Instruction: Generate impression based on findings.

Input: 69-year-old male patient with a pelvic mass appreciated on CT. ABDOMEN: Limited evaluation as described above.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: The right kidney is atrophic and contains multiple T2 hyperintense lesions, which likely represent cysts; this is presumably related to chronic kidney disease.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Fluid within the small bowel is non-specific. There is proximal distension of the duodenum up to 4 cm with fluid without obvious obstructing lesion.BONES, SOFT TISSUES: There is a 3.1 x 3.8 x 4.0 cm well-circumscribed, ovoid heterogeneously T2 hyperintense mass noted within the right iliacus musculature. This mass appears to be T1 hyperintense on in phase images and does not demonstrate saturation on T2 fat saturation images; this is suggestive of blood products. A rather well-defined, peripheral T2 hypointense rim may represent hemosiderin. This lesion was not definitively present on wide field coronal T2 images on a MRI of the abdomen from 6/7/2016. Edema type signal is noted within the inferior right iliacus muscle.OTHER: No significant abnormality noted.

Output: 1.Within the limitations of the study, a well-circumscribed ovoid mass in the right iliacus musculature is favored to represent a hematoma, particularly given that it was not present on a recent MRI from 6/7/2016. 2.Atrophic right kidney with presumed renal cysts.


Instruction: Generate impression based on findings.

Input: 65 year old male with history of coronary artery disease and previous MI and mild cardiac amyloidosis by previous cardiac MRI, now s/p stem cell transplant. He is referred for repeat cardiac MRI to evaluate for interval changes in amyloid involvement. Left VentricleThe left ventricle is normal in size with normal systolic dysfunction. The overall LV ejection fraction is 56%, which is improved from the previous study of September 2015. The LV end diastolic volume index is 88 ml/m2 (normal range: 74+/-15), the LVEDV is 168 ml (normal range 142+/-34), the LV end systolic volume index is 39 ml/m2 (normal range 25+/-9), the LVESV is 74 ml (normal range 47+/-19). There is mild hypertrophy of the basal anterior septum (11mm). There is hypokinesis of the basal to mid inferior wall and basal inferolateral wall. There is persistent late gadolinium enhancement at the basal and middle segments of the inferior, inferoseptal, and infero-lateral walls which is subendocardial and consistent with previous myocardial infarction. It involves >50% of the myocardium, suggesting low probability of viability . No other late gadolinium enhancement is seen; however, a low inversion time was selected which may mask the presence of diffuse late gadolinium enhancement related to amyloid. The TI scouts show that the myocardium nulls at a lower than expected T1 time suggesting that the gadolinium "kinetics" are mildly abnormal. The native T1 myocardial relaxation time is elevated at 1218ms in the septum; this is stable compared to the previous study. The extracellular volume fraction is elevated at 39%. Together all of these findings suggest the presence of early cardiac amyloidosis which is stable when compared to the prior study. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 50%, the RV end diastolic volume index is 56 ml/m2 (normal range 82+/-16), the RVEDV is 107 ml (normal range 142+/-31), the RV end systolic volume index is 28 ml/m2 (normal range 31+/-9), and the RVESV is 53 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is trivial pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC and drain normally into the right atrium. There is an SVC catheter.PericardiumThere is a trivial pericardial effusion.Extracardiac FindingsThere are small bilateral effusions, right greater than left. There is mild atherosclerosis in the descending aorta. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with normal systolic dysfunction, the LVEF is 56%, which is improved from the previous study. There is mild left ventricular hypertrophy of the basal anterior septum (11mm). There is hypokinesis of the basal to mid inferior wall and basal inferolateral wall.2. There is a nearly transmural myocardial infarction involving the basal to mid inferior, inferoseptum, and inferolateral walls. These segments have a low probability of viability.3. The native myocardial T1-value, ECV fraction, and decreased inversion time on T1 scout all suggest the presence of early cardiac amyloidosis. When compared to the prior study, these values are essentially unchanged. 4. The right ventricle is normal in size with normal systolic function, the RVEF is 50%. 5. SVC catheter. 6. Bilateral pleural effusions. When compared to the prior study, the LVEF is a little better; otherwise, the study is essentially unchanged.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 45-year-old female with strong family history of breast cancer (mother, a sister, 2 aunts and a maternal cousin) There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in right breast. There is a circumscribed oval mass at posterior 6:00 position in the left breast, measuring 8 x 7 x 6 mm (AP x LR x CC). The mass shows homogeneously dark signal intensity on T2 weighted images, has dark internal septations and very slow enhancement, consistent with fibroadenoma. There are scattered enhancing foci, likely parenchymal enhancement in both breasts.No abnormal lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. Fibroadenoma in the left breast.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Routine Screening Mammogram.


Instruction: Generate impression based on findings.

Input: Hemiplegic CP, R MCA ischemia History: left hemiplegic CP. There is encephalomalacia in the right cerebral hemisphere, mainly involving the right insula and inferior frontal lobe, as well as the anterior part of the right occipital lobe, with associated ex vacuo dilatation of the right lateral ventricle. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Chronic right middle cerebral artery territory infarction.


Instruction: Generate impression based on findings.

Input: 78 year old woman with history of hypertension, asthma, mitral regurgitation and recent finding of mild LV dysfunction on echocardiography who was referred for cardiac MRI to evaluate ejection fraction and for any etiologies for LV dysfunction Left VentricleThe left ventricle is severely dilated with well-preserved systolic function. The overall LV ejection fraction is 55%, the LV end diastolic volume index is 131 ml/m2 (normal range: 65+/-11), the LVEDV is 243 ml (normal range 109+/-23), the LV end systolic volume index is 59 ml/m2 (normal range 18+/-5), the LVESV is 110 ml (normal range 31+/-10), the LV mass index is 65 g/m2 (normal range 67+/-11), and the LV mass is 122 g (normal range 114+/-24). There is subtle hypokinesis of the basal inferolateral wall. There is associated transmural enhancement at this location compatible with nonviable infarct. Additionally there is limited focus of high signal at the basal inferoseptum, at the RV insertion point. This is a nonspecific finding. No evidence of iron overload in the myocardium.No intracardiac thrombus.Left AtriumThe left atrium is moderately dilated.Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 46%, the RV end diastolic volume index is 93 ml/m2 (normal range 69+/-14), the RVEDV is 173 ml (normal range 110+/-24), the RV end systolic volume index is 50 ml/m2 (normal range 22+/-8), and the RVESV is 94 ml (normal range 35+/-13). No abnormal enhancement.Right AtriumThe right atrium is mildly dilated. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely with at least mild regurgitation noted. The leaflet tips are thickened.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is a trivial pericardial effusion.Extracardiac FindingsIntrathoracic stomach. Left axillary lymph node measuring 17 mm short axis. Correlation to physical examination is recommended. The right axilla is not well visualized. No mediastinal or hilar lymphadenopathy is noted.

Output: 1. Severely dilated left ventricle with preserved systolic function (EF 55%). 2. There is transmural enhancement of the basal inferolateral wall with normal wall thickness. This is suggestive of transmural infarct.3. Normal sized right ventricle with mildly reduced systolic function (EF 46%).4. Mitral regurgitation, at least mild. 5. Biatrial dilation.6. Intrathoracic stomach. 7. Enlarged left axillary lymph node; correlation to physical examination is recommended.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: There is no acute cord compression. Metastatic lesions involve portions of the T6, T9 and L1 vertebral bodies as well as the entire L2 vertebral body and extending into the pedicle on the left at L2. The left aspect of the L2 vertebral body is convex posteriorly but but there is CSF surrounding the cord, fat surrounding the nerve root nerve root and no abnormal STIR signal in the cord at this level. No evidence of acute cord compression. Left adnexal cystic lesion and periaortic lymphadenopathy are partially imaged but appears stable compared to the recent CT abdomen and pelvis.

Output: No acute cord compression. Dedicated segment-specific MRI is recommended if symptomology localizes.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Male 6 years old Reason: orbital cellulitis, concern for intracranial involvement. ENT requesting orbital views History: Orbital cellulitis. There is diffusion restriction in the right maxillary sinus and scattered areas of restriction in the right posterior ethmoid air cells likely relating to pus. There is also near complete opacification of the right maxillary sinus, right anterior ethmoid air cells, and right frontal sinus. There is adjacent abnormal T2 hyperintensity and enhancement involving the medial extraconal fat of the right orbit. There is extraconal confluently enhancing tissue measuring approximately 5 x 16 mm (series 1201, image 9), without focal collection to suggest subperiosteal abscess. There is mild peripheral enhancement along the right medial rectus muscle, which is somewhat ill-defined but does not appear enlarged or asymmetrically enhancing. The majority of the inflammatory changes are seen anteriorly and the orbital apex is relatively clear. No evidence of intracranial extension of abnormal signal or enhancement to suggest intracranial extension of the infection.There is also partial opacification and mucosal thickening of the left maxillary sinus. The major cerebral flow voids are intact. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma 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.

Output: 1.Right post septal orbital cellulitis with a small probable phlegmon in the the medial extraconal fat and mild inflammatory changes of the medial rectus muscle. No evidence of intracranial extension of infection.2.Findings compatible with right anterior acute sinusitis.


