Instruction: Generate impression based on findings.

Input: Brain MRI:There are multiple scattered punctate to small foci of T2 hyperintensity within the supratentorial white matter, primarily subcortical white matter in location, without associated restricted diffusion, susceptibility abnormality, or enhancement. There are no posterior fossa lesions. The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. The paranasal sinuses and mastoid air cells are clear. Brain MRA:There is antegrade flow within the distal bilateral vertebral arteries, within the basilar artery, distal bilateral internal carotid arteries and carotid siphons and bilateral anterior, middle and posterior cerebral arteries. No arterial stenoses, occlusions or arteriovenous malformations are identified and there is no evidence for cerebral vasculitis. A 2 mm base dimension infundibulum is noted of the right posterior communicating artery.

Output: 1.There are multiple scattered punctate to small foci of T2 hyperintensity within the supratentorial white matter, primarily subcortical white matter in location, without associated restricted diffusion, susceptibility abnormality, or enhancement and there are no posterior fossa lesions. These are nonspecific in appearance, and for a patient aged 59 years the most likely etiology is chronic small vessel disease. However, the differential diagnosis would also include migraine sequelae or vasculitide. Given lesional morphology and locations, demyelination is felt to be unlikely. 2.A 2 mm base dimension infundibulum is noted of the right posterior communicating artery. Otherwise negative MRI of the brain.


Instruction: Generate impression based on findings.

Input: Unspecified infectious and parasitic diseases. Infectious acute disseminated Clinical question: compare to prior ADEM vs. MS evaluate for new lesionsSigns and Symptoms: R facial paresthesias The CSF spaces are appropriate for the patient's stated age with no midline shift. Several punctate subcortical and periventricular white matter lesions present in the right hemisphere - one in the right parietal lobe subcortical white matter and another in the right centrum semiovale - which are hyperintense on T2 and FLAIR images are redemonstrated and have not changed.There is a T2 and FLAIR hyperintense irregularly shaped lesion centered in the right middle cerebellar peduncle which was more evident on the prior exam than on the current exam. It measures approximately 8 x 11 mm axial dimensions on the current exam and slightly larger dimensions on the prior exam. There is no associated diffusion restriction and no associated susceptibility effect appreciated. This low signal on T1-weighted imaging and does not display any contrast enhancement.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.The right cerebellar peduncle lesion is present which is somewhat less conspicuous on the current exam. It is possible that this is sequela of ADEM but it is nonspecific.2.A couple subcortical and periventricular white matter lesions present in the right parietal lobe and right centrum semiovale which are nonspecific and stable.


Instruction: Generate impression based on findings.

Input: Male; 72 years old. Reason: Assess for HCV recurrence History: S/P TACE/RFA for HCC 2/2 HBV ABDOMEN:LIVER, BILIARY TRACT: Nodular liver contour and caudate lobe hypertrophy are again noted and compatible with cirrhosis. Patent hepatic vasculature. Perigastric varices indicative of portal hypertension. Cholelithiasis. No biliary ductal dilatation. There has not been significant interval change in size of the treatment cavities s/p ablation, with both cavities demonstrating high intrinsic T1 signal compatible with residual blood products. Subcapsular segment 6 cavity measures 5.8 x 4.8 cm, unchanged (series 9, image 34), and the segment 5 treatment cavity measures 3.6 x 2.5 cm, unchanged (series 9, image 31). No definite enhancing areas of soft tissue are noted in either cavity to indicate residual/recurrent tumor. No suspicious arterially enhancing lesions seen elsewhere in the liver. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable scattered, small bilateral renal T2 hyperintensities, likely cysts. Stable focal cortical thinning of the left kidney upper pole, mostly due to chronic infarct or prior infection.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small anterior wall hernia (Spigelian versus incisional) in the right lower quadrant containing mesenteric fat and nonobstructive loops of small bowel, partially visualized and unchanged.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Cirrhotic liver morphology without significant interval change in size and appearance of ablation cavities.2.No evidence of residual or recurrent tumor.


Instruction: Generate impression based on findings.

Input: T4N2c floor of mouth and ventral tongue squamous cell carcinoma status post biopsy and cycle 1/5 of TFH. There is interval appearance of a fluid-filled defect in the enhancing right anterior oral tongue mass, with extension across the midline and into the floor of mouth. The mass measures up to approximately 35 mm, which is not significantly changed. There is an enlarged, heterogeneously enhancing left level 1B lymph node that measures 16 x 21 mm in axial cross-section, previously 10 x 17 mm. There is also an enlarged and necrotic right level 2B lymph node that measures 13 x 16 mm, previously 7 x 12 mm. In addition, there has been increase in size of a right level 3 lymphadenopathy, which measures 16 x 25 mm, previously 9 x 13 mm. Furthermore, although not particularly large, the right level 1A lymph node appears to be hyperenhancing and is slightly larger than previously, now measuring 8 x 12 mm. The thyroid and salivary glands appear to be intact. The larynx appears to be unremarkable. The orbits and intracranial structures are grossly unremarkable. There is multilevel degenerative spondylosis of the cervical spine, including a disc-osteophyte complex at C5-6 that mildly impinges upon the spinal cord.

Output: 1. Interval biopsy changes in the oral cavity mass, but otherwise no significant interval change in size of the tumor.2. Interval increase in size of bilateral cervical lymphadenopathy.


Instruction: Generate impression based on findings.

Input: Male 62 years old with low back pain, bilateral leg pain numbness to bottom of left foot, evaluate for new or bigger herniated disc. MRI done in March, pattern of pain has changed and increased. Unable to ambulate without pain greater than 9.Additional history from EMR: Patient is status post lung transplant, with persistent severe lower back pain. Previously described small left paracentral disc extrusion at L2-L3 appears to have resolved. There is new increased T2 signal within the L2-3 disc space with corresponding loss of disc height, now moderate in degree. There is also now ill-defined T1 hypointensity and STIR hyperintensity within the adjacent L2 and L3 vertebral bodies, with areas of cortical discontinuity suggested along the endplates. Centered on the L2-L3 level, there is increased T2 signal within the psoas muscles bilaterally with effacement and inflammatory changes of the intervening paraspinal fat, greater on the left side. The left L2-3 foraminal fat is now nearly completely effaced with heterogeneous T2 and low T1 signal of uncertain etiology, but concerning for infection. There is also moderate right neural foraminal stenosis at L2-3 due to the decreased disc height loss.There is a new prominent rounded area of increased STIR signal within the L1 vertebral body.Additional mild degenerative changes elsewhere appear similar to prior exam

Output: 1. Increased signal abnormality within the L2-3 disc space with interval loss of disc height, and surrounding marrow signal changes as well as inflammatory changes involving the adjacent left greater than right psoas muscles, concerning for discitis/osteomyelitis especially given patient's history of immunocompromise, and less likely interval degenerative changes. Further evaluation could be obtained with CT of the lumbar spine to evaluate for endplate integrity, given patient's history of renal compromise and likely inability to receive gadolinium. Alternatively, DWI o of the spine could be obtained to evaluate for a "claw sign".2. There is near complete effacement of the left L2-3 neural foramina now by abnormal signal, concerning for infectious involvement. Moderate right-sided stenosis due to the disk height loss.3. Additional new rounded STIR hyperintensity within the L1 vertebral body may represent spread of infection or less likely metastatic disease (if there is a history of a primary malignancy).4. Previously described left L2-3 paracentral disc extrusion appears to be resolved. Additional mild degenerative changes appear similar to prior exam.Findings were discussed with Dr. Choi by Dr. Comeron Ghobadi on 6/20/16 at 5:30 pm.


Instruction: Generate impression based on findings.

Input: Male 77 years old Reason: cholestasis, eval for biliary disease History: cholestasis ABDOMEN:LIVER, BILIARY TRACT: Liver contour is smooth. Mild caudate hypertrophy. No focal hepatic lesions. The hepatic and portal veins are patent.Common bile duct is normal in caliber. No intrahepatic bile ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: Mild age related fatty atrophy of the pancreas. The main pancreatic duct passes anterior to the distal common bile duct and appears to drain via the minor papilla suggestive of pancreas divisum.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Focal atelectasis or consolidation at the right lung base.

Output: 1.No focal hepatic lesion.2.No biliary ductal dilatation.


Instruction: Generate impression based on findings.

Input: The cervical spine is in normal alignment, with a normal cervical lordosis. The vertebral body and disk heights are well-maintained. There is heterogeneous marrow signal in the C2-C6 vertebral bodies with foci of high T2 and STIR signal in the C2, C5, and C6 vertebral bodies. The spinal cord is of normal caliber and signal.*C2-C3: No significant disc disease, spinal canal, or neural foraminal narrowing.*C3-C4: Osteophyte disc complex and uncovertebral joint hypertrophy with mild bilateral neural foraminal narrowing.*C4-C5: No significant disc disease, spinal canal, or neural foraminal narrowing.*C5-C6: Osteophyte disc complex, uncovertebral joint hypertrophy, and ligamentum flavum thickening resulting in mild central canal and moderate bilateral neural foraminal stenosis.*C6-C7: No significant disc disease, spinal canal, or neural foraminal narrowing.*C7-T1: No significant disc disease, spinal canal, or neural foraminal narrowing.THORACIC SPINE

Output: 1.Destructive T10 vertebral body lesion with soft tissue extension into the anterior paraspinal fat and epidural space results in mild to moderate central canal stenosis but no cord compression.2.Abnormal marrow signal within the left transverse process of the T4 vertebral body corresponds with hypermetabolic lesions on PET/CT. Additional abnormal marrow signal is present in the C2, C5, C6, T5, and T6 vertebral bodies and are compatible with myelomatous involvement.3.An 8 mm synovial cyst abuts the right L5 nerve root.


