Instruction: Generate impression based on findings.

Input: History of necrotizing pancreatitis complicated by walled off necrosis. Status post endoscopic drainage. Previous MR demonstrated improvement in size of fluid collections. ABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy. Fatty liver with focal fat sparing. The liver is normal in morphology, and enhancement without a discrete lesion or biliary ductal dilatation. Seen again is strand-like narrowing of the portal vein just distal to the SMV/splenic vein confluence, unchanged. The portal vein is otherwise patent. The hepatic veins are patent.No choledocholithiasis.SPLEEN: No significant abnormality noted.PANCREAS: There is no normal pancreas parenchyma at the level of the pancreatic body and proximal tail with cystogastrostomy stents in place. There is no measurable residual fluid collection in this region. This region demonstrates post-contrast enhancement suggesting post-inflammatory tissue.Again seen is decrease in intrinsic T1 weighted signal intensity of the residual pancreatic tail parenchyma without peripancreatic inflammation, atrophy or ductal dilatation. This parenchyma demonstrates mild post-contrast enhancement.The pancreatic head is normal T1-weighted signal intensity, enhancement and has a normal pancreatic duct caliber.There is discontinuity of the pancreatic duct at the level of the pancreatic body and proximal tail. Following secretin administration there is a decreased exocrine response of the pancreas with fluid only seen filling the proximal duodenum. The pancreatic duct demonstrates no significant caliber increase following secretin administration. The pancreatic duct at the level of the pancreatic tail is not well seen on today's study.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.No measurable residual fluid collection at the level of the previously described intrapancreatic fluid collection/pseudocyst with cystogastrostomy stents in place. There is enhancing inflammatory/fibrous tissue and pancreatic duct discontinuity in this region.2.Diminished intrinsic T1 signal intensity and enhancement of the distal pancreatic tail, unchanged.3.Redemonstrated slitlike narrowing of the portal vein just distal to the SMV splenic vein confluence.4.Diminished excretory response of the pancreatic head following secretin administration. 5.Fatty liver with focal fat sparing.


Instruction: Generate impression based on findings.

Input: Female, 20 years old, with elevated prolactin level. Assess for microadenoma of the pituitary. A T2 hyperintense, T1 hypointense, hypoenhancing lesion is evident within the central aspect of the pituitary gland measuring up to 4 mm TV x 3 mm CC x 5 mm AP. This lesion causes no significant displacement of the pituitary gland from the sella, and the gland is otherwise unremarkable.No suprasellar mass is seen. The visualized portions of the optic apparatus are within normal limits. Significant left maxillary sinus mucosal thickening is seen.

Output: 1.A subcentimeter lesion is identified within the pituitary gland which, given the history, could very well represent a microadenoma. 2.Left maxillary sinus mucosal inflammation is noted incidentally.


Instruction: Generate impression based on findings.

Input: Reason: Has there been a chang in this man's History: 91 Y/O had EUS 5-9-13 which showed branched IPMT confirmed by needle aspiration. Last MRCP 4-29-15 was stable. Pt doing well. Any worrisome changes on MRCP? ABDOMEN:LIVER, BILIARY TRACT: The comment bile duct is prominent measuring 11 mm, unchanged. Punctate T2 hyperintensities throughout the liver are unchanged, likely cysts.SPLEEN: Subcentimeter splenic cyst is stable.PANCREAS: There is low T1 signal throughout the pancreas with atrophy, similar to the prior exam. There are numerous scattered cystic lesions throughout the pancreas, particularly in the head and uncinate, some of which are slightly increased since the prior exam. Reference lesion is stable measuring 13 mm (5/69), previously 12 mm. A larger cyst more inferiorly along the third portion of the duodenum is slightly increased in size measuring 20 mm (5/56), previously 16 mm. A cyst in the pancreatic tail is slightly increased measuring 13 mm (7/18), previously 8 mm. The main pancreatic duct is nondilated. No abnormal enhancement is identifiedADRENAL 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: Mild scoliosis of the lumbar spine.OTHER: No significant abnormality noted.

Output: Multiple cystic lesions throughout the pancreas measuring up to 2 cm likely represent side branch IPMNs, some of which are slightly increased in size.


Instruction: Generate impression based on findings.

Input: Reason: 61 yo female with hx of IPMN in pancreas; please evaluate for any changes and or abnormalities History: pancreas mass ABDOMEN:LIVER, BILIARY TRACT: Several subcentimeter hepatic cysts are unchanged. No suspicious hepatic lesions.No intrahepatic or extrahepatic biliary ductal dilation.SPLEEN: No significant abnormality noted.PANCREAS: Several small cystic lesions are again seen throughout the pancreas most consistent with small intraductal papillary mucinous neoplasms. The largest of these in the pancreatic head is measures up to 1.2 x 1.1 cm (series 5/22), previously 1.3 x 1.2 cm and not significantly changed. There is no discrete enhancement of these lesions. The pancreatic duct is normal in caliber.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: Stable pancreatic cystic lesions most consistent with branch type intraductal papillary mucinous neoplasms.


Instruction: Generate impression based on findings.

Input: Male, 38 years old, with primary CNS lymphoma status post chemotherapy and radiation. No significant interval change is seen in the size or morphology of a T2 hyperintense hemosiderin stained lesion involving the left globus pallidus. A focus of enhancement internal to this lesion is unchanged as well.Also unchanged is a linear T2 hyperintense hemosiderin stained lesion involving the right basal ganglia and adjacent periventricular white matter. Again, minimal linear enhancement running through this lesion is not significantly changed.Encephalomalacia involving the right superior frontal gyrus is unchanged. No new intracranial signal abnormality or pathologic intracranial enhancement is detected.Patchy paranasal sinus mucosal thickening is seen along with an air-fluid level in the right maxillary sinus.

Output: Stable lesions in the bilateral basal ganglia with no evidence of progressive or new intracranial disease.


Instruction: Generate impression based on findings.

Input: Radicular pain in the right lower extremity, assess for lumbar radiculopathy Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is minimal retrolisthesis of L2 on L3 and minimal anterolisthesis of L4 and L5. There is severe loss of disc height at the L2-L3 and L4-L5 levels and to a lesser degree at L3-L4. Edematous endplate changes are seen at the L2-L3 and L5-S1 levels. There is also mild edema involving the L3-L4 disc space most likely on a degenerative basis. Bone marrow signal is benign. The conus medullaris is normal in position.Multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: Disc bulge and endplate osteophytes, ligamentum flavum thickening, and bilateral facet arthropathy result in mild to moderate spinal canal stenosis. There is moderate right and mild to moderate left neural foraminal stenosis.L3-L4: Disc bulge, facet arthropathy, ligamentum flavum thickening with minimal spinal canal stenosis. There is mild right and moderate left neural foraminal stenosis. Suggestion of prior surgical laminotomy.L4-L5: Disc bulge, facet arthropathy, and ligamentum flavum thickening. There is no significant spinal canal stenosis. There is moderate right and moderate to severe left neural foraminal stenosis. Suggestion of prior surgical laminotomy.L5-S1: There is soft tissue measuring 11 x 10 mm with low T1 and low T2 signal dorsal to the inferior right L5 vertebral body suspected to represent extruded disc material versus granulation tissue, best seen on series 6 axial T2 image 35. There is associated effacement of the right lateral recess where there may be impingement of the right descending S1 nerve root. There is mild disc bulge, ligamentum flavum thickening, and bilateral facet arthropathy. There is no significant central canal stenosis. There is moderate right and mild to moderate left neural foraminal stenosis.There is mild atrophy involving the paraspinous musculature. Moderate degenerative changes involving the sacroiliac joints also noted.

Output: 1. Moderate degenerative changes throughout the lumbar spine. 2. There is an 11 x 10 mm soft tissue dorsal to the inferior right L5 vertebral body which may represent extruded disc material versus granulation tissue(series 6 axial T2 image 35); postcontrast images would be helpful to differentiate (also may correlate with prior records if prior surgery involved the L5-S1 level). There is associated effacement of the right lateral recess where there may be impingement of the right descending S1 nerve root. 3. There is mild to moderate spinal canal stenosis at L2-L3. There is also multilevel neural foraminal stenosis bilaterally (on the right at the L2-L3, L4-L5, and L5-S1 levels). Please see details above.


Instruction: Generate impression based on findings.

Input: Clinical question: GBM. 2 wks post reRT+TMZ+bev. Signs and Symptoms: GBM. Pre and post enhanced brain MRI:Diffusion weighted images demonstrate interval increased restricted diffusion surrounding the right hemispheric surgical cavity since prior exam.There is however interval decreased right frontal vasogenic edema since prior exam anterior to the surgical cavity.There is also interval decreased size / thickness of enhancement surrounding the surgical cavity wall since prior study. For example the thick enhancing rim anterior to the surgical cavity on prior exam measured in the range of 30 to 36 mm compared to prior study measurements of between 19 to 21 mm. Enhancement along the inferior edge of the surgical cavity which measures approximately at 22 mm on prior exam has decreased to approximately 12 mm current study. The enhancement along the dorsal aspect of the surgical cavity which measures approximately at 25 x 35 mm has decreased in size and intensity of enhancement and measuring at approximately 18 to 21 mm.There is interval expansion of right lateral ventricle secondary to decreased mass effect from tumor and complete resolution of previously noted midline deviation to the left. Changes suggestive of ovarian degeneration on the right is again identified.Mild left hemispheric periventricular white matter informed hyperintensity similar to prior exam and likely representing post treatment/radiation change.