Instruction: Generate impression based on findings.

Input: Right knee pain 4 views of the right knee are provided. The knee appears normal with no specific findings to account for the patient's pain.A sclerotic focus in the distal diaphysis of the left femur may represent a benign nonossifying fibroma.

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


Instruction: Generate impression based on findings.

Input: 39-year-old female with a history of ankylosing spondylitis and bilateral hips sclerosis presents with pain. RIGHT HIP:ACETABULAR LABRUM: Although this examination was not protocoled for evaluation of the acetabular labrum, there is increased signal abnormality traversing the superior acetabular labrum suggesting a tear (image 12:series 8).ARTICULAR CARTILAGE AND BONE: There is decreased signal abnormality within the superior acetabulum and femoral head/neck consistent with the findings of sclerosis on recent radiographs. There is linear decreased signal abnormality traversing the intertrochanteric region of the left femur which may reflect prior stress reaction. There is no increased signal abnormality on fluid sensitive sequences to suggest an acute process/acute stress reaction. There is subchondral cyst formation in the superior acetabulum likely degenerative in etiology.SOFT TISSUES: The musculature of the right hip is normal in appearance. ADDITIONAL

Output: 1. Sclerosis of the acetabulum and femoral head which appears to be degenerative in etiology. There is linear decreased signal abnormality in the intertrochanteric region of the femora, bilaterally, which may represent prior stress reaction, however, there is no increased signal abnormality to suggest an acute process/stress reaction.2. Bilateral joint effusions with foci of low intensity signal abnormality internally suggestive of a synovitis, left greater than right.3. Findings consistent with the stated history of ankylosing spondylitis.4. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Bilateral arm radicular symptoms, rule out cervical pathology/herniated disc. Left shoulder pain. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. There is mild loss of cervical lordosis. There is mild retrolisthesis of C6 on C7. Bone marrow signal is benign.The cervical spinal cord has normal signal characteristics and overall morphology.Degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: Small disc osteophyte complex and uncovertebral hypertrophy. No significant spinal canal stenosis. Mild right greater than left neural foraminal narrowing.C4-5: Small disc osteophyte complex and uncovertebral hypertrophy, particularly on the right. No significant canal stenosis. There is moderate to severe right neural foraminal stenosis and mild left neural foraminal narrowing.C5-6: Small disc osteophyte complex and mild bilateral uncovertebral hypertrophy. No significant spinal canal stenosis. Mild left greater than right neural foraminal stenosis.C6-7: Small disc osteophyte complex, uncovertebral hypertrophy, and mild retrolisthesis. No significant spinal canal stenosis. There is mild to moderate left and mild right neural foraminal stenosis. C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: Multilevel degenerative changes in the cervical spine with multi-level neural foraminal narrowing as described above, relatively worse at the right C4-C5 and left C6-C7 levels. No significant spinal canal stenosis.


Instruction: Generate impression based on findings.

Input: History of echogenic lesion in cervix and lower uterine segment and ultrasound. History of pelvic pain. PELVIS:UTERUS, ADNEXA: There is an ill-defined 3.5 x 3.4 cm T2 hypointense mass in the uterine fundus with small focus of T2 hyperintensity suggestive of a focal adenomyoma. The junctional zone measures approximately 5 mm. No significant endometrial fluid.Additional small well-defined T2 hypointense enhancing 1.6 cm left uterine body subserosal lesion, likely a fibroid.BLADDER: Contracted urinary bladder without a discrete lesion.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Mild enhancement of the left adductor musculature suggesting nonspecific muscle edema.OTHER: No significant abnormality noted.

Output: 1.3.5 cm uterine fundus adenomyoma. 2.Left uterine body subserosal 1.6 cm fibroid.3.Nonspecific mild left adductor musculature suggesting muscle edema.


Instruction: Generate impression based on findings.

Input: Patient used prophylactic antibiotics before and after the procedure as prescribed. The patient received antibiotic prophylaxis with oral Ciprofloxacin 500mg and Keflex 500 mg. The patient took 1 tablet of Ciprofloxacin 500mg the night before and morning of the procedure. The patient also took 2 tablets of Keflex 500 mg the morning of the procedure. After the procedures, the patient will take 2 tablets of Ciprofloxacin 500mg and 2 tablets of Keflex 500 mg.Following the discussion of the risks, benefits, and alternatives of the procedure, informed consent was obtained.  DynaCad was used to localize the lesion within the right peripheral zone mid gland/apex of the prostate at the site of the T2 hypointense lesion. Using the Dynatrim guidance system an 18-gauge MR- compatible needle was inserted into the right side of the prostate. Upon confirmation of the tip of the needles close to the suspected lesion, MR guided biopsy using an 18 gauge biopsy needle was performed and 3 cores were obtained.The cores were hand delivered to the pathology lab.The patient tolerated the procedure well and was discharged without any immediate complications.ESTIMATED BLOOD LOSS: Less than 5 cc.

Output: Successful core-biopsies of the right lateral mid gland/apex peripheral zone lesion.


Instruction: Generate impression based on findings.

Input: Diagnosis: Benign neoplasm of cerebral meninges. Other symptoms involving nervous and musculoskeletal systems(781.99)Clinical question: evaluate right petrous apex meningioma, and for episodes of transient speech difficulty of unclear etiology MRI of the brainThere is a 11x8 mm axial dimension extra-axial mass at the right cerebellopontine angle cistern just anterior to the porus acusticus which is adjacent to the posteromedial aspect of the right petrous apex and has a dural tail extending over the superior aspect of the right petrous apex. There is an associated dural tail which extends into the right internal auditory canal. The mass abuts but does not distort the adjacent pons. The right trigeminal nerve runs over the medial and superior aspect of the mass. The abducens nerve is expected to run between the mass and the basilar artery. On 8/1/13 it had similar dimensions.No diffusion weighted abnormalities are appreciated.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.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is small to medium size. The right posterior communicating artery is small but intact. The left posterior communicating artery is small to medium size but intact. The LVA is larger than the RVA.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries.

Output: 1.There is a right cerebellopontine angle cistern and petrous apex mass which is suspicious for a meningioma. There is an associated "dural tail" which extends into the right internal auditory canal. It is stable compared to the prior exam from 8/1/13.2.No evidence for acute ischemic cerebral infarction3.No evidence for intracranial cerebrovascular occlusive disease.4.No evidence for extracranial cerebrovascular occlusive disease.


Instruction: Generate impression based on findings.

Input: 41 year old with biopsy proven left breast cancer (2 sites) presents for staging MRI. There is heterogeneous amount of fibroglandular tissue in both breasts.Minimal parenchymal enhancement is noted bilaterally.There is an irregularly shaped enhancing mass, measuring 32 x 24 x 22 mm (AP x LR x CC) with clip artifact at posterior aspect and anterior-lateral aspect, in the left breast at posterior 12 - 1 o'clock position. This is the proven IDC, which was visualized as two masses on ultrasound, but they appear connected each other on MRI. Immediately anterior to the proven cancer, there is another irregularly shaped highly suspicious mass, measuring 27 x 23 x 19 mm. Additionally, there is a suspicious enhancing mass at anterior 12 o'clock position, measuring 11 x 16 x 15 mm. And there are multiple enhancing foci, at retroareolar region, anterior upper inner and upper outer region and middle 6 o'clock position. Those foci are all suspicious for malignancy. Overall extent of these lesions is 83 x 59 x 74 mm.There are at least two left axillary lymph nodes with possible cortical thickening. No abnormal enhancement is seen in right breast. No abnormal lymph nodes are identified in right axillary region.

Output: 1. Biopsy proven left breast cancer. MRI demonstrated multicentric disease in the left breast.2. Two possible abnormal left axillary lymph nodes.3. No MRI evidence of malignancy in the right breast or right axillaBIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: 16-year-old male patient with recurrent abdominal pain and weight loss. Evaluate for Crohn's or other intra-abdominal abnormality. 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: There are small right lower quadrant lymph nodes noted.BOWEL, MESENTERY: The terminal ileum appears normal. There is no evidence of stricture or inflammatory changes.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Unremarkable study without evidence of Crohn's disease or other inflammatory changes.


Instruction: Generate impression based on findings.

Input: 3 day old female with history open myelomeningocele. Evaluate ventricles. There is no evidence of intracranial hemorrhage, mass or edema. Moderately enlarged ventricles for age; recommend MRI for further evaluation.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Moderately enlarged ventricles for age; recommend MRI for further evaluation.


Instruction: Generate impression based on findings.

Input: Female 70 years old Reason: left completion nephrectomy 2011- please evaluate for metastasis History: left completion nephrectomy 2011- please evaluate for metastasis. ABDOMEN:LIVER, BILIARY TRACT: No suspicious hepatic lesion. Cholelithiasis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Postsurgical changes of prior left nephrectomy. No evidence of recurrent or residual disease in the nephrectomy bed. Subcentimeter right renal cysts are unchanged.RETROPERITONEUM, LYMPH NODES: IVC filter in place.BOWEL, MESENTERY: Levoscoliosis with associated degenerative changes and resulting narrowing of the spinal canal is similar to prior.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS: Artifact from a right hip prosthesis degrades image quality in the pelvis, limiting evaluation.UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Scoliosis with associated degenerative changes and resulting narrowing of the spinal canal is similar to prior. Right hip arthroplasty causing metallic artifact and field inhomogeneity. Atrophy of the right psoas muscle again noted.