Instruction: Generate impression based on findings.

Input: 54-year-old female with cervical cancer status post chemoradiation PELVIS:UTERUS, ADNEXA: A T1/T2 heterogeneous mass surface extending to the upper vagina has decreased in size. On the sagittal images, it measures 3.5 x 2.0 cm (701/38), previously 3.6 x 2.1 cm. However, on short axis oblique images it measures 2.8 x 2.1 cm (901/16) previously 4.5 x 3.0 cm. A brachytherapy applicator is present within the uterus causing some susceptibility artifact. There is ill-defined right-sided parametrial invasion both at the superior (901/24) and inferior (901/10) aspect of the uterus. A soft tissue nodule is also present within the parametrial tissues measuring 1.3 x 0.9 cm which was likely present on the prior exam. Tumor surrounds the right ureter which contains a stent. Bowel abuts tumor near the fundus of the uterus. BLADDER: Foley catheter is present.LYMPH NODES: There are multiple enlarged lymph nodes which are overall unchanged in size. An enlarged left common iliac node measures 1.7 x 1.5 cm (601/53), unchanged. A small left external iliac node measures 1.1 x 1.0 cm (601/47), previously 1 x 0.9cm A right adnexal lesion is unchanged in size measuring 3.3 x 2.9 cm (901/24), likely representing tumor. A pelvic sidewall node on the right measures 2.3 x 2.2 cm (901/14), unchanged.BOWEL, MESENTERY: A rectal tube is present.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Cervical mass with right-sided parametrial lesion is decreased in size.2.Pelvic lymphadenopathy is stable.


Instruction: Generate impression based on findings.

Input: Reason: eval MCL History: pain MENISCI: There is blunting of the free edge of the body and anterior horn as well as blunting of the posterior horn of the medial meniscus indicating degeneration/degenerative tearing. There is superficial fraying/degenerative tearing of the posterior horn of the medial meniscus. There is a longitudinal tear of the body of the lateral meniscus near the free edge of the meniscus (image 9; series 9). There is superficial fraying of the undersurface of the body of the lateral meniscus.ARTICULAR CARTILAGE AND BONE: Note is made of a lobulated lesion within the medial femoral condyle which demonstrates increased signal abnormality on fluid sensitive sequences with sclerotic margins, likely representing an enchondroma. There is full-thickness articular cartilage degeneration along the medial and lateral facet of the patella with large areas completely devoid of articular cartilage. There is subchondral cyst formation in the underlying bone.LIGAMENTS: The cruciate and collateral ligaments appear intact. There is minimal increased signal abnormality along the distal fibers of the superficial band of the MCL which may indicate a mild sprain. There is a trace amount of fluid interposed between the medial femoral condyle and superficial band of the MCL which may reflect a very mild MCL bursitis (image 8; series 9).EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Mild sprain of the MCL.2. Longitudinal tear of the body of the lateral meniscus. Degeneration/degenerative tearing of the medial meniscus.


Instruction: Generate impression based on findings.

Input: Concern for brain abnormality: abnormal eye movement. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears unremarkable, with an expected degree of myelination. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and paranasal sinuses are grossly unremarkable. There is a high T1 and low T2 signal left parietal subgaleal fluid collection that measures up to 14 mm in thickness.

Output: Subacute let parietal subgaleal hematoma, but no evidence of acute intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: Female, 22 years old, with numbness and paralysis. Evaluate for cord compression. Marrow replacing lesions are present in multiple vertebral bodies compatible with metastases. In addition, there is a large tumor within the posterior spinal canal centered at the T8 level which does compress the adjacent spinal cord. Mild epidural tumor extension is suspected at L5 on the right, potentially affecting the exiting L5 nerve root. Scattered paraspinal tumor deposits are also partially visualized.No other large intraspinal lesions are detected without the benefits of IV contrast. Spinal alignment is grossly anatomic. Endplate concavity and slight loss of vertebral body height are seen at T7. Postoperative findings are evident compatible with posterior fossa surgery. A fluid collection in the suboccipital soft tissues may represent a pseudomeningocele.

Output: Multiple osseous lesions are seen compatible with metastases. In addition, there is a large intraspinal tumor centered at the T8 level which does compress the adjacent spinal cord. The patient has already undergone decompressive surgery at the time of this interpretation.


Instruction: Generate impression based on findings.

Input: 55-year-old male with history of cirrhosis and elevated bilirubin. Evaluate for obstruction. ABDOMEN: Lack of contrast enhancement, dielectric artifact, and suboptimal MRCP images limits evaluation.LIVER, BILIARY TRACT: Cirrhotic liver morphology with evidence of an umbilical vein. Incompletely evaluated left hepatic lobe subcentimeter T2 hyperintense focus.Within the aforementioned limitations, no evidence of intra or extrahepatic biliary ductal dilatation. The bladder wall is thickened, most likely secondary to the ascites. Cholelithiasis.SPLEEN: Splenomegaly.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right T2 hyperintense renal focus, measuring up to 2 cm; findings most compatible with a cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Large volume ascites.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Lack of contrast enhancement, dielectric artifact, and suboptimal MRCP images limits evaluation. Within this limitation, no evidence of biliary ductal dilatation. 2.Cirrhosis with large volume ascites. Draining ascites prior to MRI imaging decreases chance of dielectric artifact.


Instruction: Generate impression based on findings.

Input: Re-evaluate left skull base lesion. There is no interval change in the enhancing lesion centered in the left clivus. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is unchanged mild nonspecific cerebral white matter T2 hyperintensity. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, paranasal sinuses, and scalp soft tissues are unchanged.

Output: Unchanged left central skull base lesion, which may represent a form of fibroosseous dysplasia versus an indolent neoplastic process perhaps.


Instruction: Generate impression based on findings.

Input: No abnormal orbital mass or abnormal enhancement is seen. No abnormal signal intensity is evident. The optic nerves are normal in size and signal intensity, and are symmetric bilaterally. No retrobulbar mass, chiasmatic mass, or parasellar abnormality is seen. Extraocular muscles are unremarkable.Although this exam is not dedicated for evaluation of cranial nerves as this was previously performed, there is suggestion of subtle enhancement of cranial nerves III along the cisternal portions and along the cavernous sinus, as well as possibly the cisternal sixth cranial nerves.Moderate lobulated mucosal thickening is again seen within the left maxillary sinus. The left ostiomeatal unit appears opacified. There is also mucosal retention cyst along the floor of the right maxillary sinus. There is scattered trace mucosal thickening in the ethmoid sinuses. There is a small mucous retention cyst along the adenoids.

Output: 1.No definite orbital abnormality.2.Suggestion of enhancement of the visualized portions of cranial nerves III and VI, although this is not a dedicated cranial nerve exam as this was performed previously. This would be compatible with patient's history of possible Miller Fisher syndrome, although please correlate clinically as other etiologies remain within the differential, including demyelinating, infectious, and other inflammatory processes.


Instruction: Generate impression based on findings.

Input: Reason: Assess for signs of methotrexate toxicity History: H/o relapsed ALL, recent MODS with ARF and possible methotrexate toxicity. Last intrathecal methotrexate 7/20/2015. MRI brain:There are new scattered foci of restricted diffusion in subcortical white matter of the right parietal lobe with a punctate focus in the right frontal lobe. There are additional periventricular foci of diffusion restriction in the left occipital and right parietal lobes. Extensive confluent T2 hyperintensity in the periventricular and subcortical white matter is new from the prior exam. The lateral, third and fourth ventricles are enlarged and sulci are prominent which is similar to the CT of 8/7/2015 but increased since the prior MRI, likely reflecting progressive volume loss. A small amount of susceptibility is associated with the right frontal centrum semiovale focus of diffusion restriction as well as a few foci in the right thalamus/posterior limb of the right internal capsule, likely reflecting areas of interval microhemorrhage.There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull and scalp soft tissues are grossly unremarkable. There is mucosal thickening of the sphenoid sinus, with aerated secretions the right. Opacification of the mastoid air cells bilaterally and fluid in the dependent pharynx is likely due to intubation.MRI cervical spine:Vertebral body heights and discs are intact. There is mild flexion which is likely positional, otherwise alignment is anatomic. No abnormal marrow signal. No abnormal signal within the visualized cord. No significant spinal or neuroforaminal stenosis. An NG tube and tracheostomy tube are noted fluid in the nasopharynx.

Output: 1.Multiple punctate scattered foci of diffusion restriction within the supratentorial white matter most conspicuous along the left occipital periventricular white matter, which are suspicious for acute infarcts. The distribution suggests an embolic source, possibly septic emboli provided patient's history. Of note, these lesions do not have a typical appearance for residual diffusion related changes related to methotrexate toxicity, although this possibility is not entirely excluded.2.Diffuse areas of confluent T2 hyperintensity within the subcortical and periventricular white matter are likely related to methotrexate toxicity, given time course of recent intrathecal methotrexate.3.Interval involvement of foci of punctate susceptibility along the right frontal centrum semiovale in the area of diffusion restriction as well as along the right thalamus/posterior limb of the right internal capsule, likely representing microhemorrhage.4.Normal MRI cervical spine.Findings discussed were discussed with Dr. Nubani by the resident on-call at 7:00 PM on 8/19/2015.


Instruction: Generate impression based on findings.