Output: 1.Overall there is interval improvement of patient's known right hemispheric tumor. There is interval decreased vasogenic edema, significant decreased in thickness of a large irregular rim of enhancement surrounding the surgical cavity as detailed/measured above. There is also decreased in intensity of enhancement since prior study.2.Interval decreased mass effect of right hemisphere with resultant re-expansion of the right lateral ventricle and resolution of leftward midline shift since prior study.3.There is however increased peri-surgical cavity restricted diffusion.


Instruction: Generate impression based on findings.

Input: Female, 34 years old, with numbness. Brain:Numerous small T2 hyperintense lesions are redemonstrated involving the periventricular and subcortical white matter of the cerebral hemispheres. Accounting for slightly improved image quality on the present examination, no convincing change in lesion size or number is seen. None of these lesions demonstrates any significant associated mass effect or pathologic enhancement.No new intracranial lesions are seen. No parenchymal edema is suspected. There is no evidence to suggest intracranial hemorrhage or any abnormal extra-axial fluid collection. The ventricular system is normal in size.C-spine:The visualized spinal cord demonstrates normal signal intensity and morphology throughout. No discrete lesions or areas of signal abnormality are seen. No pathologic enhancement is observed.Spinal alignment is anatomic. Vertebral body morphology and signal characteristics are within normal limits. The intervertebral disks are preserved. No significant spinal canal or neuroforaminal stenosis is seen.

Output: 1.Numerous small cerebral white matter lesions are again seen with no significant interval change in lesion size or number. None of these lesions shows evidence of pathologic enhancement.2.Normal evaluation of the cervical spine with no evidence of cord lesions.


Instruction: Generate impression based on findings.

Input: 22-year-old female with primary sclerosing cholangitis with biliary strictures ABDOMEN:LIVER, BILIARY TRACT: No focal liver lesions. The vasculature appears patent.The gallbladder is within normal limits. Redemonstrated is mild beading of the left and right intrahepatic biliary ducts centrally and at the Klatskin point. Although improved, there is mild dilation of the common bile duct measuring up to 7 mm, previously 10 mm.There is no abnormal enhancement or focal mass. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Narrowing of the biliary ducts at Klatskin point, particularly central right and left biliary ducts appearing similar to that seen on the prior examination. No focal mass or abnormal enhancement to suggest cholangiocarcinoma.


Instruction: Generate impression based on findings.

Input: Left neck mass x 2 years. Additional history from the electronic medical record: history of posterior neck schwannoma resection who presents for evaluation of left neck mass. The patient has had a left neck mass for at least 4 years. Recently, over the last 3-4 months, it has been growing in size. C-spine MR on 2/2016 demonstrated a 5 cm cystic/solid mass in the left neck which measured 1.3 cm on imaging on 10/2009. The patient underwent a CT on 3/15/2016 which demonstrated a 5 cm left neck mass, possibly representing a schwannoma or paraganglioma. There is a T2 hyperintense, tubular structure in the left neck abutting the left internal jugular and left common carotid artery measuring 1.9 x 1.4 x 4.9 cm. This lesion demonstrates minimal peripheral enhancement, with what appears to be a more nodular enhancing component along the superior and posterior aspect of the lesion, which measures 15 mm in diameter. There is otherwise no significant lymphadenopathy according to radiological criteria. The thyroid is not well-depicted, but there may be a small left upper lobe nodule. The imaged intracranial contents are unremarkable. The salivary glands and upper aerodigestive tract appear unremarkable. There is mild bilateral maxillary sinus mucosal thickening. The orbits are unremarkable. The cervical spine is unremarkable. However, there appears to be focal volume loss of the right spinal cord at the C2 level.

Output: 1. A left neck tubular cystic structure along the carotid sheath with a nodular solid component posteriorly and superiorly may represent a partially cystic peripheral nerve sheath tumor or cystic metastasis, perhaps related to a left thyroid malignancy. A thyroid ultrasound may be useful for further evaluation.2. Apparent focal volume loss of the right spinal cord at the C2 level may represent myelomalacia. Correlation with dedicated imaging of the cervical spine may be useful.


Instruction: Generate impression based on findings.

Input: 66 year old man referred to evaluate for suspected hypertrophic cardiomyopathy. Left VentricleThe left ventricle has moderate to severe hypertrophy, predominantly involving the mid to apical levels. There is mild left ventricular hypertrophy of the basal level. The maximum wall thickness at the apex is approximately 18mm; however, patient inability to cooperate with breath-holds limits the accuracy of this measurement. The overall LV systolic function is low normal. The LV ejection fraction is 54%, the LV end diastolic volume index is 75 ml/m2 (normal range: 74+/-15), the LVEDV is 182 ml (normal range 142+/-34), the LV end systolic volume index is 34 ml/m2 (normal range 25+/-9), the LVESV is 83 ml (normal range 47+/-19), the LV mass index is 110 g/m2 (normal range 85+/-15), and the LV mass is 266 g (normal range 164+/-36). There is patchy late gadolinium enhancement which involves the apical anterior and inferior wall. The late gadolinium enhancement spares the endocardium and the pattern is atypical for prior myocardial infarction. It suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process. Qualitatively, there is a moderate burden of late gadolinium enhancement.Left AtriumThe left atrium is severely dilated. The interatrial septum is aneurysmal. 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 72 ml/m2 (normal range 82+/-16), the RVEDV is 175 ml (normal range 142+/-31), the RV end systolic volume index is 33 ml/m2 (normal range 31+/-9), and the RVESV is 81 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 moderate mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is mild 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 moderately dilated.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is a small 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 ventricular is moderately hypertrophied with regional variation in a pattern that is supportive of the diagnosis of apical variant of hypertrophic cardiomyopathy. The overall systolic function is low normal (LVEF 54%).2. Normal RV size and systolic function (RVEF 54%).3. There is a moderate overall burden of late gadolinium enhancement involving the apical anterior and inferior walls. The pattern is atypical for prior myocardial infarction and suggests the presence of underlying myocardial fibrosis, inflammation, or infiltration. 4. Severe left atrial dilation.5. Moderate mitral regurgitation. 6. Moderate dilation of main pulmonary artery.7. Small pericardial effusion. 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, 35 years old, with neck pain. Alignment is anatomic. Vertebral body height and morphology are within normal limits. No evidence of marrow replacement or marrow edema is seen.The visualized spinal cord demonstrates normal signal intensity and morphology. No focal lesions are seen. No epidural abnormalities are suspected.C2-3: Unremarkable. C3-4: Unremarkable. C4-5: Unremarkable. C5-6: Mild left foraminal narrowing secondary to uncovertebral and facet hypertrophy. C6-7: Central and left paracentral disc extrusion which effaces the ventral thecal sac but causes no cord impingement and only mild narrowing of the spinal canal. No significant foraminal narrowing. C7-T1: Unremarkable.

Output: 1.A central and left paracentral disc extrusion is seen at C6-7 which causes effacement of the ventral thecal sac but no significant cord impingement.2.Mild foraminal narrowing is demonstrated on the left at C5-6 due to uncovertebral and facet hypertrophy.


Instruction: Generate impression based on findings.

Input: Metastatic embryonal rhabdomyosarcoma off therapy since May, 2013. Assess for recurrent disease. Brain: There is no evidence of intracranial mass. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift. There cerebellar tonsils appear to extend up to 7 mm inferior to the foramen magnum. The major cerebral flow voids are intact. The cerebellar tonsil remains low lying especially on the left. There is left parieto-occipital plagiocephaly. There is trace fluid in the left mastoid air cells. The orbits and scalp soft tissues are grossly unremarkable.Neck: There are post-treatment findings in the left parotid space region, but no evidence of underlying measurable mass lesions. The cervical lymph nodes are unchanged. The thyroid and major salivary glands are unchanged, including an asymmetrically small left submandibular gland. The major cervical flow voids are intact. The airways are patent. The osseous structures are unremarkable.

Output: 1. Post-treatment findings in the left parotid gland without discernible recurrent tumor.2. No significant change in the cervical lymph nodes.3. No evidence of intracranial mass.4. Findings suggestive of possible Chiari I malformation.


Instruction: Generate impression based on findings.

Input: Demyelinating disease of central nervous system, unspecified [G37.9], Reason for Study: ^Reason: Demyelinating disease; eval for progression History: paresthesias Brain MRI:There is no evidence of acute ischemic or hemorrhagic lesion.There are suspicious enhancing area which most likely represent a venous channel (series 2101, image 34). Otherwise there is no evidence of abnormal enhancement.Comparing to prior scan which showed a couple of enhancing lesions on the right posterior frontal lobe and right mid-pons lesion do not show any evidence of enhancement on today's scan.Multifocal scattered white matter T2/FLAIR high signal lesions were again seen and do not show any significant interval changes in terms of size and distribution since prior scan. 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.Cervical Spine MRIRedemonstration of subtle T2 high signal intensity lesions throughout the cervical spine, unchanged since prior scan.On Gad enhanced scan, there is no evidence of definitive, discrete enhancing lesion within the spinal cord.Spinal alignment is anatomic. Vertebral body height and morphology are normal. No concerning marrow signal abnormality or enhancement is seen. No significant spinal canal or neural foraminal stenosis. Paraspinous soft tissues are unremarkable.

Output: 1. Unchanged bihemispheric scattered FLAIR high signal intensity lesions since prior scan.2. No definitive evidence of enhancing lesion on today's scan. Specifically, previously shown nodular enhancing lesions do not show any evidence of enhancement on today's scan.3. Subtle T2 high signal lesions throughout the cervical cord is again seen without definitive enhancing lesion, unchanged since prior scan.


Instruction: Generate impression based on findings.

