Instruction: Generate impression based on findings.

Input: Clinical question: Hyperreflexia in upper extremities and lower extremities; rule out cervical pathology from last MRI in 2014. Signs and symptoms: Hyperreflexia. Nonenhanced cervical MRI:There is mild straightening of cervical lordosis however with maintained anatomic alignment.Foramen magnum is unremarkable.C2-C3 is unremarkable.C3-C4 demonstrate minimal degenerative disease and unremarkable otherwise.C4-C5 demonstrate mild degenerative disease and shallow broad-based bulging disc without spinal stenosis or neural foraminal compromise. Previously reported small central disc extrusion at this level is no longer identified. There is no evidence of a spinal stenosis or neural foraminal compromise. The signal intensity of the cord remains within normal and stable since prior exam.C5-C6 demonstrate moderate disc disease, mild bilateral symmetrical uncovertebral hypertrophy and mild ligamentum flavum hypertrophy. There is moderate bilateral neural foraminal compromise and without central spinal stenosis (best appreciated on oblique T2 series 8 and 9). No significant change since prior exam. Normal signal intensity of the cord.C6-C7 demonstrate moderate disc disease and loss of disc height, mild bilateral uncovertebral and ligamentum flavum hypertrophic changes without significant change since prior exam. No evidence of central spinal stenosis however moderate bilateral neural foraminal compromise is noted. This finding is best appreciated on oblique images on series 8 and 9. No cord signal abnormality.C7-T1 demonstrate mild disc disease and loss of disc height and moderate hypertrophic changes of the ligamentum flavum and mild facet disease. There is a left lateral and far lateral disc extrusion with resultant significant left neural foraminal compromise which is best appreciated on oblique series 9. There is suggestion of slight interval progression of this finding since prior study. However on prior exam there was a midline component of extruded disc that since prior exam has decreased in size and with resultant decrease in mass effect on the cord and better visualization of subarachnoid space. Right neural foraminal remains patent.Nonenhanced lumbar MRI:There is normal anatomical alignment of the vertebral column and with unremarkable signal intensity.The lower most visualized thoracic spine and thoracic cord from T10 inferiorly is unremarkable.T12-L1 is unremarkable.L1-L2 demonstrate mild disc desiccation and mild bilateral ligamentum flavum hypertrophy without spinal stenosis or neural foraminal compromise.L2-L3 demonstrate mild to moderate disc desiccation, mild bilateral ligamentum flavum hypertrophy and mild facet disease. No spinal stenosis or neural foraminal compromise.L3-L4 demonstrate mild disc desiccation, mild bilateral facet and ligamentum flavum hypertrophy and no evidence of central spinal stenosis. There is a far lateral left-sided broad-based disc protrusion best appreciated on axial T2 series 15 on image 17 and axial T2 series 17 image 23.L4-L5 demonstrates mild disc desiccation, mild to moderate bilateral ligamentum flavum hypertrophy and mild facet disease. No spinal stenosis or neural foraminal compromise. There is however mild right lateral recess compromise.There is a right far lateral annular failure best appreciated on axial T2 series 15 image 11 and sagittal T2 series 12 images 4 and 5. A smaller far left lateral annular fissure is also noted and best appreciated on sagittal T2 series 12 image 12 and axial T2 series 15 image 11.

Output: 1.MRI of cervical spine demonstrate normal signal intensity and caliber of the cord and without evidence of myelitis. There is interval resolution of the tiny central disc extrusion at C4-C5 since prior study. There is interval decreased in the midline component of disc extrusion at C7-T1 since prior exam however with suggestion of interval increased size of the left lateral and far lateral component of extruded disc since prior exam with resultant significant left foraminal compromise. No evidence of central spinal stenosis. There are neural foraminal compromise at multiple levels as detailed per level above.2.Nonenhanced MRI of the lumbar spine demonstrate degenerative changes without evidence of central spinal stenosis at any level and no significant neural foraminal compromise. Mild right lateral recess compromise at L4-L5 secondary to degenerative disease. Far left lateral broad-based disc protrusion at L3-L4 and bilateral small annular fissures at L4-L5 levels as detailed above.


Instruction: Generate impression based on findings.

Input: Male; 55 years old. Reason: low risk prostate cancer, please evaluate. History: low risk prostate cancer PELVIS:PROSTATE:Prostate Size: 4.2 x 4.5 x 4.2 cm.Peripheral Zone: Large amount of high T1 signal in the peripheral zone bilaterally due to hemorrhage, which limits sensitivity for tumor evaluation. Within this limitation, there is relatively low T2 signal with mild restricted diffusion in the left mid peripheral zone posteriorly, most compatible with prostate cancer and with the dominant lesion measuring up to 8 x 6 mm (series 503/264).Central Gland: Heterogeneous.Seminal Vesicles: No significant abnormality.Extracapsular Extension: None.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Left mid prostate cancer as detailed above. No extracapsular extension


Instruction: Generate impression based on findings.

Input: 65 years Male (DOB:9/17/1950)Reason: re-evaluate chronic lumbar stenosis, s/p 2 laminectomies History: as abovePROVIDER/ATTENDING NAME: HELENE G. RUBEIZ HELENE G. RUBEIZ Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. There is a T1 hyperintense lesion present within the L2 vertebral body on the right side which measures 14 mm in diameter and most likely represents a vertebral body hemangioma.Patient is status post laminectomy at L5-S1 and L4-5At L5-S1 there is loss of disc space height, disc desiccation and diffuse disc bulge associated with endplate reactive changes. Endplate reactive changes are low signal on T1 and T2. There is effacement of the fat at the lateral recess bilaterally at this level which was also present on the prior exam and does not appear to have changed substantially. There is partial effacement of the fat surrounding the exiting nerve roots bilaterally associated with some encroachment of the exiting nerve roots within the neural foramina. Encroachment of exiting nerve roots is worse on the left compared to the right side.At L4-5 there is a diffuse disc bulge present, loss of disc space height and disc desiccation and endplate reactive change. Endplate reactive changes low signal on inversion recovery images and high signal on T1. There is effacement of the fat at the lateral recess bilaterally at this level. Although the neural foraminal are narrowed, within the neural foramina the exiting nerve roots are surrounded by fat. Overall there is no substantial change compared to the prior exam.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is some loss of disc space height and disc desiccation at this levelAt L2-3 there is no significant compromise to spinal canal or neural foramina. There is right-sided facet hypertrophy at this level.At L1-2 there is no significant compromise to spinal canal or neural foramina.There is a cyst present along the right kidney measuring 44 mm in diameter is unchanged compared to the prior exam to extent of visualization. It is not entirely included on this exam. Left-sided renal cystic lesions were also present on the prior exam which are not entirely included on the current exam.

Output: 1.Overall there is no significant change compared the prior exam.2.The patient status post lumbar spine surgery at L4-5 and L5-S1 where there is some encroachment of the nerve roots at the lateral recesses.3.There is encroachment of exiting nerve roots bilaterally at L5-S1 appears slightly worse on the left side compared to the right side. This is stable compared to the prior exam.4.The patient's renal cystic lesions are redemonstrated and although they appear similar to the prior exam they are not entirely included on this exam


Instruction: Generate impression based on findings.

Input: 39-year-old female with right knee pain. Suboptimal evaluation secondary to patient motion artifact.MENISCI: The medial meniscus appears intact. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There are multiple foci of osteonecrosis within the distal femur, proximal tibia and patella. Although some of these foci of osteonecrosis extend to the articular surface, we see no subchondral fracture or articular surface collapse. There is diffuse degeneration of the articular cartilage of the patella with full-thickness defects and delamination along the median eminence. The articular cartilage of the femoral trochlea is relatively spared. The articular cartilage of the medial and lateral compartments appears relatively spared.LIGAMENTS: The ACL appears intact. The PCL appears intact. The MCL appears intact. There is minimal increased signal intensity within the femoral attachment of the lateral collateral ligament proper which may represent focal degeneration.EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: Osteonecrosis and patellar cartilage degeneration as described above.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for cause of headaches. Signs and symptoms: Headaches; history of migraine. Nonenhanced brain MRI:Negative diffusion weighted series.There is normal anatomical morphology of brain parenchyma and with normal signal intensity on all MRI sequences.Unremarkable renal cortex, cortical sulci, ventricular system, CSF spaces and brain myelination.The signal voids of major intracranial arterial branches are identified and unremarkable. The signal intensity of the intracranial venous sinuses are within normal.Unremarkable images through the orbits and paranasal sinuses. The pneumatized bilateral mastoid air cells and middle ear cavities. Unremarkable calvarium and soft tissues of the scalp.

Output: 1.Unremarkable nonenhanced brain MRI.2.Normal pneumatization signal pattern of mastoid air cells, middle ear cavities and paranasal sinuses with the exception of a small retention cyst in the left maxillary sinus.


Instruction: Generate impression based on findings.

Input: 74-year-old male with left shoulder pain especially with abduction. ROTATOR CUFF: There is a near complete to complete full-thickness tear of the supraspinatus tendon just proximal to its insertion on the greater tuberosity with proximal retraction resulting in a gap of approximately 12 mm. The tear also involves the anterior fibers of the infraspinatus and measures just over 2 cm in the AP dimension. There is thickening and increased signal intensity of the retracted supraspinatus tendon likely representing moderate tendinosis. There is mild edema along the superficial margin of the supraspinatus muscle which may reflect a strain. The infraspinatus muscle appears intact. The subscapularis and teres minor muscles and tendons appear intact.SUPRASPINATUS OUTLET: Mild osteoarthritis affects the acromioclavicular joint. There is fluid within the subacromial/subdeltoid bursa extending into the subcoracoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is a small to moderate sized glenohumeral joint effusion. There is fluid interposed between the superior labrum and the underlying glenoid likely representing a tear.BICEPS TENDON: The tendon of the long head of the biceps appears intact.