Input: Reason: change in MRI abnormality History: pulsatile tinnitus There is been no interval appreciable change in appearance or extent of abnormal ill-defined T2/FLAIR hyperintensity in the left parietal centrum semiovale extending into the left periatrial and subcortical white matter towards the vertex. There is no corresponding enhancement or susceptibility. There is no associated mass effect.The previously noted punctate focus of hyperintensity in the right orbital gyrus is not as well visualized but appears grossly unchanged. There are no new areas of parenchymal signal abnormality. Again noted is prominence of the paramedian extra-axial space along the posterior fossa which may represent a retrocerebellar cyst or mega-cisterna magna. There is mild associated splaying of the cerebellar hemispheres.Again noted is a 5 mm triangular shaped focus of enhancement along the left cerebellopontine angle cistern adjacent to the petrosal vein which remains unchanged. There remains prominent diffuse paranasal sinus disease, in similar pattern to previous exams.

Output: 1. Continued stable appearance of nonenhancing ill-defined T2/FLAIR hyperintense lesion in the left high parietal lobe with unchanged differential. Continued follow-up is recommended to exclude the possibility of low-grade neoplasm.2. Stable triangle shaped enhancing structure along the left cerebellopontine angle cistern which represent a focally dilated vascular structure, most likely venous.


Instruction: Generate impression based on findings.

Input: Headaches and hypertension. MRI: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.MRA: There is no evidence of significant intracranial steno-occlusive lesions or cerebral aneurysms.

Output: 1. No evidence of intracranial hemorrhage, mass, or acute infarct. 2. No evidence of significant intracranial steno-occlusive lesions.


Instruction: Generate impression based on findings.

Input: 47-year-old female with pain TENDONS: The posterior tibial tendon appears slightly thickened without discrete abnormal signal or fluid-filled tear, just prior to the insertion. This may represent old scarring or, at worst, mild tendinopathy. The remaining tendons are within normal limits.LIGAMENTS: The anterior talofibular ligament, posterior talofibular ligament, and calcaneofibular ligament are intact. The spring ligament and deltoid ligament are intact.ARTICULAR SURFACES AND BONE: Mild osteoarthritis with subchondral cysts affect the first MTP joint.ADDITIONAL

Output: 1.Slight thickening of the posterior tibial tendon without discrete abnormal signal or fluid-filled tear may represent old scarring or, at worst, mild tendinopathy.2.Mild osteoarthritis affects the first MTP joint.


Instruction: Generate impression based on findings.

Input: Disturbance of skin sensation [782.0], Reason for Study: ^Reason: UMN signs, weakness History: as above Normal cervical lumbar lordosis has been lost.The cranial-cervical junction is normal. The cervical spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. The paraspinal soft tissues are unremarkable.There is no evidence of abnormal enhancement, cord compression or mass. Degenerative changes are specified by the intervertebral level as follows: C2-C3: no neuroforaminal narrowing or spinal stenosis. C3-C4: no neuroforaminal narrowing or spinal stenosis. C4-C5: no neuroforaminal narrowing or spinal stenosis. C5-C6: Mild disc bulging with desiccation. No neuroforaminal narrowing or spinal stenosis. C6-C7: Mild diffuse disc bulging with minimal central focal disc protrusion with disc desiccation. No neuroforaminal narrowing or spinal stenosis. C7-T1: no neuroforaminal narrowing or spinal stenosis.

Output: 1. Diffuse bulging of disc with central focal minimal disc protrusion at the level of C67 with disc dessication. 2. No evidence of spinal stenosis or neuroforaminal stenosis. Normal spinal cord.


Instruction: Generate impression based on findings.

Input: Status post third V-C placement and Rickham reservoir. Rule out ICH. A right frontal ventricular shunt has its tip at the midline. Pneumocephalus and subcutaneous emphysema are likely postprocedural. There is no evidence of intracranial hemorrhage. The lateral and third ventricles are enlarged, and the frontal horns appear more rounded than on the prior MRI. After accounting for differences in technique, this is suggestive of slight interval increase in size of the lateral and third ventricles. The fourth ventricle is within normal limits.The visualized paranasal sinuses and mastoid air cells are within normal limits for the patient's age.

Output: Expected postoperative findings from recent shunt placement. No evidence of intracranial hemorrhage. Slight interval increase in size of lateral and third ventricles.


Instruction: Generate impression based on findings.

Input: Ms. Amerik is a 29 year old female with a personal history of BRCA1 mutation and a strong family history of breast cancer, including her mother (diagnosed at the age of 48) and a maternal aunt (diagnosed at age 44). The patient is participating in a clinical trial of screening high-risk individuals. There is heterogeneous amount of fibroglandular tissue in both breasts. There are patchy areas of enhancement seen in both breasts, compatible with moderate background parenchymal enhancement. No one area of enhancement is more suspicious than the rest. Susceptibility artifact from previously biopsied fibroadenoma in the right upper outer breast along with associated minimal surrounding residual enhancement is stable. There is no new abnormal enhancement seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. Follow up should be per the research protocol. BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Routine Screening Mammogram.


Instruction: Generate impression based on findings.

Input: Clinical question: Preop planning for tumor biopsy. Signs and symptoms: Tumor biopsy. Pre- and post enhanced Stealth brain MRI:Examination demonstrates a round well-demarcated rim enhancing necrotic tumor in the left temporal lobe measuring at 23 x 24 mm in transaxial dimensions without interval change since prior study from 5-4-15. Extensive surrounding vasogenic edema and minimal amount of internal hemorrhage is again identified and without change. Constellation of findings results in regional mass effect and without deviation of midline.

Output: Treatment planning MRI demonstrate a stable left temporal lobe necrotic rim-enhancing tumor measuring at 23 x 24 in transaxial dimensions.


Instruction: Generate impression based on findings.

Input: 53-year-old female, BRCA1 positive, status post right mastectomy for breast cancer at age 39. Additional history of melanoma and CML. Postsurgical changes of right mastectomy. On postcontrast images, minimal parenchymal enhancement is noted in the left breast.Enhancing cutaneous lesion seen on the prior exam is no longer present. No abnormal enhancement is seen in either the left breast or right chest wall. Normal sized left outer breast intramammary lymph node is stable. No abnormal lymph nodes are identified in either axillary region.Subcentimeter hepatic cyst is incidentally noted and present on prior studies.

Output: No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: 21-year-old female with remote seizure history, CVA at 3 years of age with residual left-sided weakness. Presenting with bilateral dizziness, syncope. No neck pain. Rule out bleed. The patient is status post right frontal craniotomy with areas of encephalomalacia in the right frontal lobe and right basal ganglia. When accounting for difference in technique, these appear grossly similar to the prior MRI examination from 7/12/2007. There is ex vacuo dilatation of the right lateral ventricle. The ventricles appear mild to moderately dilated. There is no evidence of intracranial hemorrhage.The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Postoperative findings. No acute intracranial abnormality is noted.


Instruction: Generate impression based on findings.

Input: Neck/upper extremity pain, history of cystic lesion Craniocervical junction within normal limits. Vertebral body heights are normal. Alignment is grossly maintained. Bone marrow signal is benign. No suspicious osseous lesions or bone marrow edema is appreciated. No abnormal signal in the cervical cord.Multilevel degenerative changes are seen throughout the cervical spine including disc desiccation and height loss at the C3-C4, C4-C5, C5-C6, and C6-C7 levels. Incidentally noted are small perineural cysts at the left C6-C7 and C7-T1 levels, as before. No abnormal enhancement or suspicious lesions within the cervical spine are appreciated. Individual levels as below:C2-3: No significant spinal canal or neural foraminal stenosis.C3-4: Small disc osteophyte complex and ligamentum flavum thickening. There is mild narrowing of the spinal canal at this level. There is mild left-sided neural foraminal narrowing related to mild uncovertebral hypertrophy and facet arthropathy.C4-5: Small disc-osteophyte complex and ligamentum flavum thickening. There is mild to moderate spinal canal narrowing. There is mild to moderate left greater than right neural foraminal narrowing. C5-6: Disc osteophyte complex and ligamentum flavum thickening contribute to mild to moderate spinal canal stenosis. There is up to moderate bilateral neural foraminal narrowing.C6-7: Small disc osteophyte complex with minimal narrowing of the spinal canal. There is mild to moderate left and mild right neural foraminal narrowing.C7-T1: No significant spinal canal or neural foraminal narrowing.

Output: 1.Multilevel degenerative changes in the cervical spine with mild to moderate spinal canal stenosis at the C4-C5 and C5-C6 levels. No cord signal abnormality. Neural foraminal narrowing at multiple levels as before.2.Small perineural cysts are again seen at the left C5-C6 and C6-C7 levels, likely representing an incidental finding of doubtful clinical significance.


Instruction: Generate impression based on findings.

Input: Clinical question: MS versus stroke. Signs and symptoms: Inability to walk. Nonenhanced brain MRI:Examination is performed without intravenous contrast due to patient's refusal.Examination of the cervical spine was not performed due to patient's claustrophobia.Negative diffusion weighted images.Examination is degraded due to motion artifact however diagnostic.There is normal anatomical morphology and normal signal intensity of brain parenchymal on all MRI sequences.There is a slight prominence of cortical sulci for patient's stated age. The ventricular system remains within normal and maintained midline.There is normal myelination of brain parenchyma. The CSF spaces remain widely patent and unremarkable.The signal void of major intracranial arterial branches are identified. The signal intensity of intracranial venous sinuses are beginning normal.Unremarkable images through the orbits, paranasal sinuses and mastoid air cells and

Output: Unremarkable nonenhanced brain MRI.


Instruction: Generate impression based on findings.

Input: 10-year-old male with first-time seizure found to have a left temporal lobe mass on CT head performed at outside hospital. There is a heterogeneous T2 hyperintense lesion with T2 hypointense rim in the left temporal lobe, measuring approximately 32 x 23 x 13 mm (AP x TR x CC). There is associated intrinsic T1 shortening and extensive susceptibility artifact. There may be mild, partial enhancement, but some of this is likely attributed to the intrinsic high T1 signal. There is no significant surrounding edema or mass effect. There is suggestion of mild volume loss of the surrounding parenchyma. There is some prominent left sided venous structures including the left basal vein of Rosenthal, which may be related to venous congestion. There is no evidence of acute infarct. The brain parenchyma otherwise appears unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable.