Input: 16 years, Male, status post Chiari decompression 3 months ago. Evaluate CSF flow and syrinx. Brain: There are postoperative changes of suboccipital craniectomy and resection of the posterior arch of C1 for Chiari I decompression. There has been significant improvement in CSF spaces at the foramen magnum when compared to the sagittal counting sequence on prior thoracic MRI which partially imaged the craniocervical junction.CSF flow sequence is technically suboptimal but demonstrates preserved biphasic flow ventrally and dorsally at the foramen magnum.Multiple brain sequences are motion degraded but demonstrate no significant signal abnormality involving the brain parenchyma. No evidence of intracranial mass, mass effect, midline shift, or herniation. Ventricles appear normal in size. No gross evidence of infarct or hemorrhage. Major flow-voids are preserved.Right maxillary sinus mucus retention cysts are incidentally noted.Cervical and Thoracic Spine:There is been marked decrease in size of the previously seen syrinx extending from approximately the C3-C4 to C7 levels. Cervical syrinx which was partially imaged on the prior thoracic study measured approximately 6 mm in the AP dimension in the sagittal plane at the C4-C5 level, and currently measures less than 1 mm in the AP dimension. Syrinx is relatively maximal on the current study at the C6-C7 level where it measures 2.8 x 5.0 mm in the AP and transverse dimensions which is also smaller than priorThe cervical and thoracic vertebral bodies are appropriate in the overall alignment and height. The thoracic spinal cord has normal signal characteristics and overall morphology. At T5-6 there is a small disc bulge present, and at T6-7 there is a small right paramedian disc protrusion present which mildly indents the cord. These findings are not significantly changed, and there is otherwise no significant spinal canal or neural foraminal stenosis.

Output: Expected postsurgical changes of Chiari I decompression with interval expansion of CSF spaces at the foramen magnum and marked decrease in size of cervical syrinx.


Instruction: Generate impression based on findings.

Input: A 49 year old male with personal history of intermittent LBBB and sinus tachycardia, hypertension, hyperlipidemia, overweight, obstructive sleep apnea. Due to chest pain he had a left cardiac catheterization in 2014 that showed non-significant coronary artery disease and a recent echocardiography showed a decrease in left ventricular systolic function from 55 to 45%. Referred to cardiac MRI for further evaluation. Left VentricleThe left ventricle is mildly dilated with mildly reduced systolic function. The overall LV ejection fraction is 45%, the LV end diastolic volume index is 112 ml/m2 (normal range: 74+/-15), the LVEDV is 279 ml (normal range 142+/-34), the LV end systolic volume index is 61 ml/m2 (normal range 25+/-9), the LVESV is 153 ml (normal range 47+/-19), the LV mass index is 38 g/m2 (normal range 85+/-15), and the LV mass is 93 g (normal range 164+/-36). The thickness of the myocardium is normal-to-thin. There is global mild hypokinesis with dyssynchrony due to conduction defects. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.The native myocardial T1-times are mildly and diffusely increased (~1100-1150ms), suggesting interstitial fibrosis.The values of Global Relative enhancement, T2-STIR edema ratio and Extracellular Volume Fraction are all between normal values.No findings to support myocardial edema in T2-STIR sequence.No myocardial iron overload.No intracavitary thrombus.Left AtriumThe left atrium is mildly dilated (103ml). Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 55%, the RV end diastolic volume index is 96 ml/m2 (normal range 82+/-16), the RVEDV is 239 ml (normal range 142+/-31), the RV end systolic volume index is 43 ml/m2 (normal range 31+/-9), and the RVESV is 108 ml (normal range 54+/-17).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 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 mildly dilated (33mm).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 mildly dilated with mildly reduced systolic function, the LVEF is 45%. The thickness of the myocardium is normal-to-thin. There is global mild hypokinesis with dyssynchrony due to conduction defects. 2. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. The native myocardial T1-times are mildly and diffusely increased, suggesting interstitial fibrosis. No findings to support myocardial edema. No myocardial iron overload. No intracavitary thrombus.3. The right ventricle is normal in size and systolic function, the RVEF is 55%. 4. There is mild biatrial enlargement.


Instruction: Generate impression based on findings.

Input: There is nonspecific straightening of the normal cervical lordosis. There is mild loss of intervertebral disc space height and endplate degenerative changes noted at C5-6. The marrow signal is benign. The cervical and upper thoracic cord are normal in signal and caliber. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.C1/2: No significant spinal canal stenosis or neural foraminal narrowing.C2/3: No significant spinal canal stenosis or neural foraminal narrowing.C3/4: No significant spinal canal stenosis or neural foraminal narrowing.C4/5: No significant spinal canal stenosis or neural foraminal narrowing.C5/6: Uncovertebral joint hypertrophy and a posterior disc osteophyte complex results in flattening of the ventral thecal sac and mild/moderate bilateral neural foraminal narrowing, right greater than leftC6/7: No significant spinal canal stenosis or neural foraminal narrowing.C7/T1: No significant spinal canal stenosis or neural foraminal narrowing.

Output: Focal degenerative changes at C5-6 resulting in mild/moderate bilateral neural foraminal narrowing. Otherwise, no significant spinal canal stenosis or neural foraminal narrowing is evident.


Instruction: Generate impression based on findings.

Input: Female 49 years old Reason: Pt s/p distal pancreatectomy and splenectomy 1/24/14 for a mucinous cystic neoplasm and endocrine neoplasm - please evaluate for recurrence History: mucinous neoplasm ABDOMEN:LIVER, BILIARY TRACT: Liver has a smooth contour. No suspicious hepatic lesion. Hepatic and portal veins are patent. The common bile duct and intrahepatic biliary tree are normal in caliber.SPLEEN: Status post splenectomy. Tiny soft tissue signal foci in postoperative bed (series 3 image 14/series 100 image 53) of unlikely clinical significance, may be mesenteric vessels or nodes, appears to have been present on earlier preoperative exam, tiny splenules also a differential consideration but considered less likely.PANCREAS: Interval distal pancreatectomy with resection of the previously described cystic lesion situated in the distal pancreatic body/tail.ADRENAL GLANDS: Left adrenal nodule measures 1.6 x 1.1 cm, appearing similar to the prior study (46; series 14). There is no signal loss on out of phase sequences to confirm microscopic fat, may be a lipidpoor adenoma but lesion is incompletely characterized on this nondedicated study. KIDNEYS, URETERS: Small renal cysts. No hydronephrosis in either kidney.RETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy. No mesenteric lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1.Interval resection of the previously described cystic mass in the pancreatic body/tail, without evidence of residual or recurrent disease.2.Stable indeterminate left adrenal nodule.


Instruction: Generate impression based on findings.

Input: 64-year-old man with history of prostate cancer on surveillance. Additional history as per chart: Biopsy on 10/5/2015 revealed Gleason 6 adenocarcinoma, last PSA of 8.1. PELVIS:PROSTATE:Prostate Size: 53 x 43 mm.Peripheral Zone: There is a very small 5 x 4 mm T2 hypointensity in the right peripheral apex (series 801, image 53) which demonstrates restriction on diffusion weighted images and mild enhancement. No additional tumor is identified.Central Gland: There is hypertrophy of the transitional zone.Seminal Vesicles: The seminal vesicles appear normal.Extracapsular Extension: There is no evidence of extracapsular extension.BLADDER: The bladder is normal.LYMPH NODES: No significant lymphadenopathy noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Very small focus of abnormal signal in the right prostatic apex without extracapsular extension which may represent adenocarcinoma.


Instruction: Generate impression based on findings.

Input: Tremors and worsening migraines, left sided weakness and numbness. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No evidence of acute intracranial hemorrhage, mass, or acute infarct.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Persistent headaches. Non-enhanced CT of brain:There is no evidence of intracranial hemorrhage, edema, mass effect or midline shift or hydrocephalus. There is a small foci of low-attenuation in the right basal ganglia close to CSF density on axial image 13 which may represent small old lacunar in part. This examination is otherwise unremarkable. Please correlate with history and risk factors and follow-up with an MRI.The cortical sulci, ventricular system, CSF cisterns and gray -- white matter remains otherwise within normal limits. Calvarium is intact. Visualized paranasal sinuses and mastoid air cells are unremarkable.

Output: 1.A single small focus of low-attenuation in the right basal ganglia measuring 7 times 4-mm in size with close to CSF density is suspected for an old lacunar infarct. Exam is otherwise unremarkable. Correlate with history and risk factors and follow.2.Normal calvarium, visualized paranasal sinuses and mastoid air cells.


Instruction: Generate impression based on findings.

Input: History of breast cancer, on chemotherapy, now with right-sided headache and blurry vision. Evaluate for metastases. There is no evidence of intracranial hemorrhage, edema or midline shift. Though no mass effect is present, evaluation for metastatic lesions is limited by a lack of intravenous contrast. If there is a high suspicion for metastases, an MRI with contrast is recommended.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. There is opacification of a few ethmoid air cells. The remaining visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: No acute intracranial abnormality. No mass lesions are identified. If there is strong clinical concern for intracranial metastases, an MRI with contrast may be considered for further evaluation.


Instruction: Generate impression based on findings.