Output: 1.Stable examination post left nephrectomy without evidence of residual or recurrent tumor.


Instruction: Generate impression based on findings.

Input: Cervical spine:Alignment is normal. The marrow signal is benign. The cervical cord is normal in signal without abnormal enhancement. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.Small benign hemangiomas are noted within the C2 and C3 vertebral bodies.C2/3: UnremarkableC3/4: UnremarkableC4/5: UnremarkableC5/6: Mild posterior osteophyte disc complex without stenosis.C6/7: UnremarkableC7/T1: UnremarkableThoracic spine:There is a smooth, physiologic thoracic kyphotic curve. The vertebral body heights and disc spaces are maintained. Marrow signal intensity is benign throughout. The spinal cord has a smooth contour and is without focal atrophy, edema, or myelomalacia. There are no masses. There is no abnormal enhancement.Benign hemangiomas are noted within the T7, L1, and L2 vertebral bodies.T1/2 demonstrates no significant disc bulge or cord encroachment.T2/3 demonstrates a small right paracentral disc protrusion which causes slight anterior right hemicord flattening without intrinsic cord signal abnormality or stenosis, unchanged.T3/4 demonstrates no significant disc bulge or cord encroachment. T4/5 demonstrates no significant disc bulge or cord encroachment. T5/6 demonstrates no significant disc bulge or cord encroachment.T6/7 demonstrates no significant disc bulge or cord encroachment. T7/8 demonstrates no significant disc bulge or cord encroachment. T8/9 demonstrates no significant disc bulge or cord encroachment. T9/10 demonstrates no significant disc bulge or cord encroachment.T10/11 demonstrates no significant disc bulge or cord encroachment. T11/12 demonstrates no significant disc bulge or cord encroachment. T12/L1 demonstrates no significant disc bulge or cord encroachment.

Output: 1.Mild degenerative changes of the cervical spine without stenosis.2.T2/3 demonstrates a small right paracentral disc protrusion which causes slight anterior right hemicord flattening without intrinsic cord signal abnormality or stenosis, unchanged.


Instruction: Generate impression based on findings.

Input: Schwannomatosis, marrow abnormalities Several foci of signal abnormality are again identified within the bones of the pelvis bilaterally. The reference lesion in the right ilium lateral to the sacroiliac joint seen on the prior study now shows more homogeneous enhancement and signal intensity although is similar in size. Posterior to this referenced lesion is a larger lesion measuring 2.3 x 1.6 cm in the transverse dimension, representing a slight increase in size from the prior exam. This particular lesion demonstrates hypointensity on T1 sequences, hyperintensity on T2 sequences, and minimal enhancement following gadolinium administration. Several remaining smaller lesions within the right ilium appear similar to the prior examination with lesions in the left ilium appearing similar or slightly smaller than the prior study. Obturator ring lesions also appear similar to the prior exam while some lesions within the proximal femora appear slightly smaller.Mild osteoarthritis affects the hips and sacroiliac joints and degenerative disc disease affects the lower lumbar spine. The previously described fluid collection lateral to the right hip is no longer present.A lesion within the left piriformis muscle at the level of S2 is unchanged. A small, minimally enhancing lesion along the anterior aspect of the left iliopsoas muscle is unchanged and may represent a small schwannoma.

Output: Multifocal marrow abnormalities involving the pelvis and proximal femora showing a mixed response with a reference lesion in the right ilium appearing more conspicuous while several lesions throughout the remaining pelvis and proximal femora appear slightly smaller.


Instruction: Generate impression based on findings.

Input: The posterior pituitary hypoenhancing lesion seen on prior exam has decreased in size. When measuring the hypoenhancing area alone, the lesion now measures 11 x 8 mm on coronal image 8 of series 7 (compared to 14 x 10 mm previously), and 5 mm AP on sagittal series 8 image 5 (compared to 8 mm previously). There is mild encroachment upon the suprasellar space without significant mass effect on the optic chiasm. There is no significant deviation of the pituitary stalk. The cavernous sinuses enhance symmetrically without evidence of mass. There is no invasion into the sphenoid sinus. There are no other foci of suspicious enhancement in the imaged brain.

Output: Mild interval decrease in size of hypoenhancing pituitary mass.


Instruction: Generate impression based on findings.

Input: 21 year old man with possible pericardial cyst seen on CT, referred for cardiac MRI for further evaluation. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 61%, the LV end diastolic volume index is 86 ml/m2 (normal range: 74+/-15), the LVEDV is 160 ml (normal range 142+/-34), the LV end systolic volume index is 34 ml/m2 (normal range 25+/-9), the LVESV is 63 ml (normal range 47+/-19). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 51%, the RV end diastolic volume index is 92 ml/m2 (normal range 82+/-16), the RVEDV is 171 ml (normal range 142+/-31), the RV end systolic volume index is 45 ml/m2 (normal range 31+/-9), and the RVESV is 84 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is a well delineated, thin walled, homogenous fluid collection attached to the pericardium along the RA free wall in the right cardiophrenic angle. It measures 45mm x 21mm. It is low intensity on T1 imaging, high intensity on T2 imaging and has no late gadolinium enhancement. Based on location and these characteristics, it is consistent with a benign pericardial cyst. There is no pericardial effusion.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 61%.2. The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 51%.3. There is a well delineated, thin walled, homogenous fluid collection attached to the pericardium along the RA free wall in the right cardiophrenic angle. It measures 45mm x 21mm. It is low intensity on T1 imaging, high intensity on T2 imaging and has no late gadolinium enhancement. Based on location and these characteristics, it is consistent with a benign pericardial cyst.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Diplopia s/p major burn. Brain: There are several T2 hyperintense lesions within the cerebral white matter with associated enhancement in some cases, but no appreciable mass effect. The largest lesion is located in the left gyrus and medial orbitofrontal gyrus, measures up to 20 mm, and displays incomplete ring enhancement. There is also a punctate focus of T2 hyperintensity in the right pontomedullary junction anteriorly. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull and paranasal sinuses are grossly unremarkable. There appears to be slight skin thickening corresponding to areas of burn injury.Orbits: There are no intraorbital mass lesions or abnormal enhancement. The globes, optic nerves, and ocular adnexa appear to be intact.

Output: 1. Multiple white matter lesions, some of which are associated with enhancement. The largest lesion is located in the inferior left frontal lobe and measures up to 20 mm. In addition, a punctate lesion involves the right anterior pontomedullary junction, which may compromise the right abducens nerve. These may represent a demyelinating or other inflammatory process and less likely neoplasm or atypical infection.2. The orbits are unremarkable.


Instruction: Generate impression based on findings.

Input: Shoulder pain and sciatica. Cervical spine:There are degenerative changes in the cervical spine, with level-specific findings as follows:C2-C3: There is mild disk-osteophyte complex, degenerative changes of uncovertebral joints and facet joints. Spinal canal and neuroforamina remain patent.C3-C4: There is mild disk-osteophyte complex, degenerative changes of uncovertebral joints and facet joints. Spinal canal remains patent. There is minimal left neuroforaminal narrowing.C4-C5: There is mild disk-osteophyte complex, degenerative changes of uncovertebral joints and facet joints. There is mild narrowing at the left lateral recess and left neuroforamen. C5-C6: There is mild disk-osteophyte complex, degenerative changes of uncovertebral joints and facet joints. There is mild narrowing at the spinal canal. Moderate bilateral neuroforaminal narrowing is also seen.C6-C7: There is moderate disk-osteophyte complex, degenerative changes of uncovertebral joints and facet joints. There is mild to moderate narrowing at the spinal canal. Moderate bilateral neuroforaminal narrowing is also seen.C7-T1: Spinal canal and neuroforamina are patent.Lumbar spine:For the purpose of labeling, 5 lumbar vertebral bodies are assumed to be present, with the most superior intervertebral level on the sagittal images assumed to be T12 - L1.Degenerative disease is seen in the lumbar spine. The degenerative changes at individual levels are as follows:T12-L1: There is central disk protrusion, with calcification. There is indentation of thecal sac. Neural foramina at this levels are patentL1-L2: Vacuum disk phenomenon is seen. There is disk bulging. Spinal canal and neural foramina remain patent.L2-L3: Vacuum disk phenomenon is seen. There is disk bulging, facet arthropathy changes and ligamentum flavum hypertrophy. Spinal canal and neural foramina remain patent.L3-L4: There is mild grade 1 anterolisthesis of L3 over L4, with disk bulging, facet arthropathy changes and ligamentum flavum hypertrophy, resulting in spinal canal stenosis and neural foraminal narrowing. L4-L5: There is disk bulging with calcification, facet arthropathy changes and ligamentum flavum hypertrophy, resulting in spinal canal. There is stenosis of the lateral recess with probably mild L5 nerve impingement bilaterally. There is neural foraminal stenosis greater on the left, with likely impingement of exiting left L4 nerve. L5-S1: There is disk bulging, posterior osteophytes, facet arthropathy changes and ligamentum flavum hypertrophy, resulting in spinal canal stenosis. There is latera recess and neural foraminal stenosis, with likely impingement of the S1 nerves at the lateral recesses.In the right iliac wing, there is a 14 mm lesion with fine internal matrix. Its imaging characteristics are of indeterminate significance. At a similar location, there is a subtle lesion seen on T1 weighted images on prior MRI of 12/07/07, suggesting this is likely a chronic lesion.There are fine calcifications in the left kidney with punctate calcification in the lower pole suggesting calculus.