Output: Near-complete to complete full-thickness tear of the supraspinatus tendon with involvement of the anterior fibers of the infraspinatus tendon and other findings as described above.


Instruction: Generate impression based on findings.

Input: 74 years Female (DOB:3/28/1942)Reason: Evaluate for etiology of memory loss and cognitive dysfunction History: as abovePROVIDER/ATTENDING NAME: JAMES A MASTRIANNI JAMES A MASTRIANNI The CSF spaces are appropriate for the patient's stated age with no midline shift. Periventricular punctateNo abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related. No abnormal mass lesions are appreciated intracranially.


Instruction: Generate impression based on findings.

Input: Reason: eval for spinal canal stenosis History: bilateral LE weakness Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. No abnormal enhancing lesions are appreciated in the lumbar spine.There is mild superior compression of the T11 vertebral body which is not present on the prior exam and is associated with high signal on T1 suggesting that this is chronic.At L5-S1 there is bilateral facet and ligamentum flavum hypertrophy of moderate degree associated with a minor disk bulge. There is no significant compromise to spinal canal or neural foramina at this level. There is no substantial change compare the prior exam.At L4-5 there is bilateral facet and ligamentum flavum hypertrophy of moderate degree associated with a minor disk bulge. There is no significant compromise to spinal canal or neural foramina at this level. Since the prior exam the patient has developed lobe with more endplate reaction.At L3-4 there is no significant compromise to spinal canal or neural foramina. Since the prior exam the patient has developed a left paramedian disk protrusion which mildly impresses on the thecal sac at the left lateral recess and minimally encroaches on the nerve roots of the left lateral recess.At L2-3 there is no significant compromise to spinal canal or neural foramina. There is a mild disk bulge present this level associate with some ligamentum flavum hypertrophy.At L1-2 there is no significant compromise to spinal canal or neural foramina. There is T2 signal hyperintensity within the disk space at this level associated with Schmorl's nodes. The endplates are preserved and there is no perivertebral soft tissue swelling appreciated. Since the prior exam the only difference is appreciated is the T2 signal hyperintensity. There is subtle adjacent endplate contrast enhancement following gadolinium administration but no disk enhancement. Since the prior exam the patient's right renal pelvis and ureter have an enlarged. The kidneys are atrophic. There is a large cyst associated with the left kidney which was not present on the prior exam. The cyst measures 32 x 40 mm axial dimensions. There is partial visualization of a kidney in the right pelvis.

Output: 1.Degenerative changes are present in the lumbar spine which have mildly progressed since the prior exam. At L3-4 there is a new left lateral recess and paramedian disk protrusion which mildly encroaches on the nerve roots at the left lateral recess at this level. 2.T2 signal hyperintensity within the L1-2 disk space is suspected to be degenerative in nature. There are no specific stigmata for diskitis appreciated. Please correlate with patient's clinical symptoms. A CT scan demonstrating vacuum disk phenomenon similar to the CT of the abdomen from 2011 may help confirm likely DJD.3.There is a mild (<10%) chronic superior endplate compression of the T11 vertebral body which is new since 2007.4.Dr Laura Carlson pager 9903 was paged to discuss the above findings and the findings were discussed.


Instruction: Generate impression based on findings.

Input: Female, 70 years old, with aphasia and right upper extremity weakness, left parietal lesion seen on head CT. History of lung cancer. Numerous, at least 7, enhancing lesions are demonstrated within the brain and cerebellum. These are found within the left frontal lobe, left parietal lobe, along the left sylvian fissure, in the right insula and temporal lobe, and in the right cerebellar hemisphere. The largest lesion, along the Sylvian fissure, measures up to 25 x 24 mm. The lesions show heterogeneous but predominantly peripheral enhancement.As the majority of lesions are present within the left cerebral hemisphere, there is extensive, nearly confluent edema tracking through all the left-sided cerebral lobes including the insula and basal ganglia. A midline shift to the right of up to 9 mm is seen, and the left uncus is medialized. No evidence of transtentorial herniation is seen. Lesions outside of the left cerebral hemisphere also elicit modest local edema.The left lateral ventricle is effaced. The right lateral ventricle is of relatively normal caliber. The third ventricle is effaced and the fourth ventricle is normal. No evidence of intracranial hemorrhage is seen.

Output: Numerous, at least 7, enhancing lesions are demonstrated in the brain and cerebellum compatible with metastases. The majority of these are located within the left cerebral hemisphere where they cause extensive, nearly confluent edema and substantial generalized mass effect.


Instruction: Generate impression based on findings.

Input: Reason for Study: Low back pain [M54.5], Reason for Study: ^Reason: r/o spinal stenosis History: on going back pain. Chronic with flares. Abn x ray of L/S spine. Not much improvement with PT For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. There is grade 1 anterolisthesis of L5 on S1.There are diffuse bone marrow edema on both L5 and S1 vertebral bodies with high signal intensity of L5S1 disc. Considering the degree of anterolisthesis, the extent of bone marrow edema is a bit excessive. Therefore, the possibility of discitis may need to be excluded.There is normal lumbar lordosis. The vertebral body height is preserved. The signal of the visualized cord is normal. The conus medullaris terminates at the T12-L1 level. Degenerative changes are specified by the intervertebral level as follows: T12-L1: Disc desiccation. No neuroforaminal narrowing or spinal stenosis. L1-L2: Disc desiccation. No neuroforaminal narrowing or spinal stenosis. L2-L3: no neuroforaminal narrowing or spinal stenosis. L3-L4: Disc desiccation. No neuroforaminal narrowing or spinal stenosis. L4-L5: Disc desiccation. There is a focal central protrusion of disc which abuts thecal sac. No neuroforaminal narrowing or spinal stenosis. L5-S1: Grade 1 anterolisthesis of L5 5 on S1 with the subtle bulging of L5-S1 disc. High signal intensity of L5-S1 disc with associated post L5 and L1 vertebral bodies bone marrow edema are seen. The extent of bone marrow edema appears to be more excessive than usual acute disc degeneration related inflammatory change (Modic 1 change). Therefore, possibility of discitis may need to be excluded. Contrast enhanced MRI can be considered for further imaging evaluation. No neuroforaminal narrowing or spinal stenosis.

Output: 1. Bone marrow edema of both L5 and S1 vertebral bodies with focal high signal intensity of L5S1 disc, indicate diagnostic possibilities of discitis and excessive endplate degenerative changes (Modic 1 change). Gad enhanced MRI can be considered for further imaging evaluation.2. Grade 1 anterolisthesis of L5 on S1.3. Multilevel various degree degenerative changes of lumbar spine.


Instruction: Generate impression based on findings.

Input: A 53 year old female with history of breast cancer treated with radiotherapy and chemotherapy, now on Herceptin. A recent echocardiography showed a decreased in left ventricular ejection fraction from normal to 42%. Referred to cardiac MRI for further evaluation Left VentricleThe left ventricle is mildly dilated with mildly reduced systolic function. The overall LV ejection fraction is 45%, the LV end diastolic volume index is 91 ml/m2 (normal range: 65+/-11), the LVEDV is 193 ml (normal range 109+/-23), the LV end systolic volume index is 50 ml/m2 (normal range 18+/-5), the LVESV is 106 ml (normal range 31+/-10), the LV mass index is 54 g/m2 (normal range 67+/-11), and the LV mass is 114 g (normal range 114+/-24). There is mild global hypokinesis. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.No iron overload.No intracavitary thrombus.Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 61%, the RV end diastolic volume index is 73 ml/m2 (normal range 69+/-14), the RVEDV is 155 ml (normal range 110+/-24), the RV end systolic volume index is 29 ml/m2 (normal range 22+/-8), and the RVESV is 61 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is trace tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. A catheter was seen in the SVC coming from a port-a-cath in the right chest. PericardiumThere is no pericardial effusion.Extracardiac FindingsS/p left mastectomy. 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 left ventricle is mildly dilated with mildly reduced systolic function, the LVEF is 45%. 2. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.3. The right ventricle is normal in size with normal systolic function, the RVEF is 61%.4. The left atrium is mildly dilated. 5. A catheter was seen in the SVC coming from a port-a-cath in the right chest. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 58-year-old man with history of chest pain. Recent TECAB. Left VentricleNormal appearing LV morphology and function. Perfusion defect noted within the basal anterolateral wall is no longer apparent. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is unremarkable. Right VentricleNormal appearing LV morphology and function.Right AtriumThe right atrium is unremarkable.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsSmall left-sided pleural effusion. 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: Perfusion defect noted noted on previous study from 5/2016 within the basal anterolateral wall is no longer apparent. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.


Instruction: Generate impression based on findings.

Input: 12-year-old with history of knee pain and multiple exostoses MENISCI: The medial and lateral menisci are normal.ARTICULAR CARTILAGE AND BONE: Innumerable broad-based osteochondromas are noted arising from the femur, tibia, and fibula. Cartilage caps are noted, none of which measure over 1 cm in thickness. The largest osteochondroma arising from the posterior femoral metaphysis measures 41 x 11 mm (series 5, image 12). The largest osteochondroma arising from the posterior tibial metaphysis measures 21 x 10 mm (series 5, image 13).Bone marrow signal is normal.LIGAMENTS: The ACL, PCL, MCL, and LCL complex are intact. The popliteus muscle and tendon are intact.EXTENSOR MECHANISM: The patellar tendon and extensor mechanism are intact.ADDITIONAL

Output: Innumerable osteochondromas arising from the femur, tibia, and fibula.