Input: 76 year old female with a remote history of breast cancer, active colon cancer undergoing treatment referred for cardiac MRI after abnormal echocardiogram (apex with unclear clot/mass limited by poor acoustic windows). Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 58%, the LV end diastolic volume index is 79 ml/m2 (normal range: 65+/-11), the LVEDV is 139 ml (normal range 109+/-23), the LV end systolic volume index is 33 ml/m2 (normal range 18+/-5), the LVESV is 58 ml (normal range 31+/-10). There is thinning of apical myocardium, is a small symmetric distribution, which likely represents a normal variant. There is sigmoid septum (normal variant). There is abnormal motion of the interventricular septum of unclear significance. There is late non-transmural gadolinium enhancement of the mid anterolateral wall that may represent previous myocardial infarction. Less likely is inflammation or infiltrative disease. There is no thrombus or mass noted in the apex. The pre-contrast native myocardial relaxation T1 times of the myocardial septum is normal (965 ms). There is no evidence of iron overload. Left AtriumThe left atrium is normal in size. Interatrial septal aneurysm.Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 58%, the RV end diastolic volume index is 72 ml/m2 (normal range 69+/-14), the RVEDV is 127 ml (normal range 110+/-24), the RV end systolic volume index is 30 ml/m2 (normal range 22+/-8), and the RVESV is 53 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is mildly dilated. 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. There is a mass in the SVC - likely catheter but a catheter related thrombus can not be excluded.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 normal in size and systolic function (LVEF 58%).2. The right ventricle is normal in size and systolic function (RVEF 58%). 3. There is late non-transmural gadolinium of the mid anterolateral wall that may represent previous myocardial infarction. Less likely is inflammation or infiltrative disease.5. There is no thrombus noted in the apex. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 76-year-old female with history of pancreatic head mass. ABDOMEN:LIVER, BILIARY TRACT: Multiple ring-enhancing T2 hyperintense lesions are seen scattered throughout the liver compatible with metastatic disease.Reference segment 2 lesion measures 2.3 x 2.2 cm (image 542 of series 1402).Reference segment 6 lesion measures 2.4 x 1.8 cm (image 357 of series 1402).Cholelithiasis.SPLEEN: No significant abnormality noted.PANCREAS: At the pancreatic head/body junction, there is a solid mass with intermediate T2 signal abnormality and persistent peripheral enhancement measuring 3.4 x 2.3 cm (image 362 of series 1402). There is significant downstream atrophy and pancreatic ductal dilatation. This lesion is intimately associated with the SMV and hepatic artery. The SMA, and splenic artery are uninvolved. The main portal and splenic veins are patent. Several prominent enhancing peripancreatic lymph nodes are present.There are additional smaller cystic lesion, for instance, located within the uncinate process measuring 13 x 12 mm (image 22 of series 601).ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral subcentimeter renal cysts, some of which are T1 hyperintense, likely representing a combination of hemorrhagic, proteinaceous, and/or simple cysts.A solid T1 hyperintense right interpolar lesion enhances avidly measures 16 x 16 mm (image 317 of series 1402).Additional exophytic right superior pole round lesion with decreased nodular peripheral signal measures 2.9 x 2.8 cm, and is nonspecific.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small right pleural effusion.

Output: 1. Findings consistent with primary pancreatic adenocarcinoma with liver metastases as above. The tumor is intimately associated with the proximal SMV and hepatic artery, however the remaining vessels appear patent. Reference measurements are provided.2. Right midpole enhancing renal lesion suspicious for neoplasm.


Instruction: Generate impression based on findings.

Input: 7-year-old female with history of left femoral osteosarcoma, concern for recurrence. Exam is significantly limited by metal related artifact from left femoral endoprosthesis.The prepubertal uterus appears normal. The ovaries are not visualized. The bladder is normal. There is no significant pelvic lymphadenopathy identified. No bowel abnormalities identified. The bone marrow signal appears normal in the pelvis and right femur. The left paraspinal muscles and left thigh musculature is diffusely atrophied.Evaluation of the hip joint itself is again limited by metal artifact. There is no evidence of gross disease recurrence or soft tissue mass identified. The known superolateral subluxation of the hip joint is better imaged on the current radiograph.

Output: 1.Extremely limited exam without gross evidence for disease recurrence.2.Diffuse muscle atrophy in the left hemipelvis and left lower extremity.


Instruction: Generate impression based on findings.

Input: Ms. Mohanty is a 42-year-old female with recent right breast excisional biopsy demonstrating DCIS (cribriform and papillary type) with several close margins. She presents today for an MRI evaluation postoperatively. Mild parenchymal enhancement is noted bilaterally.Right breast: In the right upper outer breast, post-surgical changes including a 2.1 cm post-operative seroma are identified. Immediately abutting the seroma in both the postero-superior and antero-inferior direction is non-mass-enhancement. The postero-superior component measures approximately 2.5 x 1.4 cm. The antero-inferior component of enhancement measures approximately 0.6 x 0.8 cm. Although this type of enhancement adjacent to the seroma cavity may all represent recent post-operative changes, underlying residual malignancy cannot be excluded. Left breast: No abnormal enhancement is seen in the left breast. No abnormal axillary lymph nodes are identified in either axillary region.

Output: Post-surgical seroma identified in the right upper outer breast with non-mass-enhancement abutting the seroma cavity in both the postero-superior and antero-inferior direction. Although this type of enhancement adjacent to the seroma cavity may all represent post-operative changes from her recent surgery, underlying residual malignancy cannot be excluded. Recommend correlation with final pathology from our own departmental review and surgical consultation with Dr. Chhablani. BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: 65-year-old female with known right breast malignancy and metastatic right axillary lymph node. She presents today for needle localization of the right breast malignancy (2 sites index plus adjacent satellite) and localization of right axillary lymph node which will be performed under sonographic guidance. On review of the prior studies, a right 7:00 5 cm from nipple 0.7 cm irregular hypoechoic mass corresponding to the index malignancy will be targeted. An adjacent 0.5 cm irregular hypoechoic anterior satellite mass, will also be targeted. Two abnormal right axillary lymph nodes were identified at MRI, with subsequent ultrasound-guided biopsy of one of them revealing invasive ductal carcinoma. Preprocedural ultrasound evaluation of the right axilla, revealed the clip marker to be adjacent to one of the enlarged lymph node which will be targeted.The procedure, risks including bleeding, mistargeting and infection, and benefits of needle-wire localization were discussed with the patient. Questions were answered. Consent was obtained both verbally and in writing. The time out form was completed to confirm patient identity and site of procedure. The right breast and axilla were cleansed with chlorhexidine over the target areas. Transducer was sterilely sheathed. Local anesthesia was obtained using 2% lidocaine superficially, with 1% lidocaine with 1:100,000 epinephrine at depth. Using aseptic technique, continuous ultrasound guidance and a inferior to superior approach, a 7 cm Kopans needle was placed in the index malignancy. Another 7 cm Kopans needle was placed in the adjacent satellite mass. The spring wires were then deployed. A 9 cm Kopans needle was placed in an enlarged lymph node adjacent to the biopsy clip.Repeat three view orthogonal mammograms reveal the three spring wires to be in excellent position. The posterior wire corresponds to the mass with clip. The anterior wire corresponds to the anterior satellite. The wire in the axilla corresponds to the enlarged biopsied lymph node with the clip being slightly superior to it. Patient tolerated the procedure well and was sent to the holding area in stable condition. Drs. Tremblay and Kulkarni performed the procedure. Orthogonal digital specimen radiographs were obtained and results reported separately.

Output: 1. Successful needle localization of the right breast index malignancy/adjacent satellite lesion.2. Successful needle localization of a metastatic right axillary lymph node.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: History of partial left nephrectomy in 2008. Evaluate for metastatic disease. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted. Hepatic steatosis.SPLEEN: Stable subcentimeter enhancing soft tissue nodule along the anteroinferior margin of the spleen is consistent with an accessory spleen.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Postoperative appearance of a partial nephrectomy on the left. In the surgical bed there is a stable cystic lesion measuring 2.7 x 2.6 cm (series 8/27), compared to 3.0 x 2.3 cm previously. There is internal debris but no enhancing components. No hydronephrosis. No new suspicious renal lesion. RETROPERITONEUM, LYMPH NODES: Small retroperitoneal lymph nodes are not significantly changed and measure less than 1 cm in short axis.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA:7.2 x 7.7 cm uterine fibroid in the right uterine body/fundus is similar in appearance. 2.4 cm uterine fundus fibroid. The endometrial thickness is normal. The inner myometrium/junctional zone is normal in thickness and signal intensity. Numerous nabothian and Bartholin's cysts are present.Right adnexal cyst measuring 2.8 x 2.5 cm.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Status post partial left nephrectomy with stable cystic changes at the surgical bed. No evidence of recurrent or metastatic disease.


Instruction: Generate impression based on findings.

Input: Evaluate for sacroiliitis, ankylosing spondylitis. There is no evidence of acute fracture or malalignment. Bone marrow signal is within normal limits. No specific findings of sacroiliitis. Bone island noted in the right sacral alar. Intraosseous lipoma is noted in the mid sacrum. No significant degenerative change of the lower lumbar spine. No abnormal enhancing structure is identified.

Output: No MRI evidence of sacroiliitis.


Instruction: Generate impression based on findings.

Input: Male, 78 years old, with recent falls plus minus loss of consciousness in the setting of persistent afib on warfarin. No restricted diffusion is seen. Scattered foci of white matter and basal ganglia T2 hyperintensity are demonstrated, many of which have a cystic quality and are likely reflective of chronic lacunar infarcts. No enhancing lesions are seen.No evidence of acute intracranial hemorrhage is seen. A few scattered small foci of susceptibility are noted likely indicating chronic microhemorrhage. The ventricles are within normal limits with respect to size and morphology. Mild volume loss of the cerebellum is noted.

Output: 1.No definite evidence of any acute intracranial abnormality.2.Sequelae of chronic microvascular and lacunar ischemia are seen.


Instruction: Generate impression based on findings.

Input: Male, 20 years old, with leg weakness. Assess for right lower extremity plexopathy. The lumbar spine as visualized is free of significant abnormalities. In particular, no evidence of pathologic enhancement of the cauda equina is seen. More distally along the lumbosacral plexi, no obvious lesions or abnormalities are identified.

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


Instruction: Generate impression based on findings.