Output: 1. Heterogeneous T2 hyperintense lesion measuring up to 32 mm in the left temporal lobe with hemosiderin staining peripherally is most favored to represent a large cavernous malformation. There is minimal prominence of the adjacent veins as described above which may be related to venous congestion. Underlying arteriovenous malformation or hypervascular neoplasm with remote hemorrhage are less likely possibilities. Comparison with outside CT would be helpful if made available.2. No surrounding edema or significant mass effect. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 26 year old female with VSD repair as child. TTE shows RV dysfunction. Patient is referred to exclude residual shunt. Left VentricleThe left ventricle is normal in size with low normal systolic function. The overall LV ejection fraction is 54%, the LV end diastolic volume index is 88 ml/m2 (normal range: 65+/-11), the LVEDV is 172 ml (normal range 109+/-23), the LV end systolic volume index is 40 ml/m2 (normal range 18+/-5), the LVESV is 79 ml (normal range 31+/-10), the LV mass index is 46 g/m2 (normal range 67+/-11), and the LV mass is 90 g (normal range 114+/-24). There are no regional wall motion abnormalities present. Evidence of VSD patch repair noted without evidence of residual shunting.Left AtriumThe left atrium is normal in size. No atrial septal defect is noted. Qp/Qs<1. Right VentricleThe right ventricle is upper normal in size with normal systolic function. The overall RV ejection fraction is 51%, the RV end diastolic volume index is 97 ml/m2 (normal range 69+/-14), the RVEDV is 189 ml (normal range 110+/-24), the RV end systolic volume index is 47 ml/m2 (normal range 22+/-8), and the RVESV is 92 ml (normal range 35+/-13). Right AtriumThe right atrium is mildly dilated. Aortic ValveThe aortic valve is trileaflet and opens widely. There is mild 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 right-sided aortic arch with evidence of an abbarent left subclavian artery which courses posterior to the esophagus. Proximal to where the left subclavian artery crosses the esophagus, there is an air-fluid level in the esophagus but no evidence of esophageal dilation. There was no evidence of tracheal compression.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is mildly dilated (29x31mm).Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsSmall residual thymus tissue is noted. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Normal LV size with low normal systolic function (LVEF 54%).2. Upper normal RV size with normal systolic function (RVEF 51%).3. Evidence of membranous ventricular septal repair without residual shunt.4. Mild right atrial dilation.5. No atrial septal defect. No anomalous pulmonary venous return.6. Mild dilation of the main pulmonary artery.7. There is a right-sided aortic arch with evidence of an abbarent left subclavian artery which courses posterior to the esophagus. Proximal to where the left subclavian artery crosses the esophagus, there is an air-fluid level in the esophagus but no evidence of esophageal dilation. There was no evidence of tracheal compression.


Instruction: Generate impression based on findings.

Input: Female, 51 years old, with lumbar radiculopathy. Alignment is anatomic. Vertebral body height and morphology are within normal limits. No marrow abnormalities are detected. The visualized spinal cord, conus and cauda equina are within normal limits.L1-2: Unremarkable. L2-3: Right greater than left facet hypertrophy. Ligamentum flavum thickening. Minimal bulging disc. Left foraminal disc protrusion which results in significant narrowing of the left neural foramen and possible nerve root impingement. No significant right foraminal stenosis. No spinal canal stenosis. L3-4: Facet hypertrophy with a small facet effusion on the left. Ligamentum flavum thickening. No significant spinal canal or neuroforaminal stenosis. L4-5: Facet hypertrophy. Ligamentum flavum thickening. Minimal bulging disc with a small right foraminal protrusion. No significant spinal canal stenosis. Mild right foraminal narrowing. L5-S1: Mild facet hypertrophy. Otherwise unremarkable. A left renal cyst is noted incidentally.

Output: A left foraminal disc protrusion at L2-3 is evident resulting in significant narrowing of the neural foramen and possible nerve root impingement.Otherwise only mild degenerative findings are seen without significant spinal canal or neuroforaminal stenosis.


Instruction: Generate impression based on findings.

Input: The examination is significantly limited secondary to extensive motion artifact. Of note, the examination was terminated prematurely. The previously identified left parietal lobule and left superior frontal gyrus intraparenchymal hematomas and surrounding vasogenic edema appear grossly similar in size to prior examination. There are scattered areas of subarachnoid hemorrhage. There is a small low T2 and intermediate T1 signal subdural hematoma overlying the left convexity. There is no midline shift. The ventricles are unchanged in size. There is no evidence for acute ischemia. A large right frontal scalp hematoma is again demonstrated.

Output: 1. Severely limited examination demonstrates left parietal lobe and left superior frontal gyrus hematomas with scattered areas of subarachnoid hemorrhage and small left convexity subdural hematoma, as well as a large right frontal scalp hematoma appear to be grossly similar to the prior examination, accounting for differences in technique. 2. No evidence for acute ischemia.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate left brain lesion status post resection. Signs and symptoms: Same. Pre-and post-enhanced brain MRI:Examination is to status post left temporal craniotomy for removal of tumor. A serosanguineous fluid surgical cavity superficially in the left inferior gyrus of temporal lobe measures at approximately 17 times 15-mm in size. It demonstrates a thin rim of expected restricted diffusion along its wall. Very subtle surrounding parenchymal flair/T2 hyperintensity consistent with edema which results in very subtle effacement of adjacent cortical sulci is present.On T1-weighted images the lesion demonstrates a thin band of T1 hyperintensity consistent with blood product. This however precludes precise assessment for presence of enhancement. Within this limitation however there is no detectable enhancement on post introduced series. Further follow-up is needed to entirely exclude possibility of residual tumor.Unremarkable pre-and post enhanced brain MRI otherwise.

Output: 1.Expected postoperative changes of the left inferior temporal gyrus tumor resection without convincing evidence of residual on this initial exam. However presence of blood product at the surgical site can obscure small residual tumor. Further follow-up is needed.2.Unremarkable pre-and post enhanced exam otherwise.


Instruction: Generate impression based on findings.

Input: There is transitional anatomy with lumbarization of S1. For the purposes of this exam, the last fully formed disc is at S1-S2.There are stable postoperative findings lung the lumbar region related to resection of a previous left paraspinal mass including resection of the left paraspinal musculature. There is persistent laxity of the left posterior abdominal wall with partial herniation of the left kidney. There is no mass-like enhancement within the surgical bed or within the spinal canal. The cauda equina remains along the right aspect of the spinal canal, likely secondary to the scoliosis, which has a leftward lumbar curvature and a rightward thoracic curvature. There is hypertrophy of the left lumbar posterior elements which is likely compensatory. The vertebral body heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord is of normal signal and caliber with the conus terminating at the T12 level. There is persistent multilevel left-sided foraminal narrowing along the lumbar spine secondary to the scoliosis.There is a large amount of fecal debris within the visualized colonic loops and rectum.

Output: 1. Continued stable appearance of post-operative findings without evidence of tumor recurrence.2. Chronic rotatory scoliosis and bulging of the left kidney at the surgical site, secondary to paraspinal muscle resection.


Instruction: Generate impression based on findings.

Input: 55 year old woman family history of breast cancer in twin sister age 50. Patient underwent right breast stereotactic biopsy with pathology results showing flat epithelial atypia and atypical ductal hyperplasia. There is scattered fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.Right breast: Postbiopsy changes are seen in the lower outer quadrant near the 8:00 position which include a small peripherally enhancing fluid collection/hematoma measuring up to 3.9 cm in transverse dimension. Several scattered foci of enhancement are seen not significantly changed from prior exams. No new or uniquely enhancing focus elsewhere in the right breast. Left breast: Several scattered foci of enhancement are seen, no significant change from prior exams. No new or uniquely enhancing focus is seen in the left breast. No suspicious lymph nodes in either axilla.Other: Incompletely characterized T2 bright lobulated lesion in the left hepatic lobe is unchanged dating back to 2010 is highly likely benign such as a cyst.

Output: Post procedural changes of the right breast without MRI evidence for malignancy in either breast. Given the pathology result of ADH on the recent biopsy, surgical consultation remains recommended for discussion of management options. BIRADS: 2 - Benign finding.RECOMMENDATION: T - Take Appropriate Action - No Letter.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Female, 26 years old. Rhabdomyolysis 3 months ago, with persistent pain and swelling in thigh despite therapy. The musculature of the left thigh appears normal, without edema, abnormal enhancement, or atrophy. The subcutaneous fat likewise appears normal. Bone marrow signal intensity is within normal limits. We see no masses. The soft tissues of the right thigh are unremarkable as seen on the large field-of-view coronal sequences.

Output: Normal appearing left thigh without evidence of myositis.


Instruction: Generate impression based on findings.

Input: Reason: S/P UFE, Uterine Fibroids, abdominal pain History: abdominal pain/cramping PELVIS:UTERUS, ADNEXA: Multiple T2 hypointense uterine fibroids again noted and have decreased in size and enhancement compared to prior compatible with treatment response. Previous reference largest intramural fibroid along the right lateral uterine wall has decreased in size, measuring 5.1 x 4.3 x 5.1 cm (series 5 image 26, series 10 image 23), previously 6.0 x 4.8 x 5.9 cm. Previous reference largest pedunculated fibroid along the superior aspect of the fundus measures 3.1 x 3.1 x 2.6 cm (series 5 image 16, series 10 image 18), previously 3.4 x 3.3 x 3.1 cm. Nabothian cysts again noted.The ovaries are within normal limits with no solid or cystic masses. Previously seen right tubular T2 hyperintense structure is no longer visualized, possibly representing resolved hydrosalpinx.BLADDER: No significant abnormality noted.LYMPH NODES: Small nonspecific pelvic sidewall lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Interval decrease in size and enhancement of uterine fibroids compatible with some treatment response. Reference measurements as above.2. Previously seen bright tubular structure is no longer visualized, possibly representing resolved hydrosalpinx.