Instruction: Generate impression based on findings.

Input: Reason: history of T-cell leukemia and LCH s/p radiation therapy and stem cell transplant History: monitor for meningioma s/p radiation therapy Areas of previous punctate irregular T1 and T2 hyperintensity within the caudate head and putamen bilaterally are again noted, although overall appear slightly less conspicuous than on prior exam. There is again subtle if any susceptibility associated with these areas of abnormality. There is no convincing superimposed enhancement. Additional punctate focus of susceptibility along the right parietal periatrial white matter is unchanged.The ventricles and sulci are stable, with mild global volume loss. The cisterns remain patent. There is no midline shift or mass effect. There is no diffusion abnormality. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. There is mild mucosal thickening throughout the paranasal sinuses. This includes a few lobulated areas that appear posterior to the left frontal sinus, which are actually areas of pneumatization contiguous with the sinus lumen when correlating with previous available CT images from PET/CT.

Output: 1.No evidence of intracranial mass.2.Stable nonspecific nonenhancing foci of abnormal signal along the putamen and caudate bilaterally.


Instruction: Generate impression based on findings.

Input: There is decreased flow related enhancement within the center of the right M2 segment, decreased caliber and nonvisualization of the normal distal vasculature especially along the Sylvian fissure. A tiny vessel is identified extending to the right posterior basal ganglia hemorrhage, possibly a small lenticulostriate branch (series 2512, image 175). The left middle cerebral artery is unremarkable. The intracranial internal carotid arteries are normal in course and caliber. The anterior cerebral arteries are unremarkable. The vertebral arteries, basilar artery, and posterior cerebral arteries are normal in course and caliber. There is no evidence of aneurysm.MRA NECK

Output: 1.Decreased flow related enhancement within the right M2 segment, decreased caliber and loss of normal distal vasculature, consistent with known thrombus.2.Small vessel identified extending to the right basal ganglia hemorrhage, probable lenticulostriate branch, which could relate to early collateral recruitment.


Instruction: Generate impression based on findings.

Input: Reason: evaluate any changes of right temporal lobe History: cognitive decline, slurred speech and nocturnal seizures. MRI brain:Again seen is volume loss of the right anterior and medial temporal lobe, including the right hippocampus, appearing similar to the prior exam. Subtle increased FLAIR signal in the mesial temporal lobes is unchanged. A small focus of intrinsic T1 shortening without susceptibility may reflects mineralization or laminar necrosis from prior injury. No associated abnormal enhancement, susceptibility or restricted diffusion is seen in this region or throughout the remaining parenchyma. There is ex vacuo dilatation of the right temporal horn. The ventricles and basal cisterns are otherwise 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.MRA/MRV brain:No flow limiting stenosis or aneurysms in the anterior or posterior circulation. The vertebral basilar system is patent. There is an incidental extracranial origin of the left PICA. The dural sinuses are patent. The left transverse sinus is diminutive relative to the right, likely reflecting dominance of the right side.

Output: 1.Right temporal lobe volume loss particularly involving the right anterior and medial temporal lobes including the hippocampus is not significantly changed. There is focal area of intrinsic T1 hyperintensity which is also unchanged. Subtle FLAIR hyperintensity in the right medial temporal lobe and possibly the left medial temporal lobe also appears similar to prior. Overall findings are favored to represent sequela of prior inflammation, infection, or other injury. No abnormal enhancement to suggest an active inflammatory process.2.MRA is within normal limits without evidence of stenosis.3.MR venogram is within normal limits without evidence of thrombosis.


Instruction: Generate impression based on findings.

Input: 21 year-old female with a history of gastric cancer, evaluate for brain metastases prior to starting a clinical trial. Susceptibility artifact from dental hardware/retainer slightly limits evaluation. There is no evidence of intracranial metastatic disease. There is no abnormal parenchymal or meningeal enhancement. No intracranial mass or mass effect. No evidence of infarct or hemorrhage. Brain parenchyma is unremarkable. There is no midline shift or herniation. The major cerebral flow voids are intact. The ventricles and basal cisterns are normal in size and configuration. There is a 6 x 3 mm nonenhancing structure within the posterior aspect of the pituitary gland which is not well evaluated but likely represents an incidental Rathke's cleft cyst. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. No evidence of intracranial metastatic disease.2. Subcentimeter nonenhancing structure within the posterior aspect of the pituitary gland is not well evaluated but likely represents an incidental Rathke's cleft cyst. No associated mass effect.


Instruction: Generate impression based on findings.

Input: THORACIC SPINE: The thoracic spine is in normal alignment, with a normal thoracic kyphosis. There is evidence of metastatic disease throughout the thoracic spine with relatively large lesions at T10, T11 and T12 as described below:-There is a well-circumscribed lesion along the posterior aspect of the T10 vertebral body on the right extending to the right pedicle which demonstrates decreased signal on T1-weighted images with corresponding increasing signal on T2-weighted images and marked enhancement. -There is diffuse marrow infiltration at T11 which is increased since prior MRI study on 9/10/2014. Within this process there is a well-circumscribed lesion demonstrating marked enhancement along the posterior aspect of the vertebral body on the left and extending to the left pedicle. There is associated minimal loss of vertebral body height with no evidence of intervertebral disc retropulsion or significant spinal canal stenosis, however this appears worse since the prior study. -There is a small well-circumscribed lesion within the T12 vertebral body posteriorly and to the right which demonstrates decreased T1 and T2 signal intensity with suggestion of subtle enhancement. This small lesion appears slightly larger compared to prior study measuring 7.4 mm in craniocaudal dimension, previously 5.5 mm. At T2 and T3 there are nonspecific T1 hypointense lesions abutting the posterior inferior endplate without enhancement and appear unchanged from prior study. At T11-T12 there is mild narrowing of the thecal sac as well as moderate narrowing of the left neural foramen. There is no abnormal signal within the spinal cord.At T12-L1 there is moderate left neural foraminal narrowing related to facet arthropathy and disc bulge. No significant spinal canal stenosis is noted.There is no significant disk bulge, herniation, spinal canal or foraminal stenosis throughout the remaining thoracic spine. The spinal cord is of normal caliber and signal with no abnormal leptomeningeal, epidural, or intramedullary enhancement.LUMBAR SPINE: The lumbar spine is in grossly normal alignment, with mild levocurvature and mild left lateral L4 on L5 subluxation. There is loss of height involving the left aspect of the L5 vertebral body similar to prior and possibly on a benign basis with no large underlying lesion appreciated. The distal spinal cord and conus are within normal limits with the conus terminating at the T12-L1 level.There is evidence of metastatic disease throughout the lumbar spine with relatively large lesions at L1 and L2 as described below:-There is a well-circumscribed lesion along the anterior aspect of the L1 vertebral body which demonstrates decreased T1 signal with heterogeneous increased signal on T2 as well as heterogeneous enhancement.-A similar lesion affects the L2 vertebral body.-There is extensive signal abnormality involving the lateral aspect of L5 and S1 vertebral bodies on the left.There are advanced degenerative changes seen as described below which overall appear similar to prior study: At L1-L2 there is effacement of the left lateral recess without central canal stenosis. There is moderate left and mild right neural foraminal narrowing.At L2-L3 there is moderate spinal canal stenosis. There is moderate right and mild left neural foraminal narrowing.At L3-L4 there is severe spinal canal stenosis. There is moderate right and mild left neural foraminal narrowing.At L4-L5 there is moderate spinal canal stenosis. There is moderate to severe left and moderate right neural foraminal narrowing.At L5-S1 there is mild spinal canal stenosis including effacement of the lateral recesses. There is moderate right and severe left neural foraminal narrowing. OTHER:There are multiple lesions in the sacrum including a partially imaged left S3 lesion which was present before.There is a well-circumscribed lesion of the right iliac wing with abnormal T1 and T2 signal and demonstrates marked enhancement. This small lesion appears slightly larger compared to prior study, measuring 17 mm in AP dimension, previously 13 mm. There are innumerable enhancing lesions within the partially imaged lungs compatible with metastatic disease which are better evaluated on recent CT study. There are bilateral renal cysts.

Output: 1. Multilevel metastatic disease throughout the thoracic and lumbar spine with mild progression as described above. T11 vertebral body lesion again seen with more diffuse marrow signal abnormality and minimal pathologic compression deformity appearing worse from prior study. Mild compression deformity involving the left aspect of the L5 vertebral body appears similar to prior and possibly on a degenerative basis. Otherwise no significant pathologic compression deformities in the thoracic or lumbar spine. No evidence of epidural tumor or leptomeningeal disease.2. Advanced degenerative changes in the lumbar spine with severe spinal canal stenosis at L3-4 and moderate at L2-3 and L4-5. There is also moderate to severe neural foraminal narrowing at multiple levels as detailed above.3. Innumerable pulmonary metastatic disease which is better evaluated on recent CT study.


Instruction: Generate impression based on findings.