Input: 44 years Female (DOB:9/24/1972)Reason: stroke? Chiari? History: HAsPROVIDER/ATTENDING NAME: JAMES A. MASTRIANNI JAMES A. MASTRIANNI The CSF spaces are appropriate for the patient's stated age with no midline shift. The cerebellar tonsils are low lying and extend 4 mm below the level of the foramen magnum. They are not pointed.The marrow of the skull and skull base and visualized upper cervical spine is predominantly lower signal which is a nonspecific finding.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.The cerebellar tonsils are low lying and borderline for Chiari I malformation.2.In general there is a mottled appearance to the visualized marrow structures including upper cervical spine and skull base and calvarium. This is nonspecific and could be within the range of normal at this age. Low marrow signal can be seen with chronic disease, anemia, lymphoproliferative disorder, myeloproliferative disorder. It is a nonspecific finding


Instruction: Generate impression based on findings.

Input: Clinical question: preop for brain tumor resection. Signs and symptoms: Brain tumor. Unenhanced Stealth head CT:A standard preoperative nonenhanced stealth head CT is performed. A halo is secured to patient's head.Examination demonstrates mass in the right anterior temporal lobe with extension into the inferior right frontal lobe and right basal ganglia. Mass effect and deviation of third ventricle to the left is similar to prior MRI exam from 9 -- 6 -- 11. Ventricular system remains stable in size and unchanged. There is no detectable hemorrhage or any new foci of abnormality since prior exam. There is evidence of a small burr hole in right frontal bone likely from prior surgical approach for biopsy.

Output: Nonenhanced stealth head CT reveals stable right temporal, frontal and basal ganglia mass and its associated mass effect.


Instruction: Generate impression based on findings.

Input: Yearly follow up for ganglioglioma, status post resection. Postsurgical changes of left temporal ganglioglioma resection with left-sided craniotomy are redemonstrated. The large left cerebral convexity subdural fluid collection with multiple adhesions is unchanged in size from the prior exam measuring up to 28 mm on coronal images, previously 28 mm. Ventricular asymmetry with partial effacement of the left lateral ventricle and mild right ventricular enlargement is stable. An 8 mm rightward midline shift is unchanged. Subtle increased FLAIR signal in the left temporal lobe is again noted. Volume loss in the left anterior temporal lobe is also stable. Mild enhancement along the left anterior medial aspect of the resection cavity is redemonstrated. No new enhancing lesions to suggest recurrence or metastases. Tenting of the left frontal lobe to the overlying dura is not significantly changed. No acute intracranial infarction or hemorrhage. There are prominent cortical veins bilaterally, which are unchanged from the prior examinations and do not show evidence of thrombus on postcontrast imaging.A small mucous retention cyst is again noted in the left maxillary sinus. The visualized paranasal sinuses and mastoid air cells are otherwise clear. No acute intraorbital abnormality is evident.

Output: Stable examination including large chronic left holohemispheric subdural fluid collection with midline shift. No evidence of recurrence or metastasis.


Instruction: Generate impression based on findings.

Input: Pain along anterior aspect. Check for chondral injury versus meniscal tear MENISCI: Globular signal is observed in the body of the medial meniscus extending into the posterior horn extending up to the inferior articular surface. No definite discrete linear component is identified. Associated fraying of the inner edge and apical aspect are also observed. The lateral meniscus is significant for a similar globular signal in the posterior body again without a linear distinct component (image 9 series 6 and image 18 series 4); partial radial-like tear cannot entirely be excluded. The body and anterior aspects of the lateral meniscus are otherwise unremarkable. Both menisci are properly anchored posteriorly.ARTICULAR CARTILAGE AND BONE: Diffuse moderate to severe thinning of the cartilage bilaterally is observed in all 3 compartments and most pronounced in the patellofemoral. Specifically the lateral patellar facet is nearly completely lost. Underlying moderate degenerative changes are also observed with subchondral cysts and osteophytes throughout the joint. Contusion is observed along the medial tibial plateauLIGAMENTS: Mild MCL sprain with otherwise continuous intact fibers. The LCL, ACL and PCL all otherwise intact EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Bone contusion without discrete evidence of a fracture in the medial tibial plateau, meniscal degenerative changes and cartilaginous destruction with moderate to marked degenerative osteoarthritic changes are observed. See details provided above


Instruction: Generate impression based on findings.

Input: Please note examination is significantly motion degraded as patient could not tolerate the study. Post gadolinium images were obtained of the thoracic spine. Post contrast images of the cervical spine could not be obtained.As seen on recent lumbar spine MRI from 8/1/2016 there is a fluid collection involving the ventral epidural space extending superiorly from the lumbar spine. Current cervical and thoracic MRI images demonstrate large fluid collection which extends throughout the cervical and thoracic spine. Mild peripheral enhancement is evident on the thoracic study. The collection extends superiorly to the C1 level. The cervical and thoracic cord are posteriorly displaced and there is impression on the ventral aspects of the cervical and thoracic cords. Fluid collection predominantly involves the right ventral aspect of the upper thoracic spinal canal and the bilateral ventral epidural space in the lower thoracic as well as the cervical spine. Small loculations are evident in the upper cervical spine.No obvious cord signal abnormality within the limits of the study. Minimal degenerative changes are evident in the cervical and thoracic spine.There is deformity involving the superior T12 endplate with mild height loss and prominent Schmorl's node. Vertebral body heights in the cervical and thoracic spine are grossly maintained. No obvious destructive osseous lesions. No findings to suggest discitis-osteomyelitis in the cervical or thoracic spine based on the limited sequences.

Output: Large ventral epidural fluid collection with peripheral enhancement which tracks superiorly from the lumbar spine and involves the entire thoracic as well as the cervical spine to the C1 level. There is at least moderate degree of diffuse cervical and thoracic spinal canal stenosis and mild flattening of the spinal cord. Given the extent of the epidural collection as well as a paraspinous collection, this may have originated as a pseudomeningocele/CSF leak, now with suspected superimposed infection/epidural abscess formation.


Instruction: Generate impression based on findings.

Input: Check for meniscal tear or Baker's cyst. Knee swelling MENISCI: The menisci are intact and unremarkable. Old demonstrate proper anchoring posteriorly. However, extensive multilobulated cysts are observed posteriolateral to the lateral meniscus and displacing the lateral head of the gastrocnemius. Additional similar cysts are observed posterior to the medial condyles and epiphyseal plate, compatible with ACL ganglion cysts.ARTICULAR CARTILAGE AND BONE: Moderate thinning with underlying contusion involving the patellofemoral compartment, specifically the medial facet. The remaining compartments are otherwise unremarkable. Marrow signal is normal. Small bone island observed in the medial femoral condyle.LIGAMENTS: No significant abnormality noted. Specifically the ACL appears intact with discrete fibers.EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Multiple scattered para-meniscal and ACL ganglion cysts involving largely the postero-medial and lateral aspects of the knee. See detail provided


Instruction: Generate impression based on findings.

Input: There is no evidence of acute infarction, intracranial hemorrhage, or mass lesions. There is unchanged moderate T2 hyperintensity within the supratentorial and infratentorial cerebral white matter, which are likely related to micrangiopathy. There are also punctate foci of encephalomalacia in the left cerebellar hemisphere and left basal ganglia that likely represent chronic infarcts. There is a left hippocampal remnant cyst. The ventricles and sulci are stable in size and configuration. The major cerebral flow voids are grossly intact. There is a small amount of fluid within the bilateral mastoid air cells. There are bilateral lens implants.

Output: 1.No evidence of acute infarct, mass lesion, or intracranial hemorrhage.2.Unchanged moderate cerebral white matter signal abnormality likely related to microangiopathy and punctate foci of encephalomalacia in the left cerebellar hemisphere and left basal ganglia that likely represent chronic infarcts.


Instruction: Generate impression based on findings.

Input: Female, 67 years old, with history of L1 compression fracture. Evaluate for resolution or progression. Since the prior examination, further collapse of the L1 vertebral body has occurred. There is now approximately 60-70% loss of vertebral body height centrally. Elevated STIR signal within the L1 marrow space persists compatible with edema. The degree of retropulsion and associated ventral thecal sac effacement have progressed only minimally if at all. The conus is deflected posteriorly, but does not appear to be frankly impinged as there remains a thin cushion of CSF along its posterior surface.The remaining vertebral bodies demonstrate preserved height. No worrisome marrow abnormalities are detected. A grade 1/2 anterolisthesis of L4 relative to L5 seems to have progressed slightly from the prior examination now measuring up to 8 mm, previously 6 mm. There has been slight progression in the focal kyphotic angulation of the spine centered at L1 as well.T12-L1: L1 vertebral body retropulsion results in a mild to moderate generalized spinal canal stenosis but without frank impingement of the conus. The left neural foramen is mildly narrowed. No significant changes. L1-2: No significant spinal canal stenosis or neuroforaminal narrowing. L2-3: Minimal laterally bulging disc. No significant spinal canal stenosis or neuroforaminal narrowing. No significant interval changes.L3-4: Minimal laterally bulging disc. No significant spinal canal or neuroforaminal stenosis. No significant interval changes.L4-5: Advanced facet degeneration with ligamentum flavum thickening. Disc bulging and disc uncovering with a superimposed right paracentral superiorly directed extrusion. Severe narrowing of the spinal canal with crowding and likely impingement of the cauda equina nerve roots. Moderate to severe right and mild left neuroforaminal narrowing. No interval changes. L5-S1: Advanced left and mild right facet degeneration. No significant spinal canal or neuroforaminal stenosis. No interval changes.