Instruction: Generate impression based on findings.

Input: 54-year-old male with history of laryngeal cancer and low back pain. Examination is motion degraded. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is moderate loss of disc height at L5-S1. Alignment is within normal limits. Bone marrow is heterogenous and nonspecific without destructive suspicious lesions. There is signal abnormality along the inferior endplate of L5 on a degenerative basis. The conus medullaris is normal in position terminating at the level of L1. The paraspinous soft tissues are within normal limits.Multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. No significant spinal canal or neuroforaminal stenosis.L2-L3: No significant disc disease. No significant spinal canal or neuroforaminal stenosis.L3-L4: Mild disc bulge. Moderate facet hypertrophy with inflammatory changes surrounding the right facet joint. No significant spinal canal or neuroforaminal stenosis.L4-L5: Right paracentral disc protrusion with effacement of the right lateral recess contacting the descending right L5 nerve root. Moderate facet hypertrophy. No significant central spinal canal or neuroforaminal stenosis.L5-S1: There is moderate loss of disc height with central and left foraminal disc protrusions resulting in mild right and moderate left neuroforaminal stenosis. Moderate facet hypertrophy. No significant central spinal canal stenosis.

Output: 1. Multilevel degenerative disease as above worst at L4-5 and L5-S1. There is up to moderate left L5-S1 neuroforaminal narrowing which may be impinging on the left L5 nerve root. Additional levels as above.2. Heterogenous bone marrow which is nonspecific. No suspicious focal lesions are seen to suggest metastatic disease. 3. Facet arthropathy at L3-4, L4-5, and L5-S1 with mild inflammatory changes surrounding the right greater than left L3-4 facet joints, which may be on a degenerative basis.


Instruction: Generate impression based on findings.

Input: 15-month-old with global developmental delay, possible seizure. Torsional nystagmus, rule out optic nerve dysplasia. Premature pubarche, rule out pituitary abnormality.. No intracranial mass or mass effect. No focal parenchymal signal abnormality is seen. Sulcation and myelination appear appropriate for age. Midline structures including the corpus callosum appear within normal limits. There is mild hypoplasia involving the cerebellar vermis. Brain parenchyma appears otherwise within normal limits. Ventricles are normal in size and configuration without hydrocephalus. No evidence of acute ischemia. Bone marrow signal is within normal limits.Evaluation of the orbits demonstrates no abnormality involving the bilateral globes, optic nerves, or extraocular muscles. Specifically, no abnormal T2 signal, enhancement, mass, or hypoplasia involving the optic nerves is appreciated. Pituitary gland also appears within normal limits. T1 hyperintensity of the neurohypophysis is preserved. There is normal homogeneous enhancement of the pituitary gland.

Output: There is mild hypoplasia involving the inferior cerebellar vermis, which is a nonspecific finding and of uncertain clinical significance. Otherwise, the brain parenchyma appears within normal limits for age. No abnormality involving the optic nerves or pituitary gland is appreciated.


Instruction: Generate impression based on findings.

Input: Encounter for examination for normal comparison and control in clinical research program [Z00.6], Reason for Study: ^Reason: Metastatic breast cancer needs evaluation prior to starting trial. IRB 15-0500. History: Metastatic breast cancer needs evaluation No evidence of acute ischemic or hemorrhagic lesion.No evidence of abnormal enhancement.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: Normal brain MRI


Instruction: Generate impression based on findings.

Input: Newly diagnosed left tonsil cancer, scanning per protocol 14-0905. There are enlarged and partly necrotic appearing left cervical lymph nodes with irregular and infiltrative margins suggestive of extracapsular extension. For example, a left level 2A lymph node measures 17 x 24 mm in axial section and a level 2B lymph node measures 17 x 25 mm, with invasion of the deep lobe of the parotid gland. There is no significant right cervical lymphadenopathy. There is mild asymmetric prominence and heterogeneity of the left palatine tonsil. The right parotid and bilateral submandibular glands are unremarkable. There are secretions in the right sphenoid sinus. There is also a small right maxillary sinus retention cyst. The orbits and imaged intracranial structures are unremarkable.

Output: 1. Metastatic left suprahyoid lymph node metastases with signs of extracapsular extension.2. Mild asymmetric prominence and heterogeneity of the left palatine tonsil may correspond to the known squamous cell carcinoma.


Instruction: Generate impression based on findings.

Input: Pain right anterior thigh and bilateral L5 distribution Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits aside from straightening and grade 1 L4-L5 anterolisthesis which was present previously. Bone marrow signal is benign. The conus medullaris is normal in position.Multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: Mild disc bulge eccentric to the left and bilateral facet arthropathy. No spinal canal stenosis.L3-L4: Mild disc bulge eccentric to the left with small left sided annular fissure. Mild bilateral facet arthropathy. There is mild left neural foraminal stenosis. No significant spinal canal or right neural foraminal stenosis.L4-L5: There are postsurgical changes of interbody fusion with interbody implant and left lateral screws at the L4 and L5 vertebral bodies. There is advanced bilateral facet arthropathy which along with mild disc bulge contribute to mild right and moderate to severe left neural foraminal stenosis as well as mild to moderate central spinal canal stenosis. There is also effacement of the bilateral lateral recesses. These findings are all mildly progressed since 11/13/2014.L5-S1: Spinal canal is developmentally small at this level with termination of the thecal sac. No high-grade central spinal canal stenosis. No significant disc disease. There is bilateral facet arthropathy with mild effacement of the lateral recesses. Neural foramina are patent. There is edema involving the bilateral psoas muscles as well as a small fluid collection along the left psoas muscle which may be postoperative.

Output: Postsurgical changes of interbody fusion at the L4-L5 level via left lateral retroperitoneal approach. There is mild right and moderate to severe left neural foraminal stenosis at this level related to disc bulge and advanced facet arthropathy. There is also effacement of the lateral recesses at this level and mild to moderate central spinal canal stenosis. These findings have mildly progressed since 11/13/2014.


Instruction: Generate impression based on findings.

Input: Evaluate hemangioma. ABDOMEN:LIVER, BILIARY TRACT: The left hepatic lobe partially exophytic hemangioma measures approximately 12.5 x 8.4 cm (series 301/26), compared to 12.1 x 8.1 cm previously.Multiple additional lesions with similar imaging characteristics are not significantly changed in size or number.The segment 6 mildly T2 hypointense lesion with imaging characteristics suggestive of focal nodular hyperplasia measures approximately 3.4 x 3.2 cm (series 902/1 57), compared to 3.4 x 3.0 cm previously.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: Essentially stable hemangiomatosis with the dominant left hepatic lobe hemangioma measuring approximately 12.5 x 8.4 cm.Stable segment VI lesion with imaging characteristics of a FNH.


Instruction: Generate impression based on findings.

Input: Female; 40 years old. Reason: uterine fibroids, menorrhagia History: menorrhagia PELVIS:UTERUS, ADNEXA: Enlarged uterus with multiple fibroids, the largest of which is a large, enhancing right anterior uterine body myometrial fibroid with mild central necrosis measuring up to 8.2 x 8.5 cm (series 18/50). Two smaller fibroids are seen superiorly at the fundus (series 18/26). Cervical nabothian cysts noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Trace pelvic free fluid, likely physiologic.

Output: Enlarged uterus with multiple fibroids as detailed above.


Instruction: Generate impression based on findings.

Input: Left elbow pain following injury The examination is nondiagnostic secondary to extensive metallic artifact.

Output: Nondiagnostic exam secondary to extensive metallic artifact.


Instruction: Generate impression based on findings.

Input: Extensor mechanism disruption MENISCI: Increased globular signal is noted within the posterior horn of the lateral meniscus reflecting mild intrasubstance degeneration however there is no evidence of lateral or medial meniscal tear.ARTICULAR CARTILAGE AND BONE: There is mild superficial fraying of the articular cartilage of the patella and mild focal degenerative signal heterogeneity of the articular cartilage of the femoral trochlea centrally but there is no focal fluid-filled cartilage defect within the patellofemoral, lateral, or medial compartments.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: There is a full-thickness disruption of the patellar tendon proximally with resulting patella alta. The patellar tendon itself demonstrates increased signal intensity and thickening likely reflecting a combination of retraction, edema, and underlying tendinosis. A small ossicle is noted below the inferior pole of the patella which is suspected to be chronic in nature. Otherwise the marrow signal of the patella is normal. There is slight thickening of the distal most portion of the quadriceps tendon which is likely secondary to retraction. Otherwise the distal quadriceps tendon is intact.ADDITIONAL

Output: Patellar tendon disruption with additional findings further detailed above.


Instruction: Generate impression based on findings.

Input: Vertigo. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are scattered foci of T2 hyperintensity in the cerebral white matter. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is mild scattered paranasal sinus mucosal thickening.