Input: Clinical question: History of vascular malformation of the left frontal lobe, follow-up. Signs and symptoms: Mild headache. Nonenhanced brain MRI: No diffusion weighted abnormalities.Susceptibility MRI images demonstrate a small curvilinear focus of susceptibility in the left superior frontal gyrus measuring approximately at 9 x 5-mm in transaxial dimensions. This finding is not identified on any of the other MRI sequences and there is no associated flair/T2 signal abnormality of the surrounding parenchymal. There are no prior exams for comparison. This finding could represent a focus of chronic hemorrhage. Although not typical in signal pattern possibility of a vascular malformation such as a cavernoma should also be considered.The anatomical morphology as well as the cecum intensity of brain parenchyma otherwise remains within normal for patient's stated age of 47. Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination.There is normal visualization of signal void of major intracranial arterial branches.The signal intensity of intracranial venous sinuses is again normal.Images through the orbits are unremarkable. All paranasal sinuses and bilateral mastoid air cells demonstrate normal pneumatization signal pattern with the exception of small focus of mucosal thickening in the inferior right maxillary sinus.

Output: 1.No acute intracranial process.2.Susceptibility signal change measuring 9 x 5-mm visible only on susceptibility MR sequence and without associated flair/T2 signal abnormality. Finding could represent a focus of chronic blood products and although not entirely typical possibility of a cavernous malformation cannot be entirely excluded.3.Unremarkable pre-and post enhanced brain MRI otherwise.


Instruction: Generate impression based on findings.

Input: Reason: R hip FAI History: R hip pain ACETABULAR LABRUM: There is a linear focus of high signal intensity traversing the superior labrum, consistent with a tear. No additional abnormalities are identified. ARTICULAR CARTILAGE AND BONE: Small ovoid low intensity focus in the right femoral head presumably represents a bone island. The bones and articular cartilage are otherwise within normal limits.SOFT TISSUES: No significant abnormality noted. ADDITIONAL

Output: Small tear of the superior acetabular labrum as above.


Instruction: Generate impression based on findings.

Input: 76 old female with history of spondylolisthesis Grade 1 anterolisthesis of L4 relative to L5, alignment is otherwise anatomic. Joint space narrowing of L5-S1 as well as anterior osteophytes suggestive of mild osteoarthritis.

Output: Anterolisthesis of the L4 relative to L5 vertebra as well as mild osteoarthritis similar in appearance to prior exam.


Instruction: Generate impression based on findings.

Input: Male 59 years old; Reason: PSC, evaluate for cholangiocarcinoma History: same ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Accounting for differences in technique without significant change moderate degree intrahepatic biliary duct irregularity and narrowing at confluence of left and right hepatic ducts. Narrowing and luminal irregularity involving CBD (especially proximally) stable to mildly increased from earlier study. Similar to earlier study is focal mild dilatation of midportion of CBD measuring up to 6 to 7 mm, suspicious for element of prestenotic dilatation. No definite abnormal enhancement seen to suggest interval development of neoplasm. Unchanged subcentimeter T2 hyperintense hepatic segment 2 focus, difficult to reliably characterize due to small size but most likely a benign cyst.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Tiny right renal cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Right lower quadrant intraluminal rounded increased T2 signal likely normal ileocecal valve.BONES, SOFT TISSUES: Small fat-containing umbilical hernia.OTHER: No significant abnormality noted.

Output: Findings compatible with PSC, please see details above. No suspicious lesion delineated.


Instruction: Generate impression based on findings.

Input: Check for right meniscal tear., Occasional locking and pain MENISCI: Mild globular signal in the posterior horn of the medial meniscus is otherwise not associated with any additional linear focal abnormalities. The lateral meniscus however demonstrates more extensive globular signal involving the apical segment of the lateral meniscal body extending into the anterior horn and associated with an adjacent para meniscal cyst. Again no discrete linear component is observed in both menisci are anchored posteriorly.ARTICULAR CARTILAGE AND BONE: Moderate degenerative changes are observed without abnormal marrow signal. Mild thinning of the medial patellar facet with more mild to moderate pronounced changes involving the cartilage involving the medial and lateral compartments. No underlying osseous or marrow signal abnormalities or discrete focal lesionsLIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Moderate degenerative changes with nonspecific degenerative changes largely involving the lateral meniscus with a small para meniscal cyst as described. Associated mild-to-moderate cartilaginous thinning with minimal irregularity yet without discrete focal full-thickness defects, most pronounced in the lateral compartment.


Instruction: Generate impression based on findings.

Input: Reason: 64 y/o man w/ concern for osteomyelitis There is ulceration of the soft tissues of the heal pad with a nonenhancing track extending from the skin surface to the plantar aspect of the calcaneus. There is abnormal signal intensity and enhancement throughout the majority of the calcaneus, particularly posterior body indicating osteomyelitis. Relatively low signal intensity within the calcaneus on the STIR sequence that does not enhance following gadolinium administration may represent devitalized bone. Also nonenhancing soft tissue posterior to the calcaneus that may be devitalized. Thickening of the skin along the plantar and posterior aspect of the calcaneus and reticulation of the subcutaneous fat indicating cellulitis. Additional soft tissue ulceration noted posteriorly. Visualized tendinous structures appear intact. Severe fatty atrophy of the musculature of the ankle and foot. Edema along the dorsum of the foot. Small amount of fluid in the tibiotalar and subtalar joint and small amount of fluid in the medial and lateral tendons and retrocalcaneal bursa, not necessarily of clinical significance.

Output: Osteomyelitis of the calcaneus and other findings as described above.


Instruction: Generate impression based on findings.

Input: Knee pain Exam is slightly limited by motion artifact.MENISCI: There is increased signal in the posterior horn of the lateral meniscus which extends to the articular surface of the tibia and is consistent with complex tear. Additional linear signal is also noted within the anterior horn which is likely degenerative in nature. There is an associated parameniscal cyst within the medial gutter.There is increased signal is noted in the posterior horn of the medial meniscus which does not appear to extend to either articular surface is likely degenerative in natureARTICULAR CARTILAGE AND BONE: There is moderate diffuse thinning of the articular cartilage of the medial compartment with areas of near full-thickness loss involving femoral condyle anteriorly. Similar moderate diffuse thinning with scattered areas of near full-thickness loss are noted in the lateral compartment as well. Moderate diffuse thinning of the patellofemoral articular cartilage is noted without full-thickness defect although there are areas of near full-thickness loss involving the femoral trochlea.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: A minimal amount of increased signal is noted in the patellar tendon near its attachment upon the inferior pole which may reflect a component of mild tendinosis.ADDITIONAL

Output: 1. Complex tear of the posterior horn of the medial meniscus.2. Moderate diffuse thinning of the articular cartilage with areas of near full-thickness loss at the femoral trochlea.


Instruction: Generate impression based on findings.

Input: Male, 11 months old, full-term with hypotonia and developmental delay. The morphology of the brain is within normal limits. No structural abnormalities are seen. No focal signal abnormality, edema or mass effect is observed. The pattern of white matter myelination is appropriate for age.The pituitary region is within normal limits. The corpus callosum is fully formed and normal. The brainstem, cerebellar vermis and cerebellar hemispheres are normally formed and intact. A mega cisterna magna is seen.No evidence of intracranial hemorrhage or any abnormal extra-axial fluid collection is seen. No findings to suggest white matter volume loss are noted. The ventricular system is normal in size and morphology. Prominence of the perivascular spaces through the cerebral white matter is likely a normal anatomic variant.

Output: Unremarkable evaluation with no specific findings to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Occlusion and stenosis of carotid artery with cerebral infarction [433.11], Reason for Study: ^Reason: History of stroke with left carotid stenosis for yearly follow up History: History of stroke with left carotid stenosis for yearly follow up. Brain MRI:No evidence of acute ischemic or hemorrhagic lesion.Redemonstration of encephalomalacia in the left frontal lobe, along the left middle frontal gyrus, left occipital lobe, and at the cerebral vertex compatible with chronic infarctions.Multiple scattered high signal intensity lesions in bilateral periventricular white matter and right globus pallidus indicate chronic ischemic lesion. Associated susceptibility artifacts on the right basal ganglia suggest chronic petechial hemorrhage. Above findings do not show any interval change since prior scan.The ventricles, sulci and cisterns are symmetric and unremarkable. The paranasal sinuses and 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 subtle luminal irregularities of basilar artery, right vertebrobasilar junction and distal vertebral artery. There is focal luminal narrowing on the left ICA cavernous segment which appears to be more than 50% stenosis. Above findings suggest intracranial atherosclerosis. Comparing to prior scan, there is no significant interval change. Bilateral PCAs are fetal origin, and bilateral MCAs and ACAs appear to be normal. Neck MRA3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate about 35% (based on NASCET method) left extracranial ICA. Comparing to prior scan, there is no significant interval change.Proximal right extracranial ICA shows about 5% stenosis, which again no change since prior exam. The right vertebral artery ostium shows about 50% of luminal stenosis. The left vertebral artery is hypoplastic.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. No change of multifocal chronic ischemic lesions.3. Left extracranial ICA stenosis, about 35%, no change since prior scan.4. Right extracranial ICA stenosis, about 5%, no change since prior scan.5. Right vertebral artery ostial stenosis, about 50%, no change since prior scan.


Instruction: Generate impression based on findings.

Input: There are no masses, mass effect or midline shift. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. Scattered punctate foci of T2/FLAIR hyperintensity within the periventricular and subcortical white matter are present without associated mass effect, restricted diffusion, or enhancement, and is consistent with chronic small vessel ischemic changes. There is no abnormal enhancement within the brain. There are no extraaxial fluid collections or subdural hematomas. The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. The pituitary gland is normal in size. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain.

Output: 1. No evidence of acute ischemic infarction.2. Chronic small vessel ischemic changes.


Instruction: Generate impression based on findings.