Output: 1. Degenerative disease of the cervical and lumbar spine resulting in multilevel spinal canal and neuroforaminal stenosis as described above. There is likely multi-level nerve impingement. Further correlation with MRI will be helpful.2. Left renal calculus.3. Nonspecific lesion at right iliac wing, of indeterminate significance. Continued follow-up is recommended to confirm its stability.


Instruction: Generate impression based on findings.

Input: Cerebrovascular disease, unspecified [I67.9], Reason for Study: ^Reason: stroke History: left leg weakness Brain MRIThere is a restricted diffusion on the right internal capsule posterior limb indicate acute ischemic infarct. In addition, the ischemic infarction is associated with focal internal susceptibility lesions which may indicate focal hemorrhagic conversion. However, since there are multiple bihemispheric brain parenchymal susceptibility lesions which indicate possible mineralizations or hemosiderin depositions, simple association of susceptibility lesions within acute ischemic infarct area cannot be completely excluded.Underlying brain shows patch bilateral periventricular T-2/flair high signal intensity lesions indicating nonspecific small vessel ischemic disease.There are lacunar infarcts involving right mesial posterior inferior thalami and the right frontal white matter. In addition, there is a chronic ischemic infarct related encephalomalacia on the left temporoparietal lobe.The ventricles, sulci and cisterns are unremarkable. The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate multifocal variable degree intracranial arterial luminal stenosis involving bilateral MCA distal M1 segment as well as M2 segment. In particular, right MCA genu portion and left MCA M1 segment before the bifurcation shows about 70-80% shows about 90% of luminal stenosis. There is no evidence of intracranial arterial aneurysm. Vertebrobasilar system shows tortuous course but without arterial luminal stenosis.Neck MRA3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate slightly ectatic and tortuous course, however, 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: 1. Focal acute ischemic infarct involving right internal capsule posterior limb with possible internal hemorrhagic conversion.2. Multifocal bihemispheric brain parenchymal susceptibility lesions indicating either parenchymal mineralization or hemosiderin deposition. 3. Intracranial atherosclerosis with multifocal various degree arterial luminal stenosis. In particular, bilateral MCA M1 segments show more than 70% of luminal stenosis.4. Tortuosity of extracranial arterial system indicate atherosclerotic changes. However, there is no evidence of arterial luminal narrowing or occlusion.


Instruction: Generate impression based on findings.

Input: Male 52 years old Reason: Complex liver cysts in 52 male with chronic HCV. Is the liver cirrhotic? History: Follow up complex liver cysts. ABDOMEN:LIVER, BILIARY TRACT: There are four T2 hyperintense lesions within the liver. Two of these measure less than a centimeter and are too small to characterize. The largest lesion is in the left hepatic lobe and measures 1.9 x 1.6 cm (series 8, image 13). The two larger lesions contain thin internal septations without convincing enhancement.Mild prominence of the hepatic fissures suggesting chronic liver disease. Smooth liver contour. No definite evidence of cirrhosis.SPLEEN: No significant abnormality noted. The spleen measures 9.7 cm.PANCREAS: Pancreas divisum noted. No pancreatic duct dilatation.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.

Output: 1. Mildly complex T2 hyperintense lesions within the liver. Given the T2 hyperintense signal and the absence of definite enhancement, favor mildly complex cyst. Attention can be paid to these on surveillance liver imaging. 2. Chronic liver disease without definite evidence of liver cirrhosis.3. Pancreas divisum.


Instruction: Generate impression based on findings.

Input: 18 year-old male with symptomatic NSVT. MRI to rule look for structural abnormality Left VentricleThe left ventricle is moderately dilated LV with mildly reduced systolic function . The overall LV ejection fraction is 50%, the LV end diastolic volume index is 136 ml/m2 (normal range: 74+/-15), the LVEDV is 293 ml (normal range 142+/-34), the LV end systolic volume index is 68 ml/m2 (normal range 25+/-9), the LVESV is 147 ml (normal range 47+/-19), the LV mass index is 62 g/m2 (normal range 85+/-15), and the LV mass is 133 g (normal range 164+/-36). There is global kLV hypokinesis. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 54%, the RV end diastolic volume index is 119 ml/m2 (normal range 82+/-16), the RVEDV is 257 ml (normal range 142+/-31), the RV end systolic volume index is 55 ml/m2 (normal range 31+/-9), and the RVESV is 119 ml (normal range 54+/-17). There is no evidence RV akinesia or dyskinesia.Right AtriumThe right atrium is mild-moderately dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size. The origins of the right and left coronaries are normal. Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is moderately dilated LV with mildly reduced systolic function . The overall LV ejection fraction is 50%2. The right ventricle is normal in size and systolic function. The overall RV ejection fraction is 54%. The indexed RVEDV is >110 mL/m2 however there is no evidence of RV akinesia or dyskinesia and therefore the patient does not meet major or minor criteria for ARVC.3. Normal origin of right and left coronaries.


Instruction: Generate impression based on findings.

Input: Pain prostate pain. Status post RT to prostate with progressive lower pelvic pain. PELVIS:PROSTATE:Prostate Size: 2.1 x 3.2 x 2.6 cm.Peripheral Zone: Diffusely decreased T2 signal intensity, likely related to post-radiation change. No suspicious lesions are identified.Central Gland: No significant abnormality. noted. Seminal Vesicles: No invasion identified.Extracapsular Extension: None.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No specific findings to explain the patient's pelvic pain. Post-radiation changes of the prostate with no suspicious focal lesions identified.


Instruction: Generate impression based on findings.

Input: Known DCIS now status post lumpectomy in the right inner breast. The patient also had a benign right outer breast biopsy. There is heterogeneous amount of fibroglandular tissue in both breasts. Multiple scattered high T2 cysts are present. Moderate parenchymal enhancement is noted bilaterally, somewhat limiting the study.No new or suspicious enhancement is seen in either breast. In the posterior depth of the right inner breast, there is a seroma cavity compatible with recent surgery. No suspicious nodular enhancement is seen around the cavity. In the left medial breast, an oval enhancing mass has high T2 signal and is stable compared to the recent prior MRI, measuring about 6 mm. Note is made that this had a typically benign appearance on an outside ultrasound dated 8/20/15 as well. No abnormal lymph nodes are identified in either axillary region.

Output: Expected post-surgical changes of the right inner breast. No new finding that requires additional work up is seen.BIRADS: 2 - Benign finding.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: 80 years, Female, Reason: further assess intra and extrahepatic biliary obstruction seen on US History: jaundice, weight loss, fatigue, pruritis. Limited exam due to lack of intravenous contrast.ABDOMEN:LUNG BASES: Small left pleural effusion.LIVER, BILIARY TRACT: There is lesion within the hepatic hilum at the Klatskin point, involving the proximal and mid common bile duct, which measures 3.2 x 4.4 cm (301/17). This lesion is diffusely infiltrative with additional lesions within the right hepatic lobe seen on T2/DWI (501/310 and 305), suspicious for metastases.The distal common bile duct is also dilated to 1.2 cm without a distal obstructing lesion evident.SPLEEN: No significant abnormality noted.PANCREAS: Prominent pancreatic duct. Pancreatic parenchymal appears normal.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple scattered renal cysts with a right upper pole hemorrhagic/proteinaceous cyst measuring 1.1 cm (801/17).RETROPERITONEUM, LYMPH NODES: Prominent portocaval lymph node measuring 1.2 x 0.9 cm (501/318). Enlarged left periaortic lymph node measuring 1.8 x 1.0 cm (501/312).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Mild abdominal ascites.

Output: 1.Evaluation is limited due to lack of intravenous contrast, however there is an obstructing mass within the liver causing severe intrahepatic biliary ductal dilatation which may represent either cholangiocarcinoma or metastases.2.Additional lesions within the right hepatic lobe are suspicious for metastases.3.Retroperitoneal lymphadenopathy.


Instruction: Generate impression based on findings.

Input: Chiari malformation decompressed a few years ago, now returning with headaches and neck pain. Brain: There are postoperative findings related to Chiari decompression surgery. There is flow of cerebrospinal fluid across the neo-foramen magnum, both anteriorly and posteriorly. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift. The major cerebral flow voids are intact. The orbits are grossly unremarkable. There is no pseudomeningocele.Cervical Spine: There is minimal diffuse prominence of the central canal of the cervical spinal cord. There is mild straightening of the cervical spine, but no spondylolisthesis. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is a left neural foraminal disc-osteophyte complex that results in mild narrowing of the neural foramen. There is no significant spinal canal stenosis.

