuation are present in a subcortical and periventricular deep white matter distribution, nonspecific; however, most likely represent small vessel ischemic disease, age indeterminate. No acute cortical infarction. If there is clinical concern for acute ischemia, MRI may be considered.Area of hypoattenuation located in the left frontal region, most likely encephalomalacia secondary to prior infarction.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized except for a small retention cyst in the left frontal sinus.CERVICAL SPINE:The cervical spine alignment is anatomic. The vertebral bodies, dens, lateral masses, pedicles, lamina, facets, and posterior elements are intact with no evidence of fracture or subluxation. The pre-vertebral and paraspinal soft tissues are within normal limits. Limited view of the lung apices demonstrate bullous change and emphysema.Multilevel degenerative disk changes are noted as follows:C2-3: Disk osteophyte complex with central protrusion without central or neuroforaminal narrowing.C3-4: Disk osteophyte complex with diffuse disk bulge without central or neuroforaminal narrowing.C4-5: Disk osteophyte complex with right neuroforaminal narrowing. No central canal narrowing.C5-6: Disk osteophyte complex with severe right greater than left mild neuroforaminal narrowing. No central canal narrowing.C6-7: Uncovertebral joint hypertrophy, osteophyte spurring. No central or neuroforaminal narrowing.Within the limits of CT scanning, the thecal sac and spinal cord are preserved with no evidence of significant spinal canal stenosis.

Output: 1. Diffuse intracranial parenchymal volume loss without acute abnormalities such as hemorrhage or acute cortical stroke.2. White matter disease as described above, nonspecific however most likely represent small vessel ischemic disease.3. Multilevel degenerative disease of the cervical and visualized upper thoracic spine, not significantly changed compared to the previous examination.4. No evidence of cervical spine fracture or subluxation, if spinal cord or ligamentous injury is suspected MRI is recommended.


Instruction: Generate impression based on findings.

Input: Fever, midline back pain/tenderness, L5 distribution paresthesias. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The cauda equina nerve roots appears unremarkable. The conus medullaris is positioned at the L1 vertebral body level. The paravertebral soft tissues are unremarkable.

Output: No evidence of spinal cord or cauda equina compression. However, evaluation for epidural abscess is limited without post-contrast sequences.


Instruction: Generate impression based on findings.

Input: 19 years, Male, concussion symptoms 1 week status post blunt trauma. Blurry vision, frontal headache, nausea, inability focus. Brain parenchyma appears within normal limits. No parenchymal signal abnormality. No evidence of edema or hemorrhage. Sulci and ventricles are within normal limits for age. No extra-axial collections. Major flow-voids are preserved. Sella and orbits are grossly within normal limits. Bone marrow signal and extracranial soft tissues are grossly unremarkable.

Output: Brain parenchyma appears within normal limits. Specifically, no evidence of intracranial hemorrhage or edema.


Instruction: Generate impression based on findings.

Input: 21-year-old male, evaluate for fracture or soft tissue injury TENDONS: The extensor and flexor tendons are intact. The Achilles tendon is normal.LIGAMENTS: There is extensive edema along the lateral soft tissues of the ankle overlying the lateral collateral ligaments. The ATFL and PTFL are however intact. The deltoid ligament appears within normal limits.ARTICULAR SURFACES AND BONE: The bone marrow signal is within normal limits. The talar dome is intact.ADDITIONAL

Output: 1. Edema about the lateral ankle with otherwise intact ligaments.2. No evidence of fracture.


Instruction: Generate impression based on findings.

Input: Female; 52 years old. Reason: evaluate small bowel inflammation; patient with Crohn's disease, ileostomy, PBC overlap AIH History: diarrhea, weakness ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: Pancreatic duct is minimally prominent with minimal pancreatic atrophy, similar to prior study.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable subcentimeter left renal cortical likely cyst is too small characterize.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Status post total colectomy with a right lower quadrant and ileostomy. No abnormal bowel wall thickening or enhancement is evident to suggest active inflammation. Mild gastric and proximal duodenal distention, similar to prior study. The duodenal distention demonstrates a transition point at the mid transverse duodenum where the SMA courses anteriorly, raising the question of an SMA syndrome.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: See above.BONES, SOFT TISSUES: Few sacral Tarlov cysts are noted on the right side.OTHER: No significant abnormality noted.

Output: 1. No evidence of active bowel inflammation.2. Stable proximal duodenal distention with transition point at the mid transverse duodenum where the SMA courses anteriorly, raising the question of an SMA syndrome. Clinical correlation for symptoms of SMA syndrome is recommended.