Input: 40 years, Female, Reason: 40yo female with Crohn's ileitis. MRE showed liver lesion likely FNH, though could be adenoma History: liver lesion on MRE. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: There is a well-circumscribed lobulated segment IVb lesion which restricts on diffusion, is mildly hyperintense on T2 and demonstrates homogenous enhancement, particularly on the hepatobiliary phase. These characteristics are consistent with focal nodular hyperplasia. Small region of fatty sparing in segment 4a.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Liver lesion is compatible with focal nodular hyperplasia.


Instruction: Generate impression based on findings.

Input: 65-year-old female with history of renal cell carcinoma and ganglioneuroma. Status post right nephrectomy. Evaluate for recurrent disease. CHEST:LUNGS AND PLEURA: Stable apical and lateral pleural thickening, greater on the right. No change in several small micronodules as well as stable, minimal ground glass opacity in right upper lobe.MEDIASTINUM AND HILA: Stable small to borderline superior mediastinal lymph nodes. There are also several relatively large nodes but with fatty centers in the pre-carina and aorto - pulmonary window which are stable when compared to prior exam as well as a study from September of 2008.CHEST WALL: T7 vertebral body lesion at axial image 43 of series 8 was evaluated on thoracic MRI exam of 2/4/2010. T3 vertebral body hemangioma at axial image 17 of series 8. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No change in appearance is previously described.ADRENAL GLANDS: Right adrenal appears normal. The left is not visualized.KIDNEYS, URETERS: Probable small cyst in the upper pole right kidney cyst. Status post left nephrectomy. The bowel and pancreatic tail occupy the nephrectomy bed. No evidence for local recurrence.RETROPERITONEUM, LYMPH NODES: No lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Stable 1.7 x 2.9 cm rounded low attenuation mass in the left adnexa with fluid density.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: Stable CT of the chest, abdomen and pelvis.


Instruction: Generate impression based on findings.

Input: 6-year-old male with elevated PSA. Evaluate for prostate cancer. PELVIS:PROSTATE: Prostate Size: 4.5 x 2.9 cmPeripheral Zone: Heterogeneous appearance of the peripheral zone with no evidence of a dominant lesion. Small foci of restricted diffusion throughout the prostate gland noted.Central Gland: Central gland is heterogeneous in appearance. There is subcentimeter area of restricted diffusion within the right central gland with evidence of enhancement. Seminal Vesicles: No evidence of seminal vesicle involvement.Extracapsular Extension: No evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Right iliac fossa transplant kidney without evidence of hydronephrosis.

Output: 1.Small nodule in right central gland likely BPH. 2.Heterogeneous peripheral zone suggestive of prostatitis.


Instruction: Generate impression based on findings.

Input: Reason: Eval hemobilia History: Hemobilia. ABDOMEN:LIVER, BILIARY TRACT: Scattered hepatic cysts. No intrahepatic or extra hepatic biliary ductal dilatation. Focal thickening at the gallbladder fundus measures 0.6 x 1.2 cm with punctate cysts (series 501 image 24).SPLEEN: No significant abnormality noted.PANCREAS: Atrophic pancreas. No pancreatic ductal dilatation. No pancreatic or peripancreatic inflammation. Intrapancreatic splenule in the pancreatic tail. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Antral wall thickening without definite mass, which can be seen in ulcer disease. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No ascites.

Output: 1.No MRI evidence of acute pancreatitis.2.Antral wall thickening without definite mass, which can be seen in ulcer disease. 3.Adenomyomatosis of the gallbladder.


Instruction: Generate impression based on findings.

Input: 40 years Male (DOB:4/27/1975)Reason: parkinsons History: tremorsPROVIDER/ATTENDING NAME: PETER C WARNKE PETER C WARNKE 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. An enlarged perivascular spaces present along the right external capsule.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 mucous retention cyst in the right maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: This a limited study performed for stereotactic guidance. Small or subtle abnormalities may not be detected on an exam length this.


Instruction: Generate impression based on findings.

Input: 94 year old male with incidentally noted right atrial vs. pericardial mass Left VentricleThe left ventricle is normal in size with hyperdynamic systolic function. The overall LV ejection fraction is 77%, the LV end diastolic volume index is 49 ml/m2 (normal range: 74+/-15), the LVEDV is 85 ml (normal range 142+/-34), the LV end systolic volume index is 11 ml/m2 (normal range 25+/-9), the LVESV is 19 ml (normal range 47+/-19), the LV mass index is 27 g/m2 (normal range 85+/-15), and the LV mass is 46 g (normal range 164+/-36). 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 mildly enlarged. Right VentricleThe right ventricle is normal in size with hyperdynamic systolic function. The overall RV ejection fraction is 73%, the RV end diastolic volume index is 68 ml/m2 (normal range 82+/-16), the RVEDV is 117 ml (normal range 142+/-31), the RV end systolic volume index is 19 ml/m2 (normal range 31+/-9), and the RVESV is 32 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size. There is lipomatous hypertrophy of the interatrial septum. The interatrial septum is aneurysmal. No atrial mass is seen.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size. The thoracic aorta is tortuous.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 FindingsMultiple hemangiomas and/or cysts in the liver. There are bilateral cysts in the kidneys. There is cholelithiasis and gallbladder sludge; mild gallbladder wall thickening . This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Normal size LV with hyperdynamic systolic function (EF 77%).2. Normal size RV with hyperdynamic systolic function (EF 71%).3. Aneurysmal interatrial septum with lipomatous hypertrophy. 4. No right atrial mass visualized. 5. Extra-cardiac findings as above.


Instruction: Generate impression based on findings.

Input: 2 years Male (DOB:5/2/2014)Reason: assess for structural causes of acute ataxia History: progressive ataxia following febrile illnessPROVIDER/ATTENDING NAME: JAMES H TONSGARD JAMES H TONSGARD The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: MRI of the brain is within normal limits. No intracranial lesions are appreciated which can explain the patient's ataxia on the basis of this exam alone.


Instruction: Generate impression based on findings.

Input: Benign neoplasm of meninges, unspecified [D32.9], Reason for Study: ^Reason: Eval for growth of meningioma. Please compare back to oldest MRI as well. History: meningioma. Redemonstration of left anterior temporal extra-axial mass (most likely meningioma), unchanged in terms of size, configuration and MR signal characteristics since prior scan.There is no other abnormal enhancement.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 mastoid air cells are clear.Fluid levels are seen within the left sphenoid sinus and a small right maxillary sinus retention cyst, unchanged since prior scan.

Output: Unchanged left anterior temporal meningioma in terms of size, configuration and MR characteristics since prior scan.


Instruction: Generate impression based on findings.

Input: Clinical question: History of L5-S1 fusion, now with buttock pain.? Spinal versus neural foraminal compromise. Signs and symptoms: As above. Nonenhanced lumbar MRI:L5-S1 demonstrates advanced degenerative disc disease with grade 1 anterolisthesis without significant change since prior exam and without evidence of spinal stenosis. There is however compromise of bilateral neural foraminal without significant change since prior exam. There is no evidence of acute new finding at this level. Postoperative changes of prior fusion and including transpedicular screw placement without convincing evidence of instrumental failure.Mild degenerative disc disease and hypertrophic changes of posterior elements at other levels are noted however without evidence of an acute finding, no evidence of central spinal stenosis or neural foraminal compromise.Unremarkable. Spinal soft tissues and unremarkable partially visualized SI joints.

Output: 1.Interval posterior fusion at L5-S1 level with persistent grade 1 anterolisthesis, no central spinal stenosis and stable bilateral neural foraminal compromise. No evidence of acute finding at this level.2.Mild degenerative changes at other levels however without spinal stenosis or neural foraminal compromise.


Instruction: Generate impression based on findings.

Input: Reason: 86 y/o F with RUQ pain, prior outside CT scans noted possible cysts of liver. MRI liver requested to further evaluate. History: as above ABDOMEN:LIVER, BILIARY TRACT: 9 mm nonenhancing T2 hyperintense focus in the left hepatic lobe, likely a simple cyst. A few additional T2 hyperintensities are too small to characterize but also likely cysts. No suspicious hepatic lesions. Adenomyomatosis of the gallbladder fundus.SPLEEN: No significant abnormality noted.PANCREAS: 3 mm cyst in the pancreatic tail likely represents a side branch IPMN. Main pancreatic duct is nondilated.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter T2 hyperintensities, likely cystsRETROPERITONEUM, 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.Simple cyst in the liver. No suspicious hepatic lesions.2.Punctate cyst in the pancreatic tail likely represents a small side branch IPMN.


Instruction: Generate impression based on findings.

Input: Male 56 years old with peritoneal mesothelioma. Please compare to prior CT to evaluate disease for surgery. ABDOMEN:LIVER, BILIARY TRACT: There is again minimal scalloping of the liver margin. No focal hepatic lesions are identified. The patient is status post cholecystectomy with no intra or extrahepatic biliary ductal dilatation. The hepatic vasculature is patent.The amount of perihepatic and ascites (particularly in upper quadrants) has increased since the previous exam, resultant narrowing of the IVC noted and suggestive of a gelatinous/mucinous composition of the fluid.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: Comparison of the peritoneal disease to prior CT imaging difficult due to differences in technique and modality. The peritoneal disease in the left upper quadrant is best seen on postcontrast images. A 2.5 x 2.1 cm left upper quadrant lesion medial to the spleen corresponds to a 0.7 cm focus on the prior CT (series 13, image 359; series 7, image 33 on the prior CT). The perigastric peritoneal lesion measured on the prior exam is difficult to compare and is possibly smaller measuring 2.0 x 1.9 cm (series 13, image 350; series 7, image 26 on the prior CT). There is nodular thickening of the dependent right peritoneal reflection (series 16, image 17) in the pelvis that was not well seen on the previous exam and may be new. Mild general peritoneal thickening is seen elsewhere as well, e.g., at level of pelvis.BONES, SOFT TISSUES: Susceptibility artifact in the anterior abdominal wall is most likely related to prior surgeries.OTHER: No significant abnormality noted.