Output: 1.Further interval collapse of the L1 vertebral body. Associated retropulsion and ventral thecal sac effacement are minimally changed if at all. This results in a moderate generalized spinal canal stenosis. The conus is deflected posteriorly but not frankly impinged.2.A grade 1/2 anterolisthesis of L4 relative to L5 has increased from prior, though this could represent differences in positioning. Degenerative findings at this level, including facet arthropathy, disc bulging and a right paracentral extrusion, have not significantly changed. The spinal canal is severely narrowed with crowding and impingement of the cauda equina similar to prior.


Instruction: Generate impression based on findings.

Input: Ms. Hand is a 40-year-old female with a strong family history of breast cancer including maternal grandmother, paternal grandmother, mother, sister and maternal great aunt. There is heterogeneous amount of fibroglandular tissue in both breasts. Marked background parenchymal enhancement is noted bilaterally, limiting the sensitivity of this examination.There is revisualization of three circumscribed enhancing masses, consistent with multiple benign fibroadenomata of both breasts. The mass in the right breast 3:00 position now measures 1.2 x 0.7 x 0.9 cm, previously measuring 1.2 x 0.7 x 0.9 cm. The mass in the right breast 12:00 position now measures 1.0 x 0.7 x 0.7 cm, compared to 1.0 x 0.8 x 0.7 cm. The mass in the left breast 8:00 position now measures 1.5 x 1.0 x 0.9 cm, compared to 1.5 x 1.01 x 0.9 cm. There is no new abnormal enhancement seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.

Output: Stable benign fibroadenomata of both breasts .No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Routine Screening Mammogram.


Instruction: Generate impression based on findings.

Input: Pain, unspecified [R52], Reason for Study: ^Reason: evaluate for disc herniation, nerve root compression History: L leg paresthesias, numbness, severe pain For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. Motion artifacts degraded exam quality especially axial scan. If clinically necessary, the exam can be repeated.There is slight loss of normal lumbar lordosis. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. The epidural space, thecal sac, and spinal cord are preserved with no evidence of spinal canal/neural foraminal narrowing. The conus medullaris terminates at the T12-L1 level. Degenerative changes are specified by the intervertebral level as follows: T12-L1: no neuroforaminal narrowing or spinal stenosis. L1-L2: no neuroforaminal narrowing or spinal stenosis. L2-L3: There is foraminal focal disc protrusion on the left side narrowing neuroforamen. Disc dessication is seen. No spinal stenosis. L3-L4: There is broad based disc protrusion toward left side neuroforamen results neuroforaminal stenosis. No spinal stenosis. Disc dessication is seen.L4-L5: Diffuse bulging of disc abuts thecal sac. no neuroforaminal narrowing or spinal stenosis. L5-S1: Diffuse bulging of disc. no neuroforaminal narrowing or spinal stenosis.

Output: 1. Multilevel disc protrusions including L23 and L34 toward left side neuroforamen as described above.2. No evidence of spinal cord signal abnormality.


Instruction: Generate impression based on findings.

Input: H/o unknown primary with widely metastasis. Examination demonstrates diffuse bony destruction in the thoracic and lumbar spine as well as sacrum with loss of vertebral body height in T2, T12, L1 and L2. It appears that the spinal canal narrows at Levels T2 and L1. Please refer to spine MRI for details of cord compression. Specifically, there is bony destruction in the C7, T1-7, T9-L3, and L5 vertebral bodies and sacrum, in which posterior element destruction is seen in the C7-T3, T12-L3 and L5, and rib destruction is seen at levels T1-T3 and T7. Bilateral effusion is also noted.

Output: Diffuse metastatic disease in the thoracic and lumbar spine as detailed above. spinal canal stenosis at levels T2 and L1, please refer to spine MRI for details of cord compression.


Instruction: Generate impression based on findings.

Input: 16 year old male with knee pain and instability. Evaluate meniscus and ACL MENISCI: There is a vertical tear with blunting of the posterior horn of the lateral meniscus. The medial meniscus is intact with no significant abnormality noted.ARTICULAR CARTILAGE AND BONE: No significant abnormality noted.LIGAMENTS: No significant abnormality noted. Specifically the ACL is intact with no abnormal signal noted.EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Findings compatible with a tear of the posterior horn of the lateral meniscus.


Instruction: Generate impression based on findings.

Input: Metastatic esophageal cancer with new brain metastasis. There is a lesion in the left precentral gyrus that measures up to 8 mm and contains susceptibility effect. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Preoperative planning MRI demonstrates a subcentimeter metastasis in the in the left precentral gyrus.


Instruction: Generate impression based on findings.

Input: There is slight reversal of normal upper cervical curvature. There are no fractures or subluxations. The marrow signal is benign. The cervical and upper thoracic cord are normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.Modic type I reactive endplate change with adjacent atypical hemangioma is present involving the anterosuperior aspect of C5.C2/3: UnremarkableC3/4: UnremarkableC4/5: Mild posterior osteophyte disc complex without stenosis.C5/6: Posterior osteophyte disc complex and bilateral uncinate hypertrophy. There is moderate to severe bilateral neural foraminal stenosis.C6/7: Mild posterior osteophyte disc complex without stenosis.C7/T1: Unremarkable

Output: C5/6: Moderate to severe bilateral neural foraminal stenosis.


Instruction: Generate impression based on findings.

Input: Evaluate previously identified perianal abscess. PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Multiple bilateral inguinal prominent lymph nodes are unchanged from prior.BOWEL, MESENTERY: No significant abnormality noted.BONES/SOFT TISSUES: The previously identified left perianal soft tissue fluid collection is decreased in size (series 401, image 52), now measuring approximately 1.2 x 0.4 cm, previously 1.6 x 0.7 cm, with a perianal drainage catheter in place. This collection is hyperintense on T2 imaging, hypointense on T1 imaging and has restricted diffusion, compatible with abscess. Adjacent inflammation is identified on T2 imaging, which extends to the base of the left scrotum and minimally involves the right perineum. A right perianal drainage catheter is identified, with no associated drainable collection. No new fluid collection is identified.

Output: Decreased size of the left perineal abscess and associated inflammation. Bilateral perianal drainage catheters are in place.


Instruction: Generate impression based on findings.

Input: Female, 46 years old, with worsening ataxia and falls and new right sixth nerve palsy. Again seen is severe atrophy of the right cerebral hemisphere with patchy superimposed nonmasslike parenchymal enhancement. Modest atrophy of the brainstem and left cerebral hemisphere is also redemonstrated.No CP angle or IAC masses are seen. No pathologic enhancement is demonstrated in the basal cisterns, IACs or inner ear structures.The cisternal portions of the sixth cranial nerves are identified and seem to be within normal limits. The eighth cranial nerves are likewise unremarkable bilaterally. The right facial nerve is not well seen and may be somewhat atrophic.No significant cavernous sinus lesions are suspected, though a small laterally directed right cavernous ICA aneurysm is probably revisualized. The right globe deviates nasally compatible with the stated history. The right lateral rectus muscle is somewhat thin.

Output: 1.Redemonstration of right greater than left cerebellar atrophy and atrophy of the brainstem.2.No definite CP angle, IAC or cranial nerve lesions are identified.3.The right globe deviates nasally, and the right lateral rectus muscle is somewhat thin which could reflect passive stretch or flaccidity.


Instruction: Generate impression based on findings.

Input: Prostate cancer, evaluate disease extent PELVIS:PROSTATE:Prostate Size: 7 cm in transverse dimension x 6.9 cm in craniocaudal dimension x 7.4 cm in AP dimension.Peripheral Zone: Ovoid focus of T2 hypointense signal in right-sided mid peripheral zone posteriorly measuring 9 x 7 mm. Corresponding marked low ADC signal visualized, image 184 series 704. Early arterial enhancement suggested.Central Gland: Marked BPH with median lobe hypertrophy extending into bladder.Seminal Vesicles: Symmetric signal seen.Extracapsular Extension: Right-sided 9 mm peripheral zone T2 hypointense lesion does not demonstrate extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: Right greater than left small fat-containing inguinal hernias.OTHER: Increased T1 signal seen in bilateral transition zones posteriorly, suspicious for underlying hemorrhage. To a lesser degree similar signal seen in bilateral peripheral zones. Atherosclerotic abdominal aorta, mildly aneurysmal.

Output: 1. Right-sided 9 mm mid peripheral zone lesion suspicious for prostatic adenocarcinoma given decreased T2 signal and marked low ADC signal.2. Mildly aneurysmal abdominal aorta partially imaged, measuring up to 3 cm.


Instruction: Generate impression based on findings.

Input: Diagnosis: Hemangioma of intracranial structuresClinical question: Please evaluate cavernomas for changes, 3T Scanner, QSM/Permeability, CCM Protocol. Please compare to outside scan from July.Signs and Symptoms: Brainstem cavernomas, worsening vision, gait in recent months since last MRIComments: Please evaluate cavernomas for changes, 3T Scanner, QSM/Permeability, CCM There is redemonstration of a 10 x 6 mm lesion in the right pons associated with heterogeneous signal on T2 and T1 and a popcorn-like appearance on T2. There is some associated contrast enhancement.There is a redemonstration of a heterogeneous lesion with susceptibility effect present in the left midbrain along the tectal plate which measures 10 x 7 mm axial dimensions and previously measured similar dimensions there is redemonstration of T2 signal hyperintensity along the anterior lateral aspects of the medulla bilaterally. There is some associated contrast enhancement.There is a developmental venous anomaly present along the pons.On susceptibility weighted imaging there is a punctate focus of signal loss in the medial aspect of the left occipital lobe.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Redemonstration of a pontine and midbrain cerebral cavernous hemangiomas associated with an adjacent developmental venous anomaly.2.Some signal changes in the medulla are present which are nonspecific. Stable since the prior exam and could be reactive to the above lesions.