Output: No evidence of acute intracranial hemorrhage, mass, or acute infarct. Mild scattered cerebral white matter signal abnormality may represent chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: 46 year old female with history of Crohn's disease. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postoperative changes of partial colectomy and proctectomy with left lower quadrant end colostomy. There is a 9 cm portion of neoterminal ileum demonstrating moderate wall thickening and mucosal hyperenhancement compatible with acute on chronic disease which is relatively stable compared to prior Additionally, the distal 15 cm of colon demonstrates marked wall thickening and mucosal hyperenhancement, also compatible with acute on chronic disease.A colocutaneous fistula is seen at the level of the ostomy arising from the 12:00 position of the distal colon measuring 9mm in maximal axial width (image 84 of series 15).Enhancing fistulous tracts are seen arising from the superficial enteric rectum at the 3, 4, and 10 o'clock positions forming multiple branches which terminate in bilateral gluteal clefts. A seton appears to be present in one of these fistulae.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postoperative changes of partial colectomy and proctectomy with left lower quadrant end colostomy. There is a 9 cm portion of neoterminal ileum demonstrating moderate wall thickening and mucosal hyperenhancement compatible with acute on chronic disease which is relatively stable compared to prior Additionally, the distal 15 cm of colon demonstrates marked wall thickening and mucosal hyperenhancement, also compatible with acute on chronic disease.A colocutaneous fistula is seen at the level of the ostomy arising from the 12:00 position of the distal colon measuring 9mm in maximal axial width (image 84 of series 15).Enhancing fistulous tracts are seen arising from the superficial enteric rectum at the 3, 4, and 10 o'clock positions forming multiple branches which terminate in bilateral gluteal clefts. A seton appears to be present in one of these fistulae.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Acute on chronic Crohn's disease in the distal 15 cm of colon and distal 9 cm of neoterminal ileum as above, unchanged from prior.2. Colocutaneous fistula at the level of the left lower quadrant ostomy appearing similar to prior.3. Complex perianal fistulas, however are suboptimally evaluated on this study.


Instruction: Generate impression based on findings.

Input: Diagnosis: Malignant neoplasm of liver, primary, unspecified as to typeClinical question: eval for metastatic diseaseSigns and Symptoms: back pain, hcc 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. A T1 signal hyperintense lesion measuring 1 cm located within the L4 vertebral body most likely represents a hemangioma.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is loss of disc space height, disc desiccation and endplate reactive change present at this level is associated with mild narrowing of the neural foramina bilaterally. There is mild facet hypertrophy at this level.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is mild facet hypertrophy present at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.There is a nonenhancing focus of signal abnormality present within the right kidney with a wedgelike configuration. Measuring approximately 22 mm in size .

Output: 1.Some degenerative changes are present in the lumbar spine without compromise to lumbar spinal canal or neural foramina.2.There is a lesion within the right kidney. It is suspected to represent possibly an infarction but is nonspecific. If clinically appropriate additional imaging of the kidneys with help further evaluate this.


Instruction: Generate impression based on findings.

Input: 21-year-old male with instability, knee pain and locking. MENISCI: The medial and lateral menisci are intact.ARTICULAR CARTILAGE AND BONE: There is a full-thickness focal defect of the articular cartilage of the weightbearing surface of the medial femoral condyle (series 501/25) measuring approximately 3 mm in length with underlying bone marrow edema. The remaining articular cartilage appears to be intact.LIGAMENTS: The medial collateral ligament and lateral collateral ligament complex are intactEXTENSOR MECHANISM: Extensor mechanism is intact.ADDITIONAL

Output: Full-thickness articular cartilage defect of the weightbearing surface of the medial femoral condyle and small joint effusion.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for disc herniation. Signs and symptoms: Back and left leg pain. Nonenhanced lumbar MRI:T12-L1 is unremarkable.L1-L2 is unremarkable.L2-L3 is unremarkable with the exception of mild ligamentum flavum hypertrophy.L3-L4 demonstrate mild ligamentum flavum hypertrophy and mild left facet effusion. There is a right lateral and far lateral broad-based disc protrusion with resultant significant compromise of right neural foraminal and mass effect with displaces of the right L3 nerve root beyond the neural foramen. There is also compromise of the right lateral recess of the canal at this level. This finding is best appreciated on axial T2 series 7 image 25, axial T2 series 9 image 13). There is no central spinal stenosis and the left neural foramen remains patent.L4-L5 demonstrate moderate disc disease and loss of disc height, mild bilateral facet and ligamentum flavum hypertrophy without central spinal stenosis. There is a disc osteophyte complex on the left with resultant left lateral recess compromise and without neural foraminal or spinal stenosis.L5-S1 demonstrate a left lateral disc protrusion with resultant left lateral recess compromise and mass effect/posterior displacement of left S1 nerve root. No central spinal stenosis or neural foraminal compromise.

Output: 1.At L3-L4 level there is a right lateral and far lateral broad-based protrusion with compromise of right lateral recess, significant compromise of right neural foraminal without spinal stenosis as detailed.2.At L4-L5 there is a broad-based left-sided disc and osteophyte complex resulting in left lateral recess compromise without spinal stenosis or neural foraminal compromise.3.At L5-S1 there is a left-sided broad-based disc protrusion with mass effect on the left lateral recess and left S1 nerve root.4.Mild degenerative changes at other levels. Please review detailed report per level above.


Instruction: Generate impression based on findings.

Input: Multiple sclerosis. There is no significant change in the extent of T2 hyperintense supratentorial and infratentorial white matter lesions, many of which are also T1 hypointense. However, there appear to be new punctate foci of enhancement in the left posterior cingulate gyrus and right inferior parietal lobule. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Although the extent of the demyelinating lesions has not appreciably changed, there appear to be new punctate foci of enhancement in the left posterior cingulate gyrus and right inferior parietal lobule.


Instruction: Generate impression based on findings.

Input: 47-year-old female with metastatic breast cancer to the brain. Evaluate for presence of new midline shift, lesions, edema. Chronic, large right subdural/epidural fluid collection is again noted with a small amount of more subacute blood layering dependently. Mass effect on the right cerebral hemisphere persists with mild effacement of the right lateral ventricle and approximately 6 mm midline shift to the left. Overall findings appear similar to most recent MRI study from 5/4/2010. Prominence of the left lateral ventricle as well as the periventricular and subcortical low attenuation in the left cerebral hemisphere appear similar to prior MRI as well. Low attenuation in left cerebellar hemisphere also correlates with previous MRI findings (stable).Catheter enters the right frontal skull through a burr hole and terminates in the right ventricle at the level of the foramen of Monroe (unchanged). The calvaria and skull base are otherwise radiographically normal. Note is made of a left maxillary retention cyst; otherwise the visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Chronic, large right extra-axial fluid collection with stable mass effect and midline shift to the left. Accounting for differences in technique, findings are overall unchanged on comparison to most recent MRI from 5/4/2010.


Instruction: Generate impression based on findings.

Input: Pain and swelling of the wrist. Rheumatoid arthritis. Rule out destructive changes. The bones appear demineralized. Diffuse soft tissue swelling about the wrist is noted. There is narrowing of the radiocarpal and midcarpal joints, appearing similar to that seen on the prior study, consistent with rheumatoid arthritis. There is also slight widening of the scapholunate interval and volar rotary subluxation of the scaphoid, which may have slightly progressed. Erosion along the lateral margin of the scaphoid is redemonstrated. Additional erosions seen on prior MR imaging are not clearly evident on these radiographs. Small ossicles along the distal ulna appear similar to that seen on the prior study. Mild osteoarthritis at the basilar joint is unchanged.

Output: Findings consistent with rheumatoid arthritis, appearing similar to that seen on the previous exam, perhaps with mild progression of volar rotary subluxation of the scaphoid.


Instruction: Generate impression based on findings.

Input: 17 year-old male with knee pain and instability, concern for PCL tear MENISCI: The menisci are intact bilaterally.ARTICULAR CARTILAGE AND BONE: No significant abnormality noted. No articular cartilage defect, fracture, or bone contusion.LIGAMENTS: The anterior cruciate ligament appears intact. The posterior cruciate ligament is thickened with increased signal intensity, and increased angulation on proton density images indicating a PCL tear. Discernible fibers are identified along the course of the PCL ligament indicating this is a partial tear. The lateral collateral complex ligament appears intact. There is increased signal intensity within the medial collateral ligament indicating a strain.EXTENSOR MECHANISM: No significant abnormality noted. The extensor mechanism is intact.ADDITIONAL

Output: 1.Partial tear of the PCL.2.MCL sprain.


Instruction: Generate impression based on findings.

Input: 77 years, Female, pneumocephalus, evaluate for CSF leak. There is extensive susceptibility effect related to pneumocephalus scattered throughout the brain, particularly along the right frontal convexity. There is mass effect related to the pneumocephalus on the right frontal lobe with sulcal effacement and mild mass effect on the right lateral ventricle. There is subfalcine herniation and midline shift measuring 6 mm at the level of the foramen of Monro. No hydrocephalus.Extensive foci of susceptibility limit evaluation for ischemia however no evidence of large vascular distribution infarct or large parenchymal hemorrhage is evident. There is a small extra-axial collection along the right cerebral convexity extending along the right tentorium.Diffuse global parenchymal volume loss is noted. Scattered foci of T2/FLAIR hyperintensity in the brain are nonspecific but compatible with mild chronic small vessel ischemic disease.There are subtle foci of air and T2 hyperintensity along the anterior skull base (coronal T2 images 10 and 11) which are potentially sites of CSF leak, however, the motion degradation especially on the relatively higher-resolution sequences limits identification of exact site of leak.

Output: Extensive pneumocephalus with mass effect on the right frontal convexity and mild leftward midline shift.There are subtle foci of asymmetric fluid and air at the level of the right fovea ethmoidalis and cribriform plate which are potential sites of CSF leak (coronal T2 images 10 and 11); however motion degradation limits evaluation for the exact site of leak. Suggest high resolution MRI of the anterior skull base and/or high-resolution CT of this region to identify a bony defect. No encephalocele is evident. Small right-sided subdural collection without associated mass effect.