Output: 1. Direct comparison with the prior CT suboptimal given differences in technique and modality.2. A left upper quadrant lesion medial to the spleen has increased in size since the previous exam. The perigastric peritoneal lesion measured on the prior CT exam is difficult to compare and is possibly smaller.3. Nodular thickening of the right dependent peritoneal reflection was not well seen on the previous exam and may be new. Mild generalized peritoneal thickening elsewhere appears similar to the previous exam.4. Amount of perihepatic and ascites (particularly in upper quadrants) has increased since the previous exam, resultant deformity and narrowing of the IVC noted and suggestive of a gelatinous/mucinous composition of the fluid.


Instruction: Generate impression based on findings.

Input: Female, 24 years old. Reason: Thyroid Cancer. Please assess lymph nodes in the lateral and central neck. RIGHT LOBE MEASUREMENTS: 2.2 x 2.4 x 6.9 cmLEFT LOBE MEASUREMENTS: 2.2 x 2.9 x 6.9 cmISTHMUS MEASUREMENTS: 0.6 cmRIGHT LOBE: Heterogeneous echotexture. A right lower pole nodule measures 1.5 x 0.7 x 1.1 cm, ovoid, hypoechoic, noncalcified, without significant internal vascularity.LEFT LOBE: Heterogeneous echotexture. A left lower pole nodule measures 1.8 x 0.8 x 1.5 cm, heterogeneous, with internal echogenicity which may reflect calcification.ISTHMUS: Heterogeneous echotexture.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: A right level 2 lymph node measures 0.9 x 0.5 x 2.5 cm, with a fatty hilum. A left level 2 lymph node measures 1.0 x 0.4 x 1 .2 cm, with heterogeneous echotexture and suggestion of a fatty hilum. A left level 3 lymph node measures 1.0 x 0.2 x 1.1 cm, with a fatty hilum.OTHER: No significant abnormality noted.

Output: 1. Enlarged, heterogeneous thyroid with bilateral nodules as detailed above. The nodule on the left corresponds with the patient's known thyroid cancer.2. A left level 2 nonenlarged heterogeneous lymph node is nonspecific, but presence of a fatty hilum favors benignity. No other suspicious lymph nodes are identified.


Instruction: Generate impression based on findings.

Input: SCLC treated with 6 cycles chemotherapy. There is a well-circumscribed, diffusely enhancing pineal lesion measuring up to 8 mm in diameter, which is not significantly changed from prior exam. There is minimal cerebral white matter T2 hyperintensity. The brain parenchyma otherwise appears unremarkable. There is otherwise no intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. Stable appearing enhancing pineal mass, which may represent a lung cancer metastasis versus a primary pineal tumor. No new intracranial enhancing lesions are identified.2. Minimal non-specific cerebral white-matter T2 hyperintensity suggestive of chronic microvascular ischemia.3. No evidence of intracranial hemorrhage or acute infarct.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Chronic knee pain MENISCI: There is blunting and abnormal signal intensity of the posterior horn of the medial meniscus representing undersurface tearing which extends into the body and to the tibial articular surface. This is best appreciated on series 6 images 19 through 22. The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is a tiny, near full-thickness to full-thickness articular cartilage defect seen within the medial tibial plateau (series 6 image 19 and series 4 image 11). There is heterogeneity of the articular cartilage representing degeneration but otherwise no full-thickness defects are appreciated. The articular cartilage of the lateral compartment is intact. There is near full-thickness degeneration and loss of the articular cartilage of the medial patellar facet.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Tearing of the posterior horn of the medial meniscus.2. Articular cartilage loss and degeneration further detailed above which is most notable in the medial patellar facet.


Instruction: Generate impression based on findings.

Input: The patient submitted outside studies for review. Submitted for review are standard mammogram (7/01/2015, 7/9/2015, 7/13/2015), ultrasound (7/13/2015) and MRI (7/30/2015) performed at Aspirus Hospital Wausau WI. No prior year comparisons are available. MAMMOGRAM 7/01/2015, 7/9/2015): Two standard views of both breasts were obtained. Additional right ML view and spot compression views of the right breast were obtained. The breast parenchyma is extremely dense, which limits the sensitivity of the mammogram. Given breast density, there is no definite abnormality seen in either breast. A questionable asymmetry on the right CC view may represent dense tissue. No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in either breast. ULTRASOUND (7/13/2015):RIGHT: There is a 1.2 x 0.4 x 1.4 cm hypoechoic area in the right breast 4:00 position "5 FBFN", indeterminate. Also seen is a 1.2 x 0.5 x 1.3 cm hypoechoic area in the right breast 10:00 position "4 FBFN", indeterminate.LEFT: There is a 0.9 x 0.4 x 1.2 cm hypoechoic mass in the left breast 1:00 position "2FBFN" anterior depth, indeterminate. Also seen in the left breast 1:00 position middle depth "3FBFN" is a cluster of cysts, not measured on the ultrasound.ULTRASOUND BIOPSY AND POST BIOPSY MAMMOGRAM (7/13/2015):Static images were submitted from ultrasound guided biopsy of 1.6 cm hypoechoic area in the right breast 1:00 position, with appropriate targeting. This mass was not seen on the submitted diagnostic ultrasound images.Static images from ultrasound-guided biopsy of a mass in the left breast 1:00 position anterior depth annotated "area 1" (previously seen on ultrasound 7/13/2015 as a hypoechoic mass in the left breast 1:00 position "2FBFN") and a mass in the left breast 1:00 position middle depth, annotated "area 2" (previously seen on ultrasound 7/13/2015 as a cluster of cysts in the left breast 1:00 position "3FBFN").Postbiopsy mammogram show percutaneously placed biopsy clip in the right breast middle depth near 12:30-1:00 position. Two percutaneously placed clips are also seen left breast 1:00 position anterior and middle depth, along with postbiopsy changes.OUTSIDE PATHOLOGY REPORT:Pathology report of the right breast mass 1:00 position as indicates proliferative fibrocystic changes with several foci of atypical ductal hyperplasia. Pathology report of the mass in the left breast 1:00 position anterior depth indicates benign fibroadenoma.Pathology report from the mass in the left breast 1:00 position middle depth indicates proliferative fibrocystic changes with intraductal papilloma.BREAST MRI (7/30/2015):There is moderate background enhancement which limits sensitivity. The technique of the exam is also suboptimal. Nonspecific patchy foci of enhancement are seen in both breasts, asymmetric and regional on the right central and inner breast. It is not known if this study was performed at the optimal time in the patient's menstrual cycle. Two small hematomas are seen in the left breast from sites of prior biopsies. No definite focal enhancing mass in either breast or abnormal enhancement in either axilla. Drs. Abe and Sheth concurred with this interpretation.

Output: Bilateral ultrasound findings biopsied with concordant results. Pathology should be reviewed at University of Chicago. Patchy foci of enhancement in both breasts on MR, asymmetric on the right inner breast, nonspecific. Breast MRI is recommended in 6 months, preferably during days 7-10 of her menstrual cycle to try to minimize the effect of background parenchymal enhancement which may have contributed to the degree of right breast enhancement on the outside MRI.BIRADS: 3 - Probably benign finding.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Left knee pain and swelling. MENISCI: The lateral meniscus demonstrates a transverse linear signal in the body extending to both the anterior and posterior horns, with clear extension into the superior articular surface. There is mild extrusion of the lateral meniscus laterally. The medial meniscus demonstrates a horizontal tear through the posterior horn with extension into the apex and into the body, with relative preservation of the anterior horn.ARTICULAR CARTILAGE AND BONE: There is diffuse thinning throughout the medial compartment and to a lesser extent the lateral and patellar compartment. There is no discrete focal abnormality. There are mild to moderate osteoarthritic changes.LIGAMENTS: Cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: Extensive mechanism is intact.ADDITIONAL

Output: Lateral meniscus tear with extension into the superior articular surface and mild lateral extrusion. Medial meniscus tear through the posterior horn into the apex and body.


Instruction: Generate impression based on findings.

Input: 5 lumbar type vertebral bodies are identified. The lumbar lordosis is preserved. The vertebral body heights and intervertebral disc spaces are grossly preserved. The osseous marrow signal is within normal limits. Mild inferior endplate degenerative changes demonstrated involving the L4 vertebral body with Schmorl's node which is slightly larger and associated with increased edema compared to prior. The conus is normal in signal and morphology and terminates at the T12-L1 level. The cauda equina appear unremarkable. There is congenital narrowing of the spinal canal. There is diffuse desiccation of the intervertebral discs of the lumbar spine.Individual levels as below:L1-L2: No significant spinal canal or neuroforaminal stenosis.L2-L3: There is a mild diffuse disc bulge however without neuroforaminal or spinal stenosis.L3-L4: There is a mild diffuse disc bulge causing moderate right and mild to moderate left neuroforaminal narrowing and mild spinal canal stenosis which is predominantly on the basis of developmental spinal canal narrowing. The previously seen disc extrusion at this level is no longer seen. L4-L5: There is a mild diffuse disc bulge at this level causing moderate left and mild to moderate right neural foraminal narrowing and mild spinal canal stenosis. L5-S1: There is a mild diffuse disc bulge at this level and advanced facet arthropathy. There is partial effacement of the right lateral recess as well as mild to moderate right neural foraminal stenosis. No significant central canal stenosis.