Instruction: Generate impression based on findings.

Input: Primary CNS lymphoma, please restage. Please note lack of contrast limits evaluation for tumor recurrence. Again seen are postoperative findings related to left transfrontal biopsy. There is unchanged confluent T2 hyperintensity and susceptibility effect in the superior left frontal lobe without associated mass effect or restricted diffusion. There is also unchanged scattered cerebral white matter T2 hyperintensity, particularly in a periventricular distribution, which is compatible with chronic small vessel ischemic and/or posttreatment changes. There is no evidence of acute infarct. There is global parenchymal volume loss commensurate with patient's advanced age. No hydrocephalus. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are unchanged, including a left occipital scalp lipoma.

Output: Lack of contrast again limits evaluation for tumor recurrence. There is no significant change in FLAIR hyperintensity involving the left frontal lobe, which while nonspecific, is favored to represent posttreatment change. No new mass or mass effect to suggest tumor recurrence.


Instruction: Generate impression based on findings.

Input: Reason: please do Dr. Javed MS protocol History: headaches and numbness. Brain: Compared to 10/31/2014, no significant change is seen in the multiple scattered foci of FLAIR hyperintensity within the periventricular, juxtacortical, and deep white matter. No new lesions. No lesions with enhancement to suggest active demyelination. There is no evidence of intracranial mass or mass effect. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. Brain parenchymal volume is within normal limits for age.Cervical Spine: There is no convincing T2 signal abnormality or enhancement of the spinal cord. Apparent T2 hyperintensity in the right ventral cord at the C4 level on the axial T2 sequence is not corroborated on the other sequences and likely artifactual. There are mild degenerative changes in the cervical spine including facet arthropathy but without significant spinal canal or neural foraminal stenosis at any level. There are unchanged enhancing foci within the C7 and T4 vertebral bodies with some T1 hyperintensity associated with the T4 lesion, and favored to represent hemangiomas. The vertebral body heights and alignment are preserved, aside from trace retrolisthesis of C6 on C7 as seen before.

Output: 1. Compared to10/31/2014, there are no new lesions or abnormal enhancement to suggest active demyelination. 2. No evidence of demyelinating lesions within the cervical spinal cord.3. Enhancing focus within the C7 and T4 vertebral bodies likely represent hemangiomas.


Instruction: Generate impression based on findings.

Input: Male 62 years old Reason: Left knee pain (superolateral) and instability for one month, no trauma. MENISCI: Medial and lateral menisci are intact.ARTICULAR CARTILAGE AND BONE: Marked thinning of the articular cartilage involving the lateral femoral condyle, but no focal cartilage defect. Mild irregularity of the medial facet of the patella.LIGAMENTS: Cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: Extensor mechanism is intact.ADDITIONAL

Output: No MRI findings to account for patient's symptoms. Extensive chondrocalcinosis involving the left knee on 8/27/2015 radiograph may account for patient's symptoms.


Instruction: Generate impression based on findings.

Input: 11-year-old female with chronic right hip pain in the setting of neuroblastoma. Evaluate for right hip pathology. Bone marrow signal intensity is normal. No osseous masses are evident. The femoral head is well-positioned within the acetabulum with no joint space narrowing or effusion.The surrounding soft tissues appear normal. No areas of abnormal enhancement are evident.

Output: No osseous or soft tissue abnormality affect the right hip.


Instruction: Generate impression based on findings.

Input: 61-year-old female with history of liver lesion seen on outside MRI. ABDOMEN:LIVER, BILIARY TRACT: Segment 7 T2 hyperintense lesion demonstrating discontinuous peripheral nodular enhancement with progressive filling compatible with hemangioma measuring 22 x 18 mm (image 6 of series 4). Additional T2 hyperintense lesion at the medial aspect of segment 7 also demonstrates discontinuous peripheral nodular enhancement with progressive filling compatible with hemangioma measuring 25 x 29 mm (image 11 of series 4). Hyperenhancing focus in the lateral aspect of segment 7 measures 10 x 9 mm and likely represents a flash filling hemangioma. Nonenhancing segment 6 T2 hyperintense lesion compatible with simple cyst measuring 42 x 35 mm (image 16 of series 4).Additional subcentimeter nonenhancing T2 hyperintense lesions likely represent small cysts or hemangiomas.No intra or extra hepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: 2 cm left ovarian cyst.Bilateral small breast cysts.Small volume free fluid.

Output: Benign-appearing hepatic hemangiomas and simple cysts.


Instruction: Generate impression based on findings.

Input: 55-year-old male with knee pain and previous subchondral plasty. New AVN? MENISCI: There is linear increased signal abnormality which traverses the posterior horn of the medial meniscus and extends to the tibial articular surface consistent with a horizontal tear which extends to the body of the meniscus. The anterior horn appears intact. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is full-thickness articular cartilage degeneration along the weightbearing surface of the medial femoral condyle and medial tibial plateau with underlying degenerative subchondral signal abnormality and cyst formation. There is full-thickness articular cartilage degeneration along the weightbearing surface of the medial tibial plateau and thinning of the articular cartilage along the lateral femoral condyle. There is full-thickness articular cartilage degeneration along the lateral facet of the patella. There is partial-thickness articular cartilage degeneration along the medial facet of the patella. There is full-thickness articular cartilage degeneration along the lateral facet of the femoral trochlea and centrally. There is diffuse increased signal abnormality within the medial femoral condyle and to a lesser degree the medial tibial plateau which may represent avascular necrosis although no characteristic serpentine signal abnormality is identified.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Diffuse bone marrow signal abnormality within the medial femoral condyle and medial tibial plateau may represent avascular necrosis superimposed on degenerative osteoarthritic changes, although this does not demonstrate the typical serpentine signal abnormality characteristic of this entity.2. Osteoarthritis of the right knee including full-thickness articular cartilage degeneration as described above3. Horizontal tear of the medial meniscus as described above.


Instruction: Generate impression based on findings.

Input: 26-year-old male patient with lower back pain. Evaluate for sacroiliitis/ankylosing spondylitis. We see no enhancement of the sacroiliac joints to suggest sacroiliitis. There is minimal edema-type signal along the lateral aspect of the lower right sacrum, which is nonspecific and could be degenerative rather than inflammatory in etiology. We see no definite erosions or ankylosis. Otherwise, the bone marrow signal intensity is normal.

Output: Minimal edema in the lateral aspect of the lower right sacrum is nonspecific. We see no enhancement of the sacroiliac joints to confirm sacroiliitis.


Instruction: Generate impression based on findings.

Input: Clinical question: Worst headache of life, posterior headaches, left-sided weakness, slurred speech. Signs and symptoms: Worst headache of her life, posterior headache, left-sided weakness, slurred speech. Nonenhanced CT of brain:Images through posterior fossa are unremarkable.Edema in the right anterior temporal tip with a small amount of hemorrhage is noted. Combination of these findings measures approximately 46 mm x 25 minute periodsmall area of parenchymal edema in the right frontal pole measuring 19 mm times 19-mm. No hemorrhage associated with this finding.Minimal subarachnoid hemorrhage localized to the right anterior parietal region.Suspect a small CSF density extra-axial collection in the left frontal and temporal region. This finding measures approximately 4.5 Mm in size. The gray -- white matter differentiation is preserved. Ventricular system is within normal size and no midline shift.No -attenuation of the white matter of bilateral occipital lobes and is believed to be artifactual.Calvarium is intact. Visualized paranasal sinuses and mastoid air cells demonstrate minimal findings of acute sinusitis in the right maxillary sinus no detectable fracture on this exam. No definitive abnormality of the scalp. For further evaluation MRI examination of brain is recommended.

Output: 1.Foci of edema in the right anterior temporal tip with minimal hemorrhage and right anterior -- inferior frontal lobe without hemorrhage and minimal localized right parietal subarachnoid hemorrhage. Findings are suspected for posttraumatic changes. Follow-up with an MRI is recommended to exclude extent of injury or additional cause for these findings.2.Normal size of ventricular system and no midline shift.3.Negative calvarium.


Instruction: Generate impression based on findings.

Input: T2N0 right lateral oral tongue squamous cell carcinoma. The right lateral oral tongue lesion is not discernible. There is no evidence of significant cervical lymphadenopathy based on size criteria. The thyroid and major salivary glands are unremarkable. The major cervical flow voids are intact. The osseous structures are unremarkable. The orbits and imaged intracranial structures are unremarkable.

Output: The right lateral oral tongue lesion is not discernible. No evidence of significant cervical lymphadenopathy.


Instruction: Generate impression based on findings.

Input: 49 years Female (DOB:6/13/1967)Reason: patient with MS and cognitive decline - please assess MS burden (compare with 2003) History: language impairment and retrieval memoryPROVIDER/ATTENDING NAME: JAMES A. MASTRIANNI JAMES A. MASTRIANNI The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images as well as the left pons and middle cerebellar peduncle. There is FLAIR and T2 hyperintensity present in the gray matter adjacent to the right collateral sulcus. The trigones of the lateral ventricles are generous. These findings were present on the prior exam from 2003 but have not changed substantially. Please note however that the prior exam was somewhat compromised due to motion artifact.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Multiple periventricular, subcortical and subcortical white matter lesions are present in which appear to have been present on prior exam from 2003. There is not appear to be a significant change since that time to the extent of comparison possible.2.Mild ventriculomegaly is also stable.


Instruction: Generate impression based on findings.