Instruction: Generate impression based on findings.

Input: 30 year old with Marfan's syndrome with history of ASD repair and known dilated aorta presenting for evaluation of aorta and left ventricular function. Left VentricleThe left ventricle is severely dilated with low normal systolic function. The overall LV ejection fraction is 53%, the LV end diastolic volume index is 128 ml/m2 (normal range: 65+/-11), the LVEDV is 241 ml (normal range 109+/-23), the LV end systolic volume index is 61 ml/m2 (normal range 18+/-5), the LVESV is 114 ml (normal range 31+/-10), the LV mass index is 43 g/m2 (normal range 67+/-11), and the LV mass is 80 g (normal range 114+/-24). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is normal in sizeRight VentricleThe right ventricle is mild to moderately dilated with normal systolic function. The overall RV ejection fraction is 50%, the RV end diastolic volume index is 111 ml/m2 (normal range 69+/-14), the RVEDV is 210 ml (normal range 110+/-24), the RV end systolic volume index is 55 ml/m2 (normal range 22+/-8), and the RVESV is 105 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is mild aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is trace mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is dilated with effacement of the sinotubular junction and dilated sinus of Valsalva. The most dilated portion of the aortic root is 50 mm x 43 mm approximately 2 cm above the aortic valve plane. Annulus measures approximately 3.1 x 2.1 cm.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsSternotomy wires present. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The aortic root is dilated with effacement of the sinotubular junction and dilated sinus of Valsalva. The most dilated portion of the aortic root is 50 mm x 43 mm approximately 2 cm above the aortic valve plane. There is mild aortic regurgitation. 2. The left ventricle is severely dilated with low normal systolic function. The overall LV ejection fraction is 53%. There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.3. The right ventricle is mild to moderately dilated with normal systolic function. The overall RV ejection fraction is 50%.


Instruction: Generate impression based on findings.

Input: Diagnosis: Sickle-cell disease without crisisClinical question: sickle cell dsSigns and Symptoms: eval Moya Moya or stenosis MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate minor opacity left maxillary sinus which are unchanged. The visualized portions of the mastoid air cells demonstrate partial opacification of the right mastoid air cells. This finding was present on the prior exam and has not changed. The visualized portions of the orbits are intact.There is diffuse calvarial thickening present and diffuse marrow replacement.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is extracranial origin of the posterior inferior cerebellar artery bilaterally.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. The right posterior communicating arteries are identified and are large.. The vertebral arteries are similar in size.

Output: 1.There is no evidence for intracranial cerebrovascular occlusive disease. There is no evidence for moyamoya. Compared to the prior exam there is no interval change. Previously noted mild narrowing of the left middle cerebral artery can be accounted for on the basis of time-of-flight artifact.2.Diffuse calvarial thickening and marrow replacement can be accounted for on the basis of the patient's sickle cell disease


Instruction: Generate impression based on findings.

Input: Patient presents for BB placement over anterior biopsy clip near site of calcifications which were close to the skin. Known DCIS. Right MLO and CC view of the right breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses(BiRads Density Category C), unchanged in pattern and distribution. The anterior biopsy clip was localized on the initial MLO localization view and the subsequent CC view confirms B replacement near the anterior clip. The posterior biopsy clip and some of the associated calcifications are within the field of view on the CC view.

Output: Successful localization of the anterior biopsy clip.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Headache. CVA. Cerebral infarction.IMAGE ACQUISITIONS: 4.5-mm contiguous axial CT sections of the brain without contrast infusion. No acute intracranial hemorrhage, mass effect or shift of midline structures. Small low attenuation lesions in the cerebellum consistent with chronic infarcts are again noted. A low-attenuation lesion in the genu of the right corpus callosum, consistent with chronic lacunar infarction is unchanged. Multiple small foci of periventricular low-attenuation have not significantly changed. There is abnormal low attenuation in the genu of the corpus callosum, corresponding with high signal intensity on MRI. Low-attenuation is also present in bilateral periatrial white matter. Small juxtacortical foci of low-attenuation are again noted. A chronic left occipital infarct is unchanged.

Output: Stable CT findings. No CT evidence of new infarction. No acute intracranial hemorrhage.


Instruction: Generate impression based on findings.