Output: Developmental narrowing of the mid to lower lumbar spinal canal with superimposed degenerative changes as described above. There is mild spinal canal stenosis at the L3-L4 and L4-L5 levels. Additional details including neural foraminal narrowing as above.


Instruction: Generate impression based on findings.

Input: 65-year-old male patient with elevated PSA. Degradation of signal in the left hemipelvis due to replacement hardware.PELVIS:PROSTATE:Prostate Size: 5.5 x 4.0 x 4.6 cm.Peripheral Zone: There is a region of T2 hypointensity with corresponding ADC hypointensity within the right midgland measuring 1.1 x 0.7 cm (image 23, series 801) and 0.9 x 0.7 cm (image 24, series 801); this is suspicious for tumor. Linear signal abnormality within the left mid-gland is indeterminate. Central Gland: Hyperplasia with BPH nodules.Seminal Vesicles: No definite involvement.Extracapsular Extension: The capsule overlying the right midgland of the peripheral zone appears indistinct and may represent focal extraprostatic extension (image 22, series 801). BLADDER: No significant abnormality noted.LYMPH NODES: Non-specific prominent right femoral lymph node.BONES, SOFT TISSUES: Asymmetric enhancement of the hamstring insertions on the right may reflect some degree of tendinopathy. Susceptibility artifact secondary to a left hip arthroplasty device.OTHER: Fat-containing left inguinal hernia.

Output: Signal abnormality within the right mid-gland of the peripheral zone is suspicious for tumor with questioned focal extraprostatic extension.


Instruction: Generate impression based on findings.

Input: 48-year-old man with history of Crohn's and diarrhea. ABDOMEN:LIVER, BILIARY TRACT: Punctate T2 hyperintensities are too small to actually characterize but are likely benign. Otherwise, the liver is normal in signal and morphology. The gallbladder is distended and normal. There is no intra or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: The pancreatic duct is normal in caliber. No focal parenchymal lesion.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No hydronephrosis. No focal renal lesion.RETROPERITONEUM, LYMPH NODES: No significant retroperitoneal lymphadenopathy.BOWEL, MESENTERY: There is an approximately 16 cm length of terminal ileum with circumferential wall thickening, luminal narrowing, and enhancement (17/317). The bowel immediately proximal to this area of luminal narrowing is dilated up to 28 mm. Additionally, there are small pseudodiverticula (13/23). There is fibrofatty proliferation in the right lower quadrant containing prominent mesenteric lymph nodes.Additionally, there are loops of jejunum seen on coronal images (7/35) which are difficult to evaluate given underdistention, however these could be involved by inflammation although this is indeterminate.The colon appears normal.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Terminal ileum with inflammation in the wall, luminal narrowing, proximal bowel dilation, and pseudodiverticula compatible with history of active on chronic Crohn's.


Instruction: Generate impression based on findings.

Input: PSA of 4.12 ng/ml, clinical stage T1c, and recent biopsy showing 4mm of Gleason 6 at right mid, along with 5 mm of Gleason 4+3 and 5 mm of Gleason 4+5 at left apex. PELVIS:PROSTATE:Prostate Size: 3.2 x 4.7 x 4.2 cmPeripheral Zone: There is a diffuse T1 weighted signal hyperintensity throughout the mid gland and base of the prostate likely relating hemorrhage from recent biopsy. In the left apex there is a 1.1 x 0.8 cm lesion (series 1104/124) demonstrating restricted diffusion suspicious for a site of prostatic adenocarcinoma. Central Gland: Benign prostatic hyperplasiaSeminal Vesicles: No evidence of tumor extending into the seminal vesicles.Extracapsular Extension: No evidence of extracapsular extension or tumor extending along the neurovascular bundles.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Left apex 1.1 x 0.8 cm lesion is suspicious for a site of prostatic adenocarcinoma without extracapsular extension or seminal vesicle invasion. No pelvic lymphadenopathy is identified. Extensive post-biopsy hemorrhage of the peripheral zone limits evaluation for additional sites of disease.


Instruction: Generate impression based on findings.

Input: Female, 33 years old, with Chiari malformation and large syrinx, normal neurologic exam. Assess syrinx length. Assess for cord tethering. The foramen magnum is crowded. The right cerebellar tonsil is pointed and descends 9 mm below the level of the foramen magnum. The left cerebellar tonsil also descends below the foramen magnum but to a lesser degree. Adequate CSF flow signal is seen along the ventral aspect of the brainstem through the foramen magnum. Posteriorly, flow is seen up to the level of the cerebellar tonsils but not around or above the tonsils.A spinal cord syrinx is evident beginning at the C2 level and continuing caudally to the T4 level. The syrinx cavity reaches its maximum caliber at C5 and C6 where it measures 9 mm TV and 5 mm AP. The syrinx cavity is largely positioned in the center of the cord, though at the C2 level, there is a linear slitlike component which completely traverses the right hemicord.The remainder of the spinal cord is unremarkable. The conus tip terminates at the mid L2 level which is still within normal limits. The nerve roots of the cauda equina disperse evenly through the thecal sac. No evidence of fatty filum or other intraspinal fatty lesions is seen. On prone imaging, the conus and cauda equina demonstrate clear anterior displacement.Spinal alignment is anatomic. Vertebral body height, morphology and signal characteristics are all within normal limits. The intervertebral discs are preserved and at no level is there any evidence of significant spinal canal or foraminal stenosis.

Output: 1.Findings compatible with Chiari I malformation. The foramen magnum is crowded and there is no detectable CSF flow posteriorly along the cerebellar tonsils.2.A spinal cord syrinx is evident extending from C2 down to the T4 level. The syrinx reaches its maximum caliber at C5 and C6 where it measures 9 x 5 mm.3.No evidence of tethered cord is seen. No other significant spinal abnormalities are detected.


Instruction: Generate impression based on findings.

Input: Reason: 53 yo F paraplegic, h/o L hip osteomyelitis now with recurrent drainage from L hip sinus; rule out tract; rule out active osteo History: see above. Again seen is skin ulceration and sinus tract overlying the left greater trochanter with surrounding soft tissue edema. Previously seen fluid and gas collection overlying the greater trochanter has decreased in size compared to prior, measuring approximately 2.7 x 1.6 cm, previously 4.9 x 2.4 cm. The previously seen discrete overlying gas collection is no longer visualized. No definite evidence of acute osteomyelitis.Previously seen fluid collection overlying the right greater trochanter measures 2.8 x 1.4 cm, previously 2.5 x 1.6 cm.Diffuse muscle atrophy. Edema within the left gluteal musculature has slightly decreased compared to prior. Edema within the left upper thigh musculature has resolved.Foley catheter in place. Gas within the bladder likely related to recent instrumentation. Small bilateral pelvic lymph nodes again noted, likely reactive.

Output: 1.Interval decrease in fluid collection likely representing abscess overlying the left greater trochanter with surrounding inflammatory changes and overlying skin ulceration. No definite evidence of underlying osteomyelitis. 2.Fluid collection overlying the right greater trochanter is not significantly changed. Enhancement cannot be assessed on the current examination without intravenous contrast. This collection was previously described as suggestive of trochanteric bursitis due to lack of rim enhancement.


Instruction: Generate impression based on findings.

Input: Cholangiocarcinoma status post resection in 2012. Hepatitis C cirrhosis. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology with enlarged left lobe and nodular contour. No suspicious lesion identified. Status post cholecystectomy.Dilated common bile duct, up to 11 mm, slightly more prominent than prior. However, the contour is smooth without mural nodularity or obstructive lesion, thus likely postsurgical. No intrahepatic biliary ductal dilation.SPLEEN: Status post splenectomy.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter T2 hyperintense focus in the right kidney, too small to characterize, though likely representing a cyst. No significant abnormality noted in the left kidney.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: A juxtaphrenic lymph node anterior to the liver is slightly enlarged compared to 2009. Given the absence of hypermetabolic activity in this lymph node on the prior PET, this is likely secondary to cirrhosis. Additional small perihepatic lymph nodes noted.

Output: Cirrhotic liver morphology without suspicious lesion identified.


Instruction: Generate impression based on findings.

Input: 56 year old man with metastatic renal cell cancer. Concern for new intracranial metastatic lesion. Examination is suboptimal due to extensive motion artifact. There is however noted a very large necrotic tumor in the right frontal lobe measuring approximately 34 mm by 38 mm in transaxial dimension measured on axial image 17. There is approximately 10.3 mm midline shift at the level of the septum pellucidum. This finding is consistent with a metastatic lesion. In addition a focal area of low attenuation in the left posterior parietal is noted which demonstrates no evidence of enhancement. This finding may represent an old stroke. This examination is otherwise unremarkable for an iny additional metastatic lesions. Note however should be made that due to suboptimal quality of the exam secondary to motion artifacts and repeat exam or an MRI is recommended to exclude the possibility of additional metastatic lesions. No evidence of hemorrhage or hydrocephalus is detected.

Output: Large necrotic right frontal lobe tumor believed to represent metastatic lesion from patient's known renal cell cancer. Please see above comments.


Instruction: Generate impression based on findings.