Output: 1. Postoperative findings related to Chiari decompression surgery with what appears to be adequate cerebrospinal fluid flow across the neo-foramen magnum. 2. Minimal diffuse prominence of the central canal of the cervical spinal cord. 3. No evidence of hydrocephalus or pseudomeningocele.4. Left neural foraminal disc-osteophyte complex that results in mild narrowing of the neural foramen, but no significant spinal canal stenosis.


Instruction: Generate impression based on findings.

Input: Dizziness and giddiness [R42], Reason for Study: ^Reason: dizziness, eval for etiology. History: dizziness. known CVD with prior MI and heart failure. prior stroke? No evidence of acute ischemic or hemorrhagic lesion on the scan.There are multifocal scattered high signal intensity on FLAIR images indicating nonspecific small vessel ischemic disease.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: No evidence of acute ischemic or hemorrhagic lesion.Nonspecific small vessel ischemic disease.No abnormal enhancement.


Instruction: Generate impression based on findings.

Input: Male, 75 years old, with back pain radiating to the right leg, so severe that it requires narcotics. Alignment is anatomic. There is mild anterior wedging of the T12 vertebral body without edema. The remaining vertebral bodies demonstrate normal height and morphology. No concerning marrow replacement is detected. Mild edema is seen along the superior L3 endplate.The visualized spinal cord, conus and nerve roots of the cauda equina are unremarkable. No epidural abnormalities are suspected.L1-2: Unremarkable. L2-3: Loss of disc T2 signal and mild disc bulging. No significant spinal canal or foraminal stenosis. L3-4: Mild facet arthropathy and ligamentum flavum thickening. No significant spinal canal or foraminal stenosis. L4-5: Facet arthropathy and ligamentum flavum thickening. Loss of disc T2 signal and mild disc bulging. No significant spinal canal stenosis. Mild right and moderate left foraminal narrowing. L5-S1: Facet arthropathy and ligamentum flavum thickening. Bulging disc with a small central disc protrusion. No significant spinal canal stenosis. Moderate to severe bilateral foraminal narrowing.

Output: 1.Moderate to severe bilateral foraminal narrowing is evident at L5-S1 due to a combination of disc and posterior element degeneration.2.Moderate left and mild right foraminal narrowing is seen at L4-5.3.No significant spinal canal stenosis is detected.


Instruction: Generate impression based on findings.

Input: Female 45 years old Reason: 44 yo female with pancreas body mass, probable IPMN. Needs f/u MRI in 6 months History: none ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: A 1.9 x 1.2 cm lesion is again seen in the pancreatic neck/body ( series 12, image 22), remeasured on prior study at 1.9 x 1.2 cm and unchanged. This contains thin enhancing central septations but there are no nodular components. This appears in connection with the pancreatic duct. Additional subcentimeter cystic lesions are again identified and are stable. There is no pancreatic duct dilatation.ADRENAL GLANDS: Again seen is nodularity of the left gland which is unchanged.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.

Output: 1.Stable appearance of a 1.9-cm cystic lesion within the pancreatic neck/body with thin enhancing septations. The appearance is suggestive of an IPMN.2.Additional subcentimeter cystic lesions throughout the pancreas are also stable and suggestive of small IPMNs.


Instruction: Generate impression based on findings.

Input: Complex multisystem autoimmune disorder with headache and back pain. Brain: There are new subcentimeter enhancing lesions in the left middle and superior frontal gyri. However, there is considerable interval regression of the right cerebellar and left posterior parietal lobe lesions. Otherwise, there is no significant interval change in the non-enhancing patchy white matter T2 hyperintensity in the left perirolandic and adjacent periventricular white matter and in the right superior frontal gyrus. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There are postoperative findings related to left frontal biopsy. The orbits are grossly unremarkable. There is persistent diffuse paranasal sinus mucosal thickening and secretions.Spine: Since September 2015, there has been interval increased swelling in the spinal cord at the C6 through T3 levels with associated T2 hyperintensity and marked enhancement. The rest of the spinal cord is unremarkable. The vertebral column alignment is unchanged. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The paravertebral soft tissues are unremarkable.

Output: 1. Interval development of enhancing lesions in the left frontal lobe, but regression of the right cerebellar and left posterior parietal lobe lesions, and unchanged lesions in the right superior frontal gyrus and left perirolandic and adjacent periventricular white matter.2. Since September 2015, the inflammatory lesion in the spinal cord at the C6 through T3 levels has worsened. 3. Diffuse inflammatory changes in the paranasal sinuses may represent acute sinusitis, either infectious or perhaps related to the autoimmune disorder.


Instruction: Generate impression based on findings.

Input: 50-year-old male with right shoulder pain, swelling, redness. ROTATOR CUFF: There is thickening and increased signal abnormality within the supraspinatus tendon consistent with moderate tendinosis. There is a partial thickness undersurface tear of the supraspinatus tendon at the level of its insertion on the greater tuberosity. The supraspinatus muscle is normal in appearance. The infraspinatus muscle and tendon appear intact. The teres minor and subscapularis muscle and tendon appear intact.SUPRASPINATUS OUTLET: Mild degenerative changes affect the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is edema type signal abnormality within the bone marrow of the humeral head within with associated subchondral cyst formation, presumably degenerative in etiology. There is an apparent subcentimeter cystic lesion along the posterior superior glenoid labrum which may represent a para labral cyst (7; series 5). This raises the question of a posterior superior labral tear, although this examination was not protocoled for evaluation of the glenoid labrum.BICEPS TENDON: There is a small amount of fluid along the long head of the biceps tendon which may represent fluid extension from the glenohumeral joint. ADDITIONAL

Output: 1. Extensive subcutaneous edema, skin thickening, and edema type signal abnormality, particularly along the anterior aspect of the deltoid muscle raises a question of cellulitis/myositis. No focal fluid collection is identified to suggest abscess formation.2. Partial thickness undersurface tearing of the supraspinatus tendon.3. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Hip pain, concern for septic arthritis The exam is limited by motion artifact and the patient's body habitus.BONE MARROW: There is a hematopoietic marrow reconversion but no T1 abnormalities suggest the presence of osteomyelitis. There is no evidence of fracture, malalignment, or osseous erosion.SOFT TISSUES: There is mild diffuse increase in signal of the pelvic musculature but most notably involving the obturator externus on the right and the gluteus musculature. There is also increased signal within the visualized portion of the vastus musculature bilaterally. Increased signal is also noted along the trochanteric bursa bilaterally, right greater than left with a more focal area of increased signal within the gluteal musculature of the right.JOINTS: There are no bony erosions and no joint effusion. Moderate osteoarthritic changes of the hips are noted bilaterally.

Output: 1. No evidence of osteomyelitis or septic arthritis.2. Diffusely increased signal of the pelvic musculature which is nonspecific but may relate to myositis or diabetic myopathy.3. More focal area of soft tissue enhancement within the right gluteal soft tissues may represent area of Evolution of diabetic necrosis. No drainable fluid collections.


Instruction: Generate impression based on findings.

Input: Female, 26 years old, status post ventricular mass resection. Postoperative findings are seen compatible with occipital craniotomy for resection of a tumor from the brainstem and fourth ventricle. Most of the enhancing portion of the tumor, that which occupied the fourth ventricle and abutted the inferior vermis, has been resected. A small portion of relatively nonenhancing tumor does remain where it invades the brainstem at the level of the cervicomedullary junction. The operative cavity contains expected fluid and blood product. No new intracranial lesions are seen. Supratentorially, the brain is within normal limits. Apart from deformation of the fourth ventricle, the ventricular system is normal in size and morphology. Inflammation in the temporal scalp is seen bilaterally which may be related to the surgical immobilization device. Patchy opacification the mastoid air cells is noted.

Output: Postoperative findings are seen compatible with partial resection of a tumor from the brainstem and fourth ventricle. A small portion of tumor remains where it invades the cervicomedullary junction.


Instruction: Generate impression based on findings.

Input: 18 year old female with history of Ewing sarcoma now with metastases. Status post craniotomy for tumor resection. Patient has small postoperative subdural collection The patient is status post left frontal craniotomy appeared and there is an extra-axial hemorrhagic fluid collection of present underneath the craniotomy flap with a fluid fluid level associated some air bubbles. It is adjacent to the high convexities and measures approximately 9 mm in thickness . AP hypodense subdural component extends more posteriorly measuring approximately 5 mm in thickness and is also unchanged. There is mild midline shift the shift of the Falx cerebri up to approximately 6 mm to the right of the midlineA 0.7 cm hyperdense focus is present adjacent to the right chest appear frontal gyrus which has an extra-axial location. It was present on the MRI of 11/17/09.There is vasogenic edema present where the patient's known mass was paired this is edema pattern is stable since 11/19/09 MRI. There is some mass effect associated.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.Status post left frontal craniotomy for tumor surgery with the some findings which can be accounted for on the basis of a immediate postoperative effects such as a lobe of intracranial air and subgaleal soft tissue swelling.2.There is a left-sided subdural hemorrhagic fluid collection present with some mild mass effect and midline shift. This has not changed since the prior exam.3.A 7mm extra-axial hyperdense focus is present adjacent to the right superior frontal gyrus. This could represent a small meningioma.