Input: Female, 55 years old. Reason: complains of hoarseness and has had multinodular goiter History: rule out enlargement RIGHT LOBE MEASUREMENTS: 7.9 x 2.4 x 2.2 cmLEFT LOBE MEASUREMENTS: 8.3 x 3.2 x 3.2 cmISTHMUS MEASUREMENTS: 0.6 cmRIGHT LOBE: Heterogeneous echotexture, with multiple nodules. A right superior Palmetto measures 1.3 x 0.8 by 1.6 cm, heterogeneous and hypoechoic, predominantly solid, calcified, with mild internal vascularity. A right inferior pole nodule measures 1.1 x 0.6 x 2.1 cm, heterogeneous, solid, calcified, with minimal internal vascularity. A right mid thyroid nodule measures 2.2 x 1.8 x 2.2 centimeters, solid and heterogeneous, noncalcified, with mild internal vascularity.LEFT LOBE: Heterogeneous echotexture, with multiple nodules. A lower pole nodule measures 2.1 x 1.1 x 1 .9 cm, solid and heterogeneous, with internal calcification and moderate internal vascularity. A mid to superior pole nodule measures 2.3 by 1.9 x 1 .5 cm, isoechoic and mildly heterogeneous, noncalcified, with moderate internal vascularity.ISTHMUS: Heterogeneous echotexture.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Benign-appearing cervical lymph nodes are identified. A right level 2 lymph node measures 0.7 x 0.4 x 1.4 cm, with a fatty hilum. A left level 3 lymph node measures 0.4 x 0.2 x 0.4 cm, with a fatty hilum.OTHER: No significant abnormality noted.

Output: Multinodular goiter, not significantly changed from prior.


Instruction: Generate impression based on findings.

Input: 18-year-old female with Chiari malformation, now experiencing neck pain and headache, status post the compression. Brain: There has been interval repositioning of a fourth ventricular shunt now extending from the level of the dura, into the fourth ventricle, terminating within the cerebral aqueduct. The fourth ventricular height measured in the midline is decreased from 15 to 13 mm. Overlying the dura, there is a a larger post procedural fluid collection measuring 25 mm transverse x 35 mm AP x 65 mm craniocaudal, without significant mass effect upon the adjacent dura. There has been increase in both lateral and third ventricular sizes, the former measuring 38 mm (previously 32 mm), and the latter measuring 6 mm (previously 2 mm), as measured on coronal T2 imaging at the level of the foramen Monroe.Redemonstrated are postoperative findings related to Chiari decompression. Mild deformity of the posterior inferior cerebellum and medulla associated is unchanged. There is slightly more biphasic CSF flow noted posteriorly at the level of the cerebellar tonsils. There is no evidence of acute intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. Expected vascular flow-voids are demonstrated. The paranasal sinuses and mastoid air cells are clear.Cervical Spine: There is no evidence of syringohydromyelia. The vertebral body heights are preserved. There is no significant spinal canal or neural foraminal stenosis. The vertebral bone marrow signal is unremarkable. The vertebral column alignment is unchanged with mild retroflexion of the dens and lack of the usual lordosis. There appears to be a left thyroid nodule.

Output: 1.There has been interval repositioning of a fourth ventricular shunt now extending from the level of the dura, into the fourth ventricle, terminating within the cerebral aqueduct. The fourth ventricular height measured in the midline is decreased from 15 to 13 mm. There has been increase in both lateral and third ventricular sizes. Overlying the dura, there is a a larger post procedural fluid collection measuring 25 mm transverse x 35 mm AP x 65 mm craniocaudal, without significant mass effect upon the adjacent dura. There is slightly more biphasic CSF flow noted posteriorly at the level of the cerebellar tonsils. 2.There is no evidence of syringohydromyelia.


Instruction: Generate impression based on findings.

Input: 51-year-old male. Right hip pain. Evaluate for AVN, labral path. ACETABULAR LABRUM: Intermediate signal abnormality in the anterior superior labrum consistent with degeneration. No discrete tear is evident.ARTICULAR CARTILAGE AND BONE: Abnormal low signal intensity involving the subchondral bone of the superior aspect of the right femoral head consistent with avascular necrosis. This avascular necrosis involves nearly the entire articular surface of the femoral head. There is adjacent edema in the femoral head extending into the neck and intertrochanteric region. No frank articular surface collapse of the right femoral head. There is also avascular necrosis of the left femoral head as seen on the large FOV images without frank articular collapse.SOFT TISSUES: No significant abnormality noted. ADDITIONAL

Output: 1. Avascular necrosis of the bilateral femoral heads without frank articular collapse. Large amount of associated edema in the right femoral head and neck.2. Degeneration of the right anterior superior labrum without a discrete tear.


Instruction: Generate impression based on findings.

Input: Male 37 years old Reason: evaluation of persistent shoulder pain, poss labral injury History: same ROTATOR CUFF: All components of the rotator cuff are intact. No muscle atrophy.SUPRASPINATUS OUTLET: Type I acromion.GLENOHUMERAL JOINT AND GLENOID LABRUM: Humeral head is well seated at the glenoid. No evidence of a labral tear. No loose bodies joint. No evidence of a Bankart or Hill-Sachs lesion.BICEPS TENDON: Biceps tendon is well seated within the bicipital groove.ADDITIONAL

Output: Normal MRI of the shoulder.


Instruction: Generate impression based on findings.

Input: 68-year-old male with chronic pancreatitis and pancreatic cyst, abdominal pain ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter T2 hyperintensities likely reflect cysts. The common bile duct is normal in caliber.SPLEEN: No significant abnormality noted.PANCREAS: Intrinsic T1 signal is diminished. Numerous T2 hyperintense cystic foci scattered throughout an atrophic pancreas some of which demonstrate communication with the main pancreatic duct. No pancreatic divisum is present. The main pancreatic duct is normal in caliber. Please note that calcifications are not reliably identified on MR. ADRENAL GLANDS: Mild left adrenal gland thickening.KIDNEYS, URETERS: Subcentimeter cysts in bilateral kidneys. 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.Atrophic pancreas with numerous hyperintense cystic foci scattered throughout the pancreas; provided the patient's history, findings likely represent sidebranch ectasia. Underlying IPMNs cannot be entirely excluded.


Instruction: Generate impression based on findings.

Input: Status post fall from 6 stories, status post removal of bolt. Evaluate for DAI. Evaluate for ligamentous injury, C1 fracture. Brain: Linear tract with T2/FLAIR hyperintensity is noted in the right frontal lobe related to prior ICP bolt. Remainder of the brain appears within normal limits. No evidence of intracranial hemorrhage. No restricted diffusion to suggest acute ischemia. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. No extra-axial collections. Major flow-voids are preservedSella and orbits are grossly within normal limits. There is diffuse opacification of the paranasal sinuses and mastoid air cells which may be related to intubation. Bone marrow signal is within normal limits.Cervical Spine: Images of the cervical spine are slightly motion degraded. No convincing cord signal abnormality is appreciated. Fracture involving the anterior C1 arch on the left is better appreciated on recent CT. Atlantodental interval is maintained. Transverse ligament is intact. Coronal sequence was not obtained however no obvious evidence of alar ligament injury. Minimal fluid is noted involving the occipital condyle/C1 joint and atlantoaxial joint. No evidence of cord contusion or epidural hematoma. Ligamentous structures are intact. Vertebral body heights are normal. Alignment is normal. No significant spinal canal or neural foraminal stenosis is appreciated.

Output: 1. No evidence of intracranial hemorrhage. No findings to suggest diffuse axonal injury. 2. Fracture involving the anterior C1 arch better demonstrated on CT. No findings to suggest ligamentous injury. No abnormal signal in the cervical cord. No epidural hematoma.


Instruction: Generate impression based on findings.

Input: 72-year-old male status post transphenoidal hypophysectomy. There is no evidence of intracranial hemorrhage or edema. Reidentified is a large, pituitary macroadenoma with extensive expansion of the sella and invasion of the sphenoid sinus and clivus which appears to be overall slightly smaller in size when compared to be presurgical MRI. There is no extension into the pre-pontine cistern There is bilateral involvement of the cavernous sinuses. There is significant extension of the tumor into the basal cistern.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized mastoid air cells are normally pneumatized. The paranasal sinuses and sphenoid sinus demonstrate opacification and air fluid levels which may be consistent with postsurgical blood and or packing material.

Output: Expected postsurgical changes as described above.


Instruction: Generate impression based on findings.

Input: At least ten distinct T2 hyperintense white matter lesions are seen, many of which are perpendicular to the lateral ventricles in orientation, with a few lesions in the corpus callosum anterior and posterior body. There is interval improvement of the left parietal/occipital lobe lesion in the left periatrial white matter on series 701 image 36. The remaining lesions are stable and no new lesions are seen.

Output: Mild improvement in the left parietal/occipital periatrial white matter lesion. No new white matter lesions. Other white matter lesions are stable.


Instruction: Generate impression based on findings.

Input: Reason: Grade II oligodendroglioma s/p RT/PCV. Now off all Tx. Again seen are postsurgical changes in the left frontal lobe with the resection cavity appearing similar in size compared to the prior study. Compared to most recent study, there is no significant change in extent of T2/FLAIR hyperintensity surrounding the resection cavity, involving the left frontal corona radiata and extending into the right frontal corona radiata across the body of the corpus callosum. As noted before there is slight increase in extent of FLAIR signal abnormality when compared to more remote studies which is nonspecific and may be related to posttreatment change.Additional scattered nonspecific foci of T2/FLAIR hyperintensity in the bilateral cerebral white matter are also not significantly changed. No new mass effect, midline shift, or herniation. Ventricles are normal in size aside from the ex vacuo dilatation involving the left lateral ventricle. There is no suspicious enhancement. Unchanged nodular enhancement projecting into the cavity from the midline falx and linear enhancement along the posterior inferior cavity margin. Susceptibility artifact surrounding the cavity margins is compatible with chronic blood products.

Output: No evidence of tumor progression.