Input: Male, 69 years old, with right-sided cervical radiculopathy. Evidence of anterior spinal fusion is again seen from C3 through C6. Marrow signal is not well assessed through this region due to metallic artifact. Elsewhere, no concerning marrow replacement or marrow edema is seen.A trace anterolisthesis of C2 relative to C3 is noted and this may be new from the prior examination. Spinal alignment is otherwise unremarkable.The visualized spinal cord demonstrates normal signal and morphology throughout.C2-3: Right facet hypertrophy. Mild disc osteophyte formation, improved from prior. No significant spinal canal stenosis. No significant foraminal narrowing. C3-4: Facet hypertrophy. At least partial fusion across the disc space. Mild osteophytic ridging along the endplates. No significant spinal canal stenosis. Mild bilateral foraminal narrowing, similar on the right and perhaps slightly progressed on the left compared to prior. C4-5: Facet hypertrophy. Posterior disc-osteophyte complex formation asymmetric to the left paracentral zone, slightly more prominent than on the prior exam. Mild effacement of the left ventral thecal sac but no significant generalized spinal canal stenosis. Mild bilateral foraminal narrowing similar to prior. C5-6: Facet hypertrophy. At least partial fusion across the disc space. Mild left paracentral osteophytic spurring from the endplates without significant interval change. Mild narrowing of the left ventral thecal sac also unchanged. No significant generalized canal stenosis. Mild to moderate left foraminal narrowing, unchanged. C6-7: Facet hypertrophy. Minimal disc osteophyte formation. No significant generalized spinal canal stenosis. Mild bilateral foraminal narrowing. No significant interval changes. C7-T1: Facet hypertrophy. Very small central disc protrusion. No significant spinal canal stenosis or foraminal narrowing. No interval changes. Absence of the right vertebral artery flow void is noted, a new finding when compared to the prior examination. The left vertebral artery flow void is visualized throughout.

Output: 1.Redemonstration of postoperative findings compatible with anterior instrumented fusion from C3 through C6.2.Redemonstration of multilevel disc and posterior element degeneration. No areas of significant or marked worsening are suspected. There may be slight progression of mild foraminal narrowing on the left at C3-4, and perhaps a slightly progressed disc osteophyte at C4-5 but without significant spinal canal narrowing.3.Absence of the right vertebral artery flow-void is a new finding when compared to the prior examination. This could represent either slow flow or occlusion. If clinical concern warrants, this can be further evaluated with dedicated vascular imaging.


Instruction: Generate impression based on findings.

Input: Clinical question answered: 10 month old male with fever x 2 days with swelling behind right ear. Access versus tendinitis. Look for retropharyngeal extension. Signs and symptoms: Fever swelling behind right ear. Examination demonstrates extensive area of soft tissue swelling with stranding of subcutaneous fat and effacement of fascial planes on the right side of neck extending from the right occipital region inferiorly into the right parapharyngeal space and retropharyngeal space with extension into the right submandibular region and inferiorly into the right submental region. At the level of right submandibular region there are multiple loculated necrotic cavities which are believed to represent necrotic lymph nodes. There is significant mass-effect and anterior and medial displacement of right carotid artery. There is complete occlusion of right internal jugular at the level of skull base. There is fixation of edema and swelling into the retropharyngeal space allover no evidence of cavity formation is detected. No evidence of any significant airway compromise is detected. The mastoid air cells and middle ear cavity as well as the external auditory canals remain within normal limits. There is normal enhancement of the right lateral (transverse) sinus and sigmoid sinus as well as the right jugular bulb however as mentioned above the internal jugular vein is occluded exactly at the level of the skull base. Soft tissue swelling with subtle enhancement overlapping the right occipital bone demonstrates suspected minimal lytic changes of the bone. This finding is best appreciated on axial images 62 through 65. This finding is not associated with any abnormality of the lateral or the sigmoid sinus on the right and the inner table of the skull remains intact at this level. This finding may be normal anatomical variation of irregularity of the bone and I believe possibly two of an overlapping infectious process (osteomyelitis) is considered less likely. Entirely exclude possibility of osteomyelitis an MRI examination might be helpful.

Output: 1.Extensive soft tissue thickening extending from the right occipital region into the right parapharyngeal space, right retropharyngeal space, right submandibular region and right submental region as detailed.2.Enhancement of abnormal soft tissue thickening contains areas of internal necrosis in the right submandibular region which are believed to represent the chronic lymph nodes.3.Edema of retropharyngeal space with no evidence of abscess formation or any significant airway compromise.4.Mass effect and anterior displacement of right internal carotid artery by the above findings.5.Complete occlusion of right internal jugular at the level of skull base and inferior.6.Normal enhancement of right lateral and sigmoid sinuses and jugular bulb.7.Minimal irregularity of outer table of the skull in the right occipital region may be anatomical variation and unlikely osteomyelitis. Please see above comments.8.No evidence of spread of infection into the intracranial space or spinal canal.9.Normal pneumatization of right external auditory canal, right middle ear cavity and mastoid air cells.


Instruction: Generate impression based on findings.

Input: 25 years, Female, Reason: dedicated liver MRI, interested in the liver mass (Focal Nodular Hyperplasia vs Ewing's sarcoma) History: Recent scans showing liver mass, biopsy in 2012 FNH. Chest mass found on CXR/CTs, plan for surgery 3/5. Eval liver mass prior to surgery. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Large segment IVb lesion shows mild T2 hyperintensity, homogenous arterial enhancement which mildly persists on delayed phases including hepatobiliary phase, and measures 4.0 x 4.5 cm (901/197), previously 2.6 x 2.6 cm. These signal characteristics are compatible with focal nodular hyperplasia.Additional lesions are also increased in size including a segment 3 lesion which measures 2.3 x 1.6 cm (901/222), previously 1.4 x 0.8 cm and a segment 6/7 lesion which measures 2.3 x 1.6 cm, previously 1.6 x 1.5 cm. These lesions show arterial enhancement as well as delayed enhancement on hepatobiliary phase, likely representing focal nodular hyperplasia. Additional smaller lesions have similar signal characteristics.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left hepatic lesion is seen previously is no longer visualized, possibly artifact on the prior exam.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: Multiple hepatic lesions have signal characteristics compatible with focal nodular hyperplasia.


Instruction: Generate impression based on findings.

Input: Breast cancer status post neoadjuvant chemotherapy, assess response. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.Index enhancing 9 o'clock right breast mass with associated susceptibility artifact from biopsy clip is decreased in size and measures 2.8 x 2.1 x 1.3 cm and previously measured 3.4 x 3.3 x 2.1 cm. A second satellite mass anterior and superior to the index lesion is markedly decreased in size and measures 6 mm (previously 1.4 x 1.0 x 1.2 cm). Interval near resolution of non mass-like enhancement extending anterior from the known mass. The total extent of disease now measures 6.3 cm. Small right axillary lymph nodes are poorly visualized. No areas of abnormal enhancement are present within the left breast. No enlarged lymph nodes are present within the left axilla.

Output: Interval response to therapy with measurements provided above.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Reason: cuff tear? History: pain Exam is slightly limited by patient motion artifact.ROTATOR CUFF: Complete full-thickness tear of supraspinatus tendon from its insertion at the greater tuberosity with retraction to the level of the glenohumeral joint. This tear extends posteriorly to involve the anterior fibers of the infraspinatus tendon, although posterior fibers of the infraspinatus tendon can be traced to their insertion at the greater tuberosity. Moderate fatty atrophy of the supraspinatus and infraspinatus muscles. There is also an incomplete but full-thickness tear of the subscapularis tendon with retraction of the superior tendon fibers anterior to the glenoid, although inferior fibers can be traced to the insertion on the humerus. Severe fatty atrophy of the subscapularis. Teres minor muscle and tendon are intact.SUPRASPINATUS OUTLET: There is extensive fluid within the subdeltoid bursa that extends into the acromioclavicular joint. There are foci of intermediate and low signal within the subdeltoid bursal fluid collection, which may represent old blood products. Tapering of the distal clavicle may reflect prior surgery or chronic erosion.GLENOHUMERAL JOINT AND GLENOID LABRUM: Severe osteoarthritis of the glenohumeral joint with diffuse full-thickness cartilage loss, osteophyte formation, and subchondral cysts. Intermediate signal intensity within the glenohumeral joint likely represents synovitis. Extensive tearing of the labrum.BICEPS TENDON: Tendon of the long head of the biceps is not well visualized within the intertubercular sulcus or rotator interval, likely representing rupture. ADDITIONAL

Output: Massive rotator cuff tear, rotator cuff arthropathy, subdeltoid bursa effusion and other findings as above.


Instruction: Generate impression based on findings.

Input: 52-year-old male with history of resected pancreatic cancer and questionable portocaval lymphadenopathy. ABDOMEN:LIVER, BILIARY TRACT: Hepatic steatosis. No suspicious hepatic lesions.SPLEEN: No significant abnormality noted.PANCREAS: Postoperative changes from prior Whipple procedure.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Reference enhancing periaortic lymph node appears stable measuring 1.4 x 1.0 cm, previously 1.3 x 0.9 cm (image 151 series 12). Stable portocaval node measuring 5 mm (image 25 of series 8).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Unchanged, nonspecific small periaortic and portocaval lymph nodes. Continued followup recommended.


Instruction: Generate impression based on findings.

Input: 70-year-old female with complaint of confusion, and aphasia. Patient on Coumadin. Rule out intracranial hemorrhage. There is no evidence of intracranial hemorrhage, mass or edema. Diffuse hypodensity and apparent low distribution consistent with small vessel ischemic disease, age indeterminate. If there is clinical concern for acute ischemia, MRI may be considered. Well-defined area of encephalomalacia involves the left occipitoparietal region consistent with previous ischemic event.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: No acute intracranial abnormalities. Diffuse hypodensity and apparent low distribution consistent with small vessel ischemic disease, age indeterminate. If there is clinical concern for acute ischemia, MRI may be considered.