Instruction: Generate impression based on findings.

Input: Ms. Foley is a 51 year old female with a strong family history of breast cancer in maternal great grandmother, maternal aunts, and two maternal cousins. Personal history of benign left breast excisional biopsy in 2006 for focal fibrosis and benign right breast excisional biopsy in 2004 for axillary skin. There is scattered fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: NS - Routine Screening Mammogram.


Instruction: Generate impression based on findings.

Input: Migraine with aura, intractable, without status migrainosus [G43.119], Reason for Study: ^Reason: worsening of headaches, rule out pathology History: worsening of headaches, rule out pathology Brain MRINo evidence of acute ischemic or hemorrhagic lesion. The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear. There is a retention cyst on the left maxillary sinus.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal. Bilateral PCAs are fetal origin.Patent Acom artery. No aneurysm. No arterial luminal stenosis.

Output: 1. Normal Brain MRI2. Normal brain MRA


Instruction: Generate impression based on findings.

Input: Clinical question bone left-sided weakness. Signs and symptoms: left-sided weakness. Status post craniotomy. Nonenhanced CT of brain:Examination demonstrate a large right frontal -- temporal craniotomy. Residual air and blood (epidural space) under the craniotomy flap is noted. This finding measures approximately 10.4 mm in thickness. There is large area of vasogenic edema in the right frontal lobe with multiple foci of small hemorrhage. The area of vasogenic edema was noted on prior MRI examination however no hemorrhage was detected on preoperative study. There is diffuse effacement of cortical sulci in the right hemisphere. There is approximately 2 mm midline shift. No hydrocephalus.

Output: 1.Epidural blood under the craniotomy flap measuring approximately 10.4 mm.2.extensive vasogenic edema of right frontal lobe with multiple small foci of hemorrhage.3.Approximately 2 mm midline shift. No hydrocephalus.


Instruction: Generate impression based on findings.

Input: Reason: eval for lesion History: aphasia MRI of the brainthere is diffusion restriction present knee right half of the corpus callosum with a couple punctate foci of diffusion restriction right centrum semiovale. There is a signal hyperintensity on T2 and flair line involving left basal ganglia including left caudate nucleus as well as left lentiform nuclei and adjacent centrum semiovale.T2 and flair signal hyperintensities are present along the globus pallidus bilaterally. More subtle T2 and flair signal hyperintensity is present along the brainstem especially at the pons, midbrain, left cerebral peduncle and also along the thalami.On susceptibility weighted imaging there is a focus of susceptibility effect present along the occipital horn of the right lateral ventricle. Punctate foci of susceptibility are present along the isthmus of the left cingulate gyrus, the subcortical white matter of the right occipital lobe. the right centrum semiovale, with a multiple foci of punctate susceptibility in the right cerebellar hemisphere , left cerebral hemisphere and in the pons.T1 signal hyperintensity in the left basal ganglia is present.The CSF spaces are appropriate for the patient's stated age with no midline shift. 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.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. The right posterior communicating artery is relatively small but can be identified. The left posterior cerebral artery has fetal origin. The vertebral arteries are similar in size.There is fetal origin of posterior cerebral arteries present bilaterally. The anterior communicating artery is medium size.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries.

Output: 1.Lesions are asymmetrically distributed in the basal ganglia - especially globus pallidi but also caudate nuclei, thalami, left putamen, left centrum semiovale, corpus callosum and brainstem. In the appropriate clinical settings this pattern is suggestive of toxic/metabolic such as carbon monoxide poisoning, extrapontine myelonolysis, Wilson's disease or viral encephalitis. Please correlate with clinical findings.2.Microhemorrhages distributed in a pattern suggestive of hypertension.3.No evidence for intracranial aneurysm.4.No evidence for intracranial or extracranial cervicocerebral vascular occlusive disease.5.Findings were discussed with the referring physician.


Instruction: Generate impression based on findings.

Input: Clinical question: Rule out mass, cauda equina. Signs and symptoms: Left sciatica, urinary incontinence, concern for lumbosacral compression. Nonenhanced lumbar MRI:There is normal anatomical alignment the vertebral column.There is normal signal intensity and height and morphology of vertebral bodies and posterior elements.There is no distal spinal canal compromise or stenosis at any level.There is advanced degenerative changes at L4 -- L5 and L5 -- S1 levels. Significant left and moderate right neural foraminal compromise at L5 -- S1 level is detected. Moderate right and mild left neural foraminal compromise at L4 -- right is present.Incidental note is made of multiple superficially located well demarcated cysts of the kidneys.Nonenhanced total spine MRI:Examination is performed utilizing cord compression protocol and without axial series.The signal intensity in the alignment of vertebral column is unremarkable.The signal intensity and caliber of the cervical and thoracic cord is within normal.There is no evidence of a spinal stenosis or compromise at any level. Note however should be made that this examination contains no axial series.Degenerative changes of the cervical spine in particular at C5 -- 6 results in mild central spinal stenosis.

Output: 1.Nonenhanced total spine MRI utilizing cord compression protocol demonstrate mild central spinal stenosis at C5-C6 and unremarkable otherwise.2.Nonenhanced lumbar MRI demonstrate normal signal intensity and alignment of the vertebral column without central spinal stenosis. There is degenerative changes at L4 -- L5 and L5 -- S1 levels with resultant moderate to severe neural foraminal compromise at the L4 -- L5 as detailed.


Instruction: Generate impression based on findings.

Input: 20 year-old male with history of osteosarcoma. There are postsurgical changes from left proximal fibular resection with adjacent scarring and mildly increased T2 signal within the surgical bed and soft tissues likely representing edema. There are foci of signal void artifact within the lateral proximal tibia and soft tissues of the surgical bed related to orthopedic hardware and clips. On postcontrast imaging there is no evidence of abnormal enhancing mass to suggest residual tumor or tumor recurrence. There is mild edema-like signal about the medial femoral condyle which is nonspecific. There are periosteal changes at the resection margin of the fibular as well as increased marrow signal which is favored to be postoperative in etiology. There is no lymphadenopathy. The remainder of the visualized tibia, fibula, and femur are unremarkable.

Output: Postsurgical changes without definitive evidence of residual tumor or tumor recurrence.


Instruction: Generate impression based on findings.

Input: Left jugulotympanic paraganglioma tumor status post radiation therapy in spring 2015. There is interval decrease in size of the avidly enhancing mass with prominent flow voids centered in the left jugular foramen, which measures up to 28 mm, previously 36 mm. The tumor persistently protrudes into the left middle ear cavity as well, but no mass effect upon the brainstem or cerebellum. There is no evidence of intracranial hemorrhage or acute infarct. There is mild scattered nonspecific cerebral white matter T2 hyperintensity. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable. There is fluid within the right mastoid air cells. There are scattered paranasal sinus retention cysts.

Output: Interval decrease in size of the left jugulotympanic paraganglioma.


Instruction: Generate impression based on findings.

Input: 57 year old with history of left lumpectomy for invasive ductal carcinoma 5/2013. Patient received radiation and chemotherapy. She has dense breasts. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. Left breast skin thickening is related to post radiation changes. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: The cervical spine is in normal alignment, with straightening of the normal cervical lordosis. The vertebral body heights are well-maintained. There is multilevel disc narrowing, most conspicuous at C4-C5 where it is moderate-severe in degree. There is increased ventral disc bulge at C5-C6. Ventral osteophytes are again noted. No worrisome focal marrow signal abnormality is appreciated. There is redemonstration of abnormal signal social with the right T1 vertebral body extending into the posterior elements with mild pedicular expansion, consistent with a known intraosseous hemangioma. The spinal cord is of normal caliber and signal.At C2-C3, there is no significant disk pathology or stenosis.At C3-C4, there is slight increased prominence of a central disk extrusion migrating cranially by 3 mm. There is overall moderate-severe central spinal canal stenosis with indentation of the ventral cord.At C4-C5, there is a mild posterior osteophyte disk complex with moderate-severe central spinal stenosis, with slight further effacement of CSF space within the thecal sac. There is bilateral uncovertebral hypertrophy contributing to moderate-severe right greater than left foraminal narrowing.At C5-C6, there is a stable posterior osteophyte disk complex with bilateral uncovertebral hypertrophy, with slightly progressed now moderate-severe central spinal stenosis as well as moderate-severe right greater than left foraminal narrowing.At C6-C7, there is a minimal posterior osteophyte disk complex, with moderate left and mild-moderate right foraminal narrowing. There is mild central spinal stenosis.At C7-T1, there is a stable trace disk bulge. There is mild ligamentum flavum thickening. Mild bilateral foraminal stenosis is present.LUMBAR SPINE

Output: 1.Slight progression of cervical spondylotic changes as detailed above with further effacement of CSF space sac, with moderate severe central spinal canal stenosis from C3-C4 through C5-C6 although scattered high-grade foraminal narrowings do not appear significant changed.2.Limited evaluation of the lumbar spine due to artifact from postoperative changes, although no significant interval change is appreciated. No high-grade central spinal canal stenosis at any level.3.Trace fatty filum again questioned which can be an incidental finding although has been associated with tethered cord. Please correlate clinically.