Instruction: Generate impression based on findings.

Input: Ex-25 5/6 week preemie, subglottic stenosis status post dilatation x 2, concern for vocal cord dysfunction. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. However, there appears to be delayed myelination, with the expected degree of T1 hyperintensity in the anterior limbs of the internal capsules and posterior corpus callosum, for example. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Cervical Spine: The larynx was not imaged in this exam. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable. There are areas of consolidation in the right lung, which may represent atelectasis.

Output: 1. Relative paucity of cerebral myelination related to prematurity, but no evidence of acute intracranial hemorrhage, mass, or acute infarct.2. Unremarkable cervical spine.3. The larynx was not imaged in this exam. Therefore, dedicated neck imaging may be useful for further evaluation.


Instruction: Generate impression based on findings.

Input: 80 year-old male status post fall with head laceration. CT HEAD:There is a left parietal scalp hematoma with foci of subcutaneous air consistent with the patient's history of scalp laceration. No skull fracture underlying this location or elsewhere.There is no acute intracranial hemorrhage or extra-axial fluid collection. Ventricles and sulci are normal. There is no mass effect, midline shift, or basal cistern effacement.Again seen is an area of hypoattenuation in the right insular cortex and temporal lobe which appears grossly unchanged when compared to the MRI performed last month. There is no evidence of new intracranial mass. There is preservation of the gray-white matter interface. There is no evidence of acute territorial ischemia. Previously described small vessel ischemic disease is poorly seen on CT examination. Moderate calcification of the intracranial vessels. Small maxillary sinus retention cysts or polyps are present. The visualized mastoid air cells and remaining paranasal sinuses are clear. The visualized orbits are within normal limits. There is no evidence of retrobulbar hematoma. The lenses are not well visualized bilaterally consistent with the prior MRI findings of cataract surgery. CT CERVICAL SPINE:There is mild rightward curvature at the cervicothoracic junction. However, there is no evidence of acute malalignment or fracture. It should be noted that CT does not evaluate for ligamentous stability. There is moderate to severe degenerative disc disease affecting the cervical spine. There are multilevel disc osteophyte complexes most pronounced at the level of C5/6 and C6/7 with partial ventral thecal sac effacement. Severe facet arthropathy is present, greatest at left C4-C5 which appears nearly fused. There is severe uncovertebral joint hypertrophy at the levels of C5/6 and C6/7, associated with severe neuroforaminal narrowing at right C6/7.Redemonstrated bilateral pleuroparenchymal scarring, on the left with associated calcifications. The remainder of the lung apices are clear. There is diffuse heterogeneity of the thyroid gland without evidence of a dominant nodule. Severe left and mild right carotid bifurcation calcifications.

Output: 1. Left scalp laceration without skull fracture or acute intracranial hemorrhage. 2. Redemonstration of right temporal lobe mass characterized by recent MRI examination.3. No evidence of fracture or acute malalignment of the cervical spine. It should be noted that CT does not evaluate for ligamentous stability. 4. Moderate cervical spine degenerative changes.


Instruction: Generate impression based on findings.

Input: 62 year old female with a history of multi-level cervical stenosis. There is loss of the normal cervical lordosis which is likely a combination of positioning and degenerative change. There is also degenerative grade 1 anterolisthesis of C4 upon C5 and grade 1 retrolisthesis of C5 upon C6. No acute malalignment is present. There is preservation of the vertebral body heights with no evidence of acute fracture. However, degenerative endplate changes are present at C3 through C7 resulting in some sclerosis and, at the inferior endplates of C3 and C4, Schmorl's nodes. Anterior osteophytes are noted at several cervical spine levels, most conspicuous at C5/C6 and C6/C7 with associated elevation of the prevertebral muscles. Multilevel degenerative disk disease is present. By level:C2/C3: Right paracentral disk protrusion with associated partial thecal sac effacement. There is mild right and moderate left sided facet arthropathy but no neural foraminal narrowing.C3/C4: There is moderate loss of intervertebral disk height. Note is made of a Schmorl's node indenting the inferior endplate of C3. There is a posterior disk osteophyte complex and mild ligamentum flavum hypertrophy associated with effacement of the dorsal and ventral thecal sac. Additionally, there is moderate bilateral facet arthropathy, moderate uncovertebral hypertrophy, and mild bilateral neuroforaminal stenosis. C4/C5: Grade 1 anterolisthesis of C4 on C5. There is mild loss of the intervertebral disc height with an associated vacuum disk. Note is made of a moderate posterior disk osteophyte complex and ligamentum flavum hypertrophy with resulting dorsal and ventral thecal sac effacement. On subsequent MRI, there was found to be mild cord flattening and cord signal increase at this level. There is also severe right-sided and moderate left-sided facet arthropathy, mild uncovertebral hypertrophy, and mild right-sided neuroforaminal stenosis. C5/C6: There is severe loss of the intervertebral disk height in the context of grade I retrolisthesis and vacuum disk. There is a posterior disc osteophyte complex associated with dorsal and ventral thecal sac effacement. On subsequent MRI, there was found to be mild cord flattening at this level. There is minimal uncovertebral hypertrophy and mild bilateral facet arthropathy. There is no evidence of neuroforaminal stenosis. C6/C7: There is moderate loss of the intervertebral disc height with associated vacuum phenomenon. There is a posterior disc osteophyte complex with associated partial effacement of the dorsal and ventral thecal sac. There is mild uncovertebral hypertrophy and minimal bilateral neuroforaminal stenosis. C7/T1: Minimal bilateral facet arthropathy. No evidence of uncovertebral hypertrophy or disc herniation.There is no exophytic aerodigestive tract mass, but there is noted to be asymmetric fullness of the right lingual tonsil--this region is found to have signal characteristics indistinguishable from lymphoid tissue on the subsequently performed MRI. There is mild mucosal thickening of the sphenoid sinuses. Paraspinal soft tissues unremarkable. There is no enlargement of the cervical lymph nodes by CT criteria. Moderate left greater than right carotid bifurcation calcification.The visualized intracranial contents are unremarkable apart from vascular calcifications of the left cavernous carotid artery are noted. The apices of the lungs are clear bilaterally.

Output: Severe multilevel degenerative changes of the cervical spine most prominent at the levels of C3/C4, C4/C5, C5/C6, and C6/C7. Subsequent MRI identifies thecal sac effacement at these levels with mild cord flattening at C4/C5 and C5/C6 and cord signal increase at C4/C5.Fullness of right lingual tonsil, at MRI found to have signal characteristics similar to surrounding lymphoid tissue. Suggest clinical correlation.


Instruction: Generate impression based on findings.

Input: Other malaise and fatigue [780.79], Reason for Study: ^Reason: right face and arm weakness/paresthesias History: as above No evidence of acute ischemic or hemorrhagic lesion on the scan.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. Incidental finding of empty sella is found. The paranasal sinuses and mastoid air cells are clear.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal.3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The vertebral artery origins are normal. There is normal flow enhancement through the bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries.

Output: Normal brain MRI.Normal brain MRA and neck MRA.


Instruction: Generate impression based on findings.

Input: Reason: eval trapezius, serratus, rhomboids, other periscapular musculature for wasting History: scapular dyskinesia The left latissimus dorsi is small compared to the right. The serratus anterior, rhomboids, trapezius and paraspinal musculature are symmetric without evidence of atrophy. Please note that this study is not diagnostic for rotator cuff cough pathology, however the rotator cuff muscles are intact without evidence of atrophy. No evidence of edema. No lymphadenopathy. Mild degenerative changes affect the thoracic spine

Output: The left latissimus dorsi is small compared to the right


Instruction: Generate impression based on findings.

Input: Male, 60 years old, with septic emboli versus watershed ischemia, reevaluate lesions. Scattered relatively discrete foci of bright diffusion signal are seen along the posterior aspect of the cerebral watershed zones bilaterally, appearing relatively similar to the prior examination. These lesions show a very mild corresponding ADC hypointensity. These lesions do not enhance.Very ill-defined diffusion hyperintense signal is seen bilaterally and symmetrically within the periventricular and watershed white matter. The signal is corroborated by the ADC map, and furthermore, it appears more conspicuous than on the prior examination. No associated enhancement is seen.A region of right occipital encephalomalacia is again seen with gyriform T1 hyperintensity, patchy susceptibility artifact and patchy associated enhancement. To a much lesser degree, similar signal abnormality, susceptibility artifact and minimal enhancement are seen within the left occipital lobe.Scattered foci of susceptibility are seen within the cerebellum without significant interval change. No evidence of acute intracranial hemorrhage is seen. There are a few scattered foci of subcortical T2 hyperintensity, some of which correspond to the areas of restricted diffusion as noted above. Ill-defined periventricular T2 hyperintensity is also noted. No significant parenchymal edema or mass effect is seen. The ventricular system remains normal in size and morphology.

Output: 1.Scattered discrete foci of diffusion restriction are seen within the posterior cerebral watershed zones bilaterally. There is no associated hemorrhage or enhancement with these lesions, and they appear relatively similar in size and number to the prior examination. These are favored to reflect late acute watershed infarcts.2.A much more ill-defined pattern of mild restricted diffusion is seen within the periventricular and watershed zone white matter of both cerebral hemispheres. This finding has become more conspicuous when compared to the prior examination. This is favored to reflect evolving perfusional or watershed ischemia. A metabolic or toxic process is considered less likely.3.A hemosiderin stained lesion in the right occipital lobe demonstrates imaging features compatible with a late subacute infarct. Scattered foci of susceptibility within the cerebellum are unchanged and likely reflect chronic ischemic lesions.