Input: Cervical spine:Metallic artifact from the patient's braces distorts the images at the level of C2-C6.A small syrinx is seen at the level of C5-C6 measuring up to 1.5 cm in length (image 9, series 501). The cervical cord is otherwise normal in signal. The cerebellar tonsils extend below the level of the foramen magnum approximately 10 mm and demonstrate a pointed morphology. On the CSF flow images, there is maintained biphasic flow anterior and posterior to the tonsils. The cervicomedullary junction is normal. The visualized paraspinal contents are unremarkable. Alignment is normal. The marrow signal is benign. No significant central canal or neural foraminal narrowing.Thoracic spine:There is a smooth, physiologic thoracic kyphotic curve. The vertebral body heights and disc spaces are maintained. Marrow signal intensity is benign throughout. The spinal cord has a smooth contour and is without focal atrophy, edema, or myelomalacia. There are no masses. No central canal or neural foraminal narrowing.Lumbar spine:Alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign. The conus is normal in signal and morphology and terminates at an appropriate level. The visualized intra-abdominal and paraspinal contents are unremarkable. No central canal or neural foraminal narrowing.

Output: 1.10 mm caudal extension of the cerebellar tonsils below the level of the foramen magnum is again noted, with maintained biphasic CSF flow around the tonsils anteriorly and posteriorly.2.Small syrinx is seen in the lower cervical spinal cord.


Instruction: Generate impression based on findings.

Input: Diagnosis: Cerebral cysts Communicating hydrocephalusClinical question: arachnoid cyst and hydrocephalus, yearly evaluationSigns and Symptoms: yearly evaluation There is redemonstration of a large cystic lesion present within the fourth ventricle measuring 35 x 75 mm in sagittal dimensions and previously measuring the same. It expands the fourth ventricle. The quadrigeminal plate as well as the cerebellar hemispheres drape around this cyst. The pineal gland is displaced superiorly. The vena Galen and straight sinus are also displaced by this cystic mass. It appears to extend through the foramina of Luschka. It follows CSF on all pulse sequences.The patient is status post ventriculostomy tube placement. A ventriculostomy tube courses to the right frontal lobe into the right lateral ventricle with tip in the region of foramen of Monro in the third ventricle. The lateral ventricles remain slitlike. In general the corpus callosum is relatively thin especially along its posterior aspect.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.There is an intraventricular arachnoid cyst centered in the fourth ventricle which is stable in appearance when compared to the previous exam from 8/20/20122.A ventriculostomy tube is in stable position. The lateral ventricles and third ventricle remain slitlike.


Instruction: Generate impression based on findings.

Input: History of multifocal hepatocellular carcinoma status post resection and subsequent TACE/RFA. Evaluate for tumor recurrence. History of omental and diaphragmatic metastases in 2011. ABDOMEN:LIVER, BILIARY TRACT: The segment 6 ablation cavity measures approximately 5.8 x 5.3 cm (series 4/238), compared to 5.8 x 5.7 cm previously containing heterogeneous proteinaceous/hemorrhagic debris.The segment 5 ablation cavity measures approximately 4.0 x 3.5 cm (series 4/237) compared to 3.9 x 3.7 cm previously containing heterogeneous proteinaceous/hemorrhagic debris.No evidence of residual or recurrent disease along the ablation margin.Very faintly enhancing segment 8 focus is less conspicuous than on the prior study without evidence of washout on delayed phase imaging. This may represent a perfusional anomaly.Cirrhotic liver morphology with mild fibrotic changes.No intrahepatic or extrahepatic biliary ductal dilatation. Cholelithiasis without evidence of cholecystitis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral simple appearing cortical renal cysts. No hydronephrosis or suspicious lesion. Mild left cortical scarring.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: Cirrhotic liver with grossly stable postablation changes without evidence of a marginal recurrence or suspicious lesion. Faintly enhancing segment 8 focus is less conspicuous on today's study without washout and may represent a perfusional anomaly.


Instruction: Generate impression based on findings.

Input: Multiple sclerosis: paresthesias. Brain: There are numerous supratentorial and infratentorial T2 hyperintense white matter lesions, which appear to have slightly increased in extent since 2014. Many of the lesions display T1 hypointensity. 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.Spine: There are numerous patchy T2 hyperintense lesions throughout the cervical and thoracic spinal cord. While the usual cervical lordosis is lacking, there is no spondylolisthesis and the thoracic vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The paravertebral soft tissues are unremarkable.

Output: 1. Numerous supratentorial and infratentorial demyelinating lesions appear to have slightly increased in extent since 2014. 2. Multiple demyelinating lesions in the spinal cord.