Instruction: Generate impression based on findings.

Input: Reason: Liver lesion interpeted as adenoma seen in MRI 2006, US and CT 2014 shows a different lesion in left lobe - FNH protocol needed History: liver lesion ABDOMEN:LIVER, BILIARY TRACT: Previously seen lesion on MRI from 2006 (series 104:9) is not demonstrated on recent CT and today's MRI. In retrospect, this may have represented aortic pulsation artifact, or the lesion itself has resolved.Subcentimeter hypodensity in the periphery of the right lobe of the liver (12:62) likely has increased T2 signal (6:20), demonstrates no obvious enhancement, and is too small to actually characterize, but favor cyst. This may have also been seen on MRI from 2006.SPLEEN: Redemonstrated small remnant spleen.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: 1.Previously seen hepatic lesion on MRI from 2006 is not visualized on today's scan, further described above.


Instruction: Generate impression based on findings.

Input: Clinical question: r/o disc disease. Signs and Symptoms: pain. Nonenhanced cervical MRI:Foramen magnum is unremarkable.C2-C3 is unremarkable.C3-C4 demonstrate mild asymmetric right-sided uncovertebral hypertrophic changes with resultant moderate to severe right neural foraminal compromise.C4-C5 demonstrate mild degenerative changes without spinal stenosis or neural foraminalC5-C6 demonstrate mild disc disease and loss of disc height, shallow bulging disc, small bilateral uncovertebral hypertrophic spurs and mild facet and ligamentum flavum hypertrophy. Constellation of changes results in mild central spinal stenosis, moderate right and mild-to-moderate left neural foraminal compromise.C6-C7 demonstrate mild degenerative disc disease and mild ligamentum flavum hypertrophy without spinal stenosis or neural foraminal compromiseC7-T1 demonstrate mild degenerative disease without spinal stenosis or neural foraminal compromise.There is a tiny linear T2/T2 STIR hyperintensity is noted along the posterior right lateral aspect of the cord extending from mid C6 level to approximately upper C7 level best appreciated on sagittal T2 series 301 image 8 and axial T2 series 601 images 9 and 10. Finding is nonspecific however is suspected of a small focus of myelopathy.

Output: 1.Degenerative changes cervical spine with resultant mild central spinal stenosis only at C5-C6 level.2.Multi level neural foraminal compromise at detailed per level above.3.Tiny focus of T2 hyperintensity of the cervical cord at 6 level which is nonspecific however could represent small focus of myelopathy.


Instruction: Generate impression based on findings.

Input: History of prostate cancer. Pancreatic cystic lesion and pancreatic ductal dilatation noted on prior CT scans. Evaluate. ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in signal and morphology. The hepatic vasculature is patent. There is a subcentimeter focus of increased T2 signal that does not enhance in the inferior right lobe of the liver compatible with a benign cyst.No intrahepatic or extrahepatic biliary ductal dilatation. The gallbladder is unremarkable. No cholelithiasis.SPLEEN: Spleen is normal in size. There is a 1.4 cm focus of mildly increased T2 signal that has progressive peripheral enhancement on the postcontrast images compatible with a small hemangioma.PANCREAS: There are multiple cystic foci in the body and tail of the pancreas which have high T2 signal, no internal complexity, and no postcontrast enhancement. Appearance is compatible with sidebranch IPMNs . The largest lesion is in the tail and measures 15 x 9 mm (series 3 image 20). The second largest is in the body and measures 12 x 12 mm. There is mild prominence of the distal pancreatic duct within the pancreatic tail measuring up to 4 mm in diameter which is grossly stable compared to 6/30/2015 and may reflect a small stricture or extrinsic compression. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple bilateral peripelvic and parenchymal simple cysts. No hydronephrosis.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.Multiple sidebranch IPMN measuring up to 15 x 9 mm.2.Mild dilation of the distal pancreatic duct within the pancreatic tail measuring up to 4 mm in diameter which is grossly stable compared to 6/30/2015 and may reflect a small stricture or be secondary to extrinsic compression. No associated enhancing mass lesion is evident.


Instruction: Generate impression based on findings.

Input: Reason: evaluate for spondylolysis and/or disc herniation History: lbp with extension for 2 years worse now with some radicular sx in legs 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.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is no significant compromise to spinal canal or neural foramina.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.

Output: 1.No compromise to lumbar spinal canal or neural foramina.2.Although there are no indirect or direct findings to suggest spondylolysis on this exam, please not that plain films and CT are more sensitive in evaluating bony lesions such as pars defect relative to MRI.


Instruction: Generate impression based on findings.

Input: 64-year-old male with cachexia and bright red blood per rectum. Evaluate for malignancy and also for pancreatic pseudocyst; patient has experienced weight loss. ABDOMEN: LUNG BASES: New small bilateral pleural effusions with associated lower lobe volume loss bilaterally. Cachexia.LIVER, BILIARY TRACT: Hepatomegaly, the liver measures more than 20 cm craniocaudally. Diffuse fatty infiltration throughout the liver. The presence of fat limits the ability to see liver masses. If liver masses are of concern, MRI examination would be recommended. Heterogeneous soft tissue density is seen in the lateral segment of left lobe and in the right lobe described on the previous examination are most likely due to focal sparing from fat deposition due to lack of displacement of vessels.Gallstones and biliary sludge are present. No gallbladder wall thickening. No intrahepatic or extrahepatic biliary duct dilatation. Multiple subcentimeter hepatic hypodensities are too small to characterize.SPLEEN: No significant abnormality notedPANCREAS: Punctate focal calcification in the head of the pancreas. These were not present on 2008 examination and may be the sequela of pancreatitis. Pancreatic parenchyma otherwise appears normal with no mass is identified. No pancreatic ductal dilatation is seen.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No hydronephrosis. Subcentimeter left lower pole renal cortical hypodensity is most likely due to a simple cyst..RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Diffuse osteopenia without focal mass. Degenerative changes throughout the lumbar spine.OTHER: Small amount of ascites is new.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: A large soft tissue mass protrudes from the anus measuring 3 cm in diameter at coronal image 16/74. This may be due to rectal prolapse or prominent external hemorrhoids or both. The marked contrast enhancement most likely represents inflammatory change and possible bleeding focus in this mass.BONES, SOFT TISSUES: Bony ankylosis of the sacroiliac joints. Degenerative changes in the lumbosacral spine and pelvis.OTHER: Small amount of ascites is present.

Output: 1. Hepatomegaly. Diffuse fatty infiltration of the liver. 2. Gallstones and biliary sludge without acute cholecystitis. 3. New bilateral pleural effusions and small amount of ascites have developed since the prior exam. 4. Rectal prolapse and/or external hemorrhoids are probable source of melena. See above.


Instruction: Generate impression based on findings.

Input: Right frontoparietal grade 2 meningioma status post STR and XRT. Again seen are postsurgical changes related to near total resection of a large right parietal parasagittal meningioma. Residual tumor involving the mid superior sagittal sinus is not significantly changed when compared to most recent local exam from 12/23/2015, measuring up to 9 mm in the transverse dimension and 12 mm in the craniocaudal dimension. Superior sagittal sinus posterior to this level remains patent. Again seen is encephalomalacia involving the right paracentral lobule.Extra-axial fluid collection along the high parietal convexity beneath the craniotomy measuring approximately 13 mm in thickness is not significantly changed. Chronic blood products along the superficial aspect of the right parietal lobe as well as a focus in the right parietal corona radiata again seen.There is no evidence of acute ischemia or new hemorrhage. Extent of FLAIR signal involving the bilateral frontoparietal centrum semiovale extending into the corona radiata is similar to recent outside MRI although increased when compared to 12/23/2015, findings likely reflecting post radiation change. There is focal enhancement involving the left parietal calvarium, series 11 image 9, measuring approximately 19 mm, previous 14 mm on 12/23/2015. Lesion is not apparent on earlier MRI from 7/11/2015. There is also focal enhancement involving the left frontal calvarium, series 11 image 6, which also appears more conspicuous than on 12/23/2015. There is no evidence of intracranial mass effect, midline shift, or herniation. Ventricular system is unchanged without evidence of hydrocephalus.

Output: 1. Postsurgical changes of near total right parietal meningioma resection. No significant change in residual meningioma involving the superior sagittal sinus compared to 12/23/2015.2. Increased T2/FLAIR hyperintensity involving the frontoparietal centrum semiovale and corona radiata likely representing post radiation change.3. Enhancing lesions involving the left parietal and left frontal calvarium which appears slightly larger than on 12/23/2015 and difficult to appreciate on earlier prior studies. Unclear if these reflect posttreatment change, benign lesions which appear more prominent due to slight differences in technique or more sinister etiology. Would suggest obtaining head CT for further evaluation to assess for destructive osseous changes in these regions.


Instruction: Generate impression based on findings.