Instruction: Generate impression based on findings.

Input: Nasopharyngeal cancer, status post treatment. There are post-treatment findings in the posterior nasopharynx, but no evidence of measurable nasopharyngeal mass. The skull base appears to be intact. There is no significant cervical lymphadenopathy. The salivary glands and thyroid appear unchanged. There is a posterior small disc osteophyte complex at C5-6. There is a small amount of fluid in the right mastoid air cells. The orbits are unremarkable. The numerous subcentimeter non-enhancing lesions with associated susceptibility effect in the brain are better depicted on the recent brain MRI. There is a 3 mm diameter posteromedially directed right aneurysm arising from the anterior genu of the internal carotid artery.

Output: 1. Post-treatment findings in the nasopharyngeal region without evidence of measurable locoregional tumor.2. The numerous subcentimeter non-enhancing lesions with associated susceptibility effect in the brain are better depicted on the recent brain MRI. 3. A 3 mm diameter posteromedially directed right aneurysm arising from the anterior genu of the internal carotid artery is better depicted on the recent brain MRA.


Instruction: Generate impression based on findings.

Input: Left-sided abdominal pain radiating to the back, rule out pancreatic or biliary abnormality. ABDOMEN:LIVER, BILIARY TRACT: The liver demonstrates normal parenchymal signal intensity. No suspicious focal hepatic lesions are identified.The gallbladder is surgically absent. The common bile duct is mildly prominent measuring up to 7 mm in diameter. Within the pancreatic head, the distal common bile duct smoothly tapers and is no longer seen approximately 6 mm from the ampulla which is suspicious for a benign stricture. No biliary stones are identified.SPLEEN: No significant abnormality noted.PANCREAS: The pancreas demonstrates normal signal intensity and enhancement without focal lesions. The pancreatic duct is not dilated.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: 1.Suspected benign stricture of the distal common bile duct just proximal to the ampulla. Mild prominence of the common bile duct up to 7 mm which may be related to postcholecystectomy state or aforementioned stricture.2.Pancreatic duct within normal limits.


Instruction: Generate impression based on findings.

Input: History of virilization. Evaluate for adrenal pathology. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: There is minimal left adrenal nodularity without a discrete characterizable lesion.KIDNEYS, URETERS: Small simple appearing renal cysts.RETROPERITONEUM, LYMPH NODES: There is a prominent distal thoracic peri-aortic lymph node measuring 1.3 cm in short-axis with a fatty hilum (series 3/10). Several additional prominent retroperitoneal lymph nodes are noted. On the coronal image only there is a prominent left common iliac lymph node as well (series 14/35).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: ]1. Minimal left adrenal nodularity without a discrete characterizable lesion.2. Non-specific prominent perio-aortic and retroperitoneal lymph nodes.


Instruction: Generate impression based on findings.

Input: The risks (including, but not limited to, those of bleeding, infection, allergic reaction, temporary nerve block, pain, and inability to access the joint) and benefits of the procedure were explained to the patient, and informed written consent was obtained. A pre-procedural “time-out” form was completed.The patient was placed supine on the fluoroscopy table. The right hip was localized fluoroscopically, and a spot radiograph was obtained. The course of the femoral artery was noted on the patient's skin using an ink marker. The skin was cleansed and covered with a sterile drape. The skin and subcutaneous tissues were anesthetized with 1% lidocaine using 25-gauge and 22-gauge needles.Under fluoroscopic guidance, a 20-gauge spinal needle was advanced into the joint. Attempted aspiration yielded no fluid. Next, 10 ml of a 50/50 mixture of Omnipaque 240 (to confirm the intra-articular position of the needle) and dilute Multihance (0.1 cc in a 10 cc vial of saline, for subsequent MR imaging) were injected into the joint. Contrast opacified the joint in the expected manner. A spot radiograph was obtained for documentation. Following this, 1 cc of Kenalog 40 mg/mL was injected. The needle was then withdrawn. Blood loss was negligible (<1cc), and patient tolerated the procedure well without immediate complication. An adhesive bandage was placed on the patient’s skin. Routine post procedure instructions were communicated to the patient. The patient was escorted to the MRI suite for further imaging in stable condition. Please refer to the subsequent MRI report for further information.Exposure time: 2 minutes and 26 seconds.

Output: Successful fluoroscopic guided right hip arthrogram injection with dilute gadolinium and steroid.


Instruction: Generate impression based on findings.

Input: Left knee pain MENISCI: The lateral meniscus is intact. There is branching signal abnormality within the posterior horn and body of the medial meniscus with extension to the tibial articular surface indicating a complex tear. The anterior horn is intact.ARTICULAR CARTILAGE AND BONE: The full-thickness articular cartilage defect along the weightbearing portion of the medial femoral condyle is no longer seen, perhaps secondary to interval microfracture surgery. There is mild thickening and heterogeneity of the articular cartilage in this location with a focus of abnormal subchondral signal intensity that could represent a degenerative cyst or the sequela of prior microfracture. There is also a focal bony protuberance extending into the articular cartilage at this location which is new from the prior exam, perhaps due to prior microfracture. A second bony protuberance is noted along the femoral trochlea centrally, perhaps representing an additional site of microfracture. There is a small near full-thickness to full-thickness cleft just above this bony protuberance. There is mild degeneration of the articular cartilage of the patella, particularly of the medial facet, with a small focus of underlying degenerative subchondral signal abnormality.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Due to technologist error, the right knee was incorrectly imaged. The patient will not be charged for the exam and will be recalled for appropriate imaging of the left knee.2. Medial meniscal tear with findings suggestive of prior microfracture surgery as described above.


Instruction: Generate impression based on findings.

Input: Female, 65 years old, with headaches and confluent white matter disease. Extensive bilateral and symmetric white matter T2 signal abnormality is redemonstrated showing no significant interval change. The basal ganglia, thalami, and central pons are involved as well. No significant mass effect is seen. There is no diffusion restriction. No evidence of intracranial hemorrhage or any abnormal extra-axial fluid is seen. The ventricles are normal in size and morphology.

Output: Stable extensive white matter signal abnormality without evidence of edema or any new findings.


Instruction: Generate impression based on findings.

Input: NSCLC and brain metastases; June 2013 CyberKnife. There are three new supratentorial enhancing lesions with associated vasogenic edema. These include a left paracentral lobular lesion measures up to 4 mm, a right paracentral lobular lesion measures up to 8 mm, and a left occipital lobe lesion measures up to 6 mm. There is interval increase in size of a right lateral cerebellar hemisphere enhancing lesion and vasogenic edema, which measures up to 8 mm, previously 3 mm. There is also interval increase in size and enhancement of the previously treated right medial cerebellar hemisphere lesion, which now measures up to 10 mm. There is no evidence of acute intracranial hemorrhage or acute infarct. There is no midline shift or herniation. The ventricles and basal cisterns are unchanged in size and configuration. The major cerebral flow voids are intact. The skull, orbits, and scalp soft tissues are unremarkable. There is scattered paranasal sinus mucosal thickening.

Output: New and enlarging supratentorial and infratentorial metastases with vasogenic edema, including the previously treated right cerebellar hemisphere metastasis, but no evidence of associated hemorrhage or midline shift.


Instruction: Generate impression based on findings.

Input: Female, 77 years old, with known brain abscess. A prominently cystic lesion is redemonstrated within the left parietal lobe measuring 19 x 13 mm in the axial plane and 20 mm in the coronal plane. By size, the lesion has not significantly changed from prior exams.The lesion is predominantly T2 hyperintense compatible with cystic components. Most of the lesion shows facilitated diffusion, though there is a small amount of nodular restricted diffusion within the lesion, as well as a punctate focus along the lateral margin.Fairly extensive T2 hyperintensity surrounding this lesion, compatible with vasogenic edema, shows little if any significant interval change from the recent prior exams. The regional sulci are effaced, and the left lateral ventricles partly effaced. Background fairly extensive periventricular T2 hyperintensity is also unchanged. The ventricles and sulci are quite prominent, similar to prior exams, likely reflecting parenchymal volume loss. A burr hole defect is seen within the left parietal calvarium overlying the lesion compatible with prior stereotactic biopsy.

Output: 1.No significant change in size of the left parietal lobe abscess.2.No significant change in the degree of surrounding vasogenic edema and associated mass effect.


Instruction: Generate impression based on findings.

Input: Clinical question: Follow-up progression. Signs and symptoms: History of brain tumor. Pre-and post-enhanced brain MRI:Examination demonstrate extensive flair hyperintensity throughout the right hemisphere white matter without associated mass effect which remains identical to prior study. In the high convexity right anterior parietal lobe and right posterior temporal occipital region similar to prior exam there are linear irregular foci of T1 hyperintensity suggestive of mineralization. Susceptibility signal changes in the right posterior temporal -- occipital and right high convexity anterior parietal region also remains stable and consistent with chronic hemorrhagic changes.There is very minimal enhancement at the site of mineralization in the right parietal lobe without appreciable change since prior exam. Findings is suggestive of posttreatment change. There is no convincing evidence of abnormal enhancement at the hemorrhagic surgical site in the right posterior temporal -- occipital region.

Output: 1.No significant interval change since prior exam.2.Revisualization of stable postoperative changes in the right posterior temporal -- occipital region and including chronic hemorrhage and mineralization and without detectable abnormal enhancement.3.Stable focus of flair/T2 hyperintensity and mineralization in high convexity right anterior parietal lobe with very subtle enhancement which is highly suggestive of posttreatment change.4.Stable extensive flair hyperintensity of right hemisphere and to a lesser degree of the periventricular and subcortical white matter of left hemisphere without evidence of mass effect since prior exam and likely representing posttreatment changes.