Input: Diagnosis: Other spondylosis with radiculopathy, lumbar regionClinical question: disc herniation? foraminal/spinal stenosis?Signs and Symptoms: LBP radiating to LLE Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall height. The conus medullaris on sagittal imaging is grossly intact. There are low signal foci present within the L5 vertebral body which correspond to sclerotic change CT of the abdomen. From 7/30/2015 ,3/20 1/13 , 7/5/2011 and 4/3/2010 but less conspicuous on 6/19/2008At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is mild disc desiccation and a minor facet hypertrophy at this level.At L4-5 there is no significant compromise to spinal canal. There is a right far lateral disc protrusion present at this level which encroaches on the right-sided exiting nerve root within the neural foramen.At L3-4 there is loss of disc space height, endplate reactive change and disc desiccation associated with mild anterior subluxation of L3 on L4 there is ligamentum flavum hypertrophy present bilaterally at this level. There is partial effacement of the fat surrounding the exiting nerve roots within the neural foramina at this level. There is a cystic lesion along the posterior aspect of the spinal canal contiguous with the left facet joint at this level most likely representing synovial cyst. There is no significant spinal canal stenosis at this level.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.Multiple small cystic lesions are present in the kidneys.

Output: 1.There are degenerative changes present in the lumbar spine with mild subluxation at L3-4 where there is also a synovial cyst and some mild encroachment of the exiting nerve roots within the neural foramina.2.There is a right far lateral disc protrusion at L4-5 which encroaches on the right-sided exiting nerve root within the neural foramen at this level.3.A sclerotic focus within the L5 vertebral body which hasn't present since CT scan from 4/13/2010 but was less conspicuous prior to that time. Although this could be degenerative patient has known prostate cancer metastatic disease may have a similar appearance. A bone scan would be able to help further assess it for metabolic activity.


Instruction: Generate impression based on findings.

Input: Limited images through the brain demonstrate T2 hyperintensity within the periventricular and subcortical white matter. Additionally there is a suggestive of diffuse volume loss. Noncontrast images of the internal auditory canals demonstrate the seventh and eighth nerves to be normal in size and symmetric bilaterally without masses along the course of these nerves or in the cerebellopontine angle cisterns bilaterally. The inner ear structures are normal in appearance and symmetric bilaterally without congenital inner ear anomalies identified on either side.

Output: 1.Negative noncontrast MRI internal auditory canals.2.Limited images through the brain demonstrate findings suggestive of chronic small vessel ischemic disease and diffuse volume loss.


Instruction: Generate impression based on findings.

Input: Acute onset bilateral lower extremity weakness, syncope. Past medical history of prostate cancer. The vertebral bodies are appropriate in the overall alignment and height. The spinal cord has grossly normal signal characteristics and overall morphology. There is developmental narrowing of the cervical spinal canal which along with small disc osteophyte complexes produces at least mild degree of spinal canal stenosis at the C3-C4 and C4-C5 levels. There is however no evidence of acute cord compression. There is also no high-grade spinal canal stenosis in the thoracic or lumbar spine to suggest cord or cauda equina compression.

Output: This is a limited exam specific for the exclusion of cord compression only and does not exclude more subtle lesions such as intrinsic cord abnormalities. No cord compression is identified.Due to the screening nature of this protocol details are not as evident on imaging as dedicated protocols of the spine.


Instruction: Generate impression based on findings.

Input: There are postoperative findings are redemonstrated related to right-sided L4-L5 microdiscectomy. There is persistent enhancement and effusion with a subcentimeter synovial cyst associated with the left L4-L5 facet joint. There is also enhancement along the right aspect of the L4-L5 intervertebral disc. There is a diffuse disc bulge at L4-5, with superimposed right foraminal component and associated facet arthropathy resulting in moderate bilateral neural foraminal stenosis at L4-L5 level and posterior epidural lipomatosis with mild-to-moderate spinal canal stenosis. There is a disc bulge at L5-S1, resulting in bilateral moderate neural foraminal stenosis. The vertebral body heights are preserved. There is endplate degenerative changes and Schmorl's node in the inferior endplate of L5 vertebra. The vertebral bone marrow signal is otherwise unremarkable. There is loss of disc height at L5-S1 and mild loss of disc height at L1-L2 and L4-L5 level. There is no abnormal signal within the imaged portion of the spinal cord. There is an unchanged perineural cyst in the sacral spinal canal.

Output: 1. Postoperative findings related to right L4-L5 microdiscectomy with residual eccentric right disc protrusion and what appears to be associated scar versus granulation tissue.2. Persistent enhancement and effusion associated with a subcentimeter synovial cyst involving the left L4-L5 facet joint may represent synovitis.3. Degenerative spondylosis at L5-S1 with bilateral moderate neural foraminal stenosis.


Instruction: Generate impression based on findings.

Input: Male 42 years old. Reason: eval labrum tear. History: FAI, anterior groin pain ACETABULAR LABRUM: Gadolinium enters the acetabular labrum indicating a tear extending from the 11 o'clock position posteriorly to the two o'clock position anteriorly. Parts of the labrum appear completely detached from the underlying acetabulum. There is additional degeneration and undersurface fraying of the labrum more anteriorly.ARTICULAR CARTILAGE AND BONE: There is subjective thinning of the cartilage along the superior aspect of the hip joint with focal degeneration along the superolateral rim of the acetabulum. There is a CAM deformity along the anterior and lateral aspect of the femoral head/neck junction with an alpha angle between 60 and 70 degrees. Bone marrow signal intensity appears normal.SOFT TISSUES: There are foci of low signal intensity along the inferior aspect of the lateral facet of the greater trochanter with mild adjacent soft tissue edema reflecting hydroxyapatite deposition and mild adjacent inflammation. Musculature of the hip appear normal. On the larger field-of-view images, there are mild osteoarthritic changes affecting the left hip. The pubic symphysis and SI joints are unremarkable. Severe degenerative disk disease affects L3/4 and L4/5.

Output: 1.Labral tear as described above.2.CAM deformity and degenerative arthritic changes as described above.3.Calcium hydroxyapatite deposition along the greater trochanter with adjacent inflammatory changes.


Instruction: Generate impression based on findings.

Input: Perennial allergic rhinitis and the possibility of mild past vestibular neuritis. There are mildly prominent upper cervical lymph nodes. For example, a left level 2 lymph node measures up to 15 mm in short axis. However, the lymph nodes display homogeneous signal characteristics. The salivary glands appear unremarkable. There is a left cerebellar hemisphere developmental venous anomaly. There is mild scattered paranasal sinus mucosal thickening and prominence of the nasal turbinate mucosa diffusely. There is torus mandibularis. The orbits and temporal bone regions bilaterally appear unremarkable.

Output: 1. Nonspecific mildly prominent upper cervical lymph nodes, which may be reactive.2. Mild scattered paranasal sinus mucosal thickening and prominence of the nasal turbinate mucosa diffusely are likely related to allergic rhinitis.


Instruction: Generate impression based on findings.

Input: Abdominal painEXAMINATION: MR enterography without and with IV contrast 07/22/2016, 1353 hrs. ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesions. No intrahepatic or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: The kidneys enhance symmetrically, without focal lesion or hydronephrosis. No obstructing urinary stone.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY:No abnormal bowel wall thickening, hyperenhancement, abnormal motility, or surrounding inflammatory changes. No evidence of obstruction. No abnormal free fluid.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: As aboveBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Normal examination.


Instruction: Generate impression based on findings.

Input: Male, 64 years old, with left cervical radiculopathy in the C8 distribution. The cervical lordosis is mildly reversed centered at C5-C7. Sagittal alignment is unremarkable.Vertebral body heights are not significantly compromised. There is mild degenerative anterior wedging of C5-C7.Severe loss of disc height and degenerative endplate signal abnormality is noted at C5-6 and C6-7. Elsewhere, marrow signal characteristics are unremarkable.The visualized spinal cord demonstrates normal signal intensity throughout. No epidural abnormalities are suspected.C2-3: Severe right facet hypertrophy. No significant spinal canal or neuroforaminal stenosis. C3-4: Moderate bilateral facet hypertrophy. Minimal posterior disc-osteophyte complex formation. No significant spinal canal or foraminal stenosis. C4-5: Right greater than left moderate facet hypertrophy. Mild posterior disc-osteophyte complex formation with a small central protruding component. No significant spinal canal or foraminal stenosis. C5-6: Moderate bilateral facet hypertrophy. Loss of disc height and disc osteophyte formation. Mild generalized spinal canal narrowing. Mild bilateral foraminal narrowing. C6-7: Moderate facet hypertrophy. Loss of disc height and disc osteophyte formation. Moderate generalized spinal canal narrowing. Moderate to severe bilateral foraminal narrowing. C7-T1: Moderate right greater than left facet hypertrophy. No significant spinal canal or foraminal stenosis.

Output: Degenerative disc disease is seen most conspicuously affecting C5-6 and C6-7. At C5-6, there is a mild spinal canal stenosis and mild bilateral foraminal narrowing. At C6-7, there is a moderate spinal canal stenosis and moderate to severe bilateral foraminal narrowing. Facet arthropathy is noted at all levels.