Instruction: Generate impression based on findings.

Input: 20-year-old female with left knee pain, tender to palpation and positive McMurray test MENISCI: The lateral meniscus is intact. The medial meniscus is intact.ARTICULAR CARTILAGE AND BONE: Edema within the anterior tibial plateau and anterior medial femoral condyle is compatible with bone contusions. A linear region of decreased T1 signal along the medial tibial plateau without depression may represent a nondisplaced fracture. There is generalized thinning of the patellar cartilage without a fluid-filled defect. The trochlear, medial compartment and lateral compartment articular cartilage is intact.LIGAMENTS: The ACL and PCL are intact. The MCL and lateral collateral ligament complexes are intact. EXTENSOR MECHANISM: Extensor mechanism is intact.ADDITIONAL

Output: Nondisplaced fracture of the medial tibial plateau.Numerous attempts were made to contact the service. The provided contact number was of Dr. Vasishta, who said that she did not know the patient and the contact number must have been entered in error. Attempts were made to contact Dr.Reider, who was not available, and Dr. Saper, who did not return pages. The patient was called twice without response. An email was finally sent to the patient informing the patient about the MRI findings and advising them to contact their primary physician/orthopedist immediately.


Instruction: Generate impression based on findings.

Input: Evaluate left renal mass. History of chronic kidney disease and hypertension. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology, signal intensity and size. No focal suspicious lesion, or biliary ductal dilatation. Normally distended gallbladder without gallstones.SPLEEN: 9.6 x 9.5 cm homogeneously T2 weighted hyperintense lesion with a very hypointense mural nodule (may represent calcification) is nonspecific but demonstrates no postcontrast enhancement, and is likely benign.PANCREAS: No focal lesion or main pancreatic ductal dilatation.ADRENAL GLANDS: Subcentimeter right adrenal lateral limb nodularity.KIDNEYS, URETERS: Several punctate T2 hyperintense and hypointense subcentimeter right renal lesions are too small to characterize, likely benign cysts.Left renal superior pole 9.9 x 8.1 cm lesion demonstrating T2 weighted intermediate hyperintensity and T1-weighted hyperintensity with ill-defined hypointense margins and a heterogeneous mural nodule. There is equivocal wall enhancement and suspected enhancing mural nodularity (series 102, image 38). Additional T2-weighted markedly hyperintense lesions including an inferior pole exophytic 8.6 x 5.6 cm lesion without suspicious enhancement.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.The left renal superior pole predominantly cystic 9.9 cm hemorrhagic lesion has equivocal wall enhancement and suspected enhancing mural nodularity.2.Additional large left inferior pole cystic lesion demonstrates no suspicious post-contrast enhancement.3.Additional bilateral simple cysts, minimally complex cysts and too small to characterize renal lesions.


Instruction: Generate impression based on findings.

Input: 70-year-old female with right arm pain. Evaluate for fractures. The bones appear demineralized suggesting osteopenia, but we see no fracture. There is lateral spurring of the acromion process and perhaps narrowing of the acromiohumeral interval. If there is clinical concern for a rotator cuff tear, MRI could be considered.

Output: Acromial spurring without evidence of fracture.


Instruction: Generate impression based on findings.

Input: Preoperative planning for a pituitary mass. There is a heterogeneous sellar and suprasellar mass that measures up to 38 mm. The tumor has mass effect upon the optic apparatus and anterior cerebral arteries, adjacent to a prominent ACOM complex. There are skin fiducial markers in position.

Output: Pretreatment planning MRI demonstrates a heterogeneous sellar and suprasellar mass. Please refer to the prior neuroimaging for additional details.


Instruction: Generate impression based on findings.

Input: Post op SDH burr holes, with minimal responsiveness, increased tone. There are postoperative findings related to recent bilateral frontal burr holes and bilateral parietal burr hole drainage of bilateral cerebral convexity predominantly high T1 and T2 signal subdural hematomas, which are mixed with pneumocephalus and areas of relatively intermediate T1 and low T2 signal hemorrhage, but are not significantly changed in size, accounting for differences in technique. There are drainage tubes that course through the right frontoparietal burr hole and the left parietal burr hole, terminating in the bilateral subdural spaces. The right frontal convexity catheter forms a partial loop, indenting the underlying brain parenchyma. There are multiple curvilinear areas of susceptibility effect, which represent hemorrhage, and surrounding T2 hyperintensity, which represents vasogenic edema, in the bilateral frontal and parietal lobes related to catheter tract injuries. The transparietal tracts extend to the corpus callosum. Thine areas of apparent restricted diffusion accompanying portions of the bilateral parietal lobe tracts may be attributable to devitalized tissues along the margins of the tracts versus artifact from susceptibility effects. However, there is no acute territorial infarct. There is trace left lateral ventricular hemorrhage. There is scattered sulcal and basal cistern T2 hyperintensity, which corresponds to subarachnoid hemorrhage. There is persistent effacement of the basal cisterns and third and lateral ventricles. There is also persistent midline shift towards the right measuring approximately 6 mm and mild left uncal herniation.

Output: 1. Postoperative findings related to recent drainage of bilateral predominantly subacute cerebral convexity subdural hematomas with acute components, which have otherwise not significantly changed in size. The right frontal convexity catheter continues to form a partial loop and indents the underlying brain.2. Multiple areas of intraparenchymal hemorrhage and edema assocated with bilateral frontal and parietal cerebral contusions and lacerations, most of which are more conspicuous than on the previous CT examinations due to differences in technique.3. Persistent scattered subarachnoid hemorrhage and trace intraventricular hemorrhage.4. Persistent midline shift towards the right measuring approximately 6 mm and mild left uncal herniation.


Instruction: Generate impression based on findings.

Input: Calvarium metastases from breast cancer. There has been gradual decrease in size of multiple heterogenously enhancing skull lesions. The largest of these is located in the occipital bone with epidural extension and mass effect upon the torcula herophili. This lesion now measures approximately 20 x 65 mm in cross-section, versus 32 x 72 mm in January 2015. There is no evidence of abnormal brain parenchymal or leptomeningeal enhancement. There is no evidence of intracranial hemorrhage or acute infarct. The pituitary gland appears unremarkable. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. There is unchanged deformity of the right lamina papyracea defect with protrusion of orbital fat. There is nonspecific fluid within the mastoid air cells, right more than left.

Output: 1. Gradual decrease in size of multiple skull metastases.2. No evidence of leptomeningeal or intraparenchymal brain metastases.


Instruction: Generate impression based on findings.

Input: 57 years, Male, Reason: history of low volume Gleason 6 prostate cancer, biopsy to follow History: see above. PELVIS:PROSTATE:Prostate Size: 5.3 x 2.8 x 3.2 cm Peripheral Zone: There is a lesion in the right apex measuring 1.1 x 0.8 centimeters (804/124) with low T2/ADC signal suspicious for prostatic adenocarcinoma. A lesion in the right mid gland peripheral zone measuring 1.3 x 1.0 cm (804/224) with low T2/ADC signal is suspicious for prostatic adenocarcinoma. Small lesion in the left peripheral zone mid gland measures 0.6 x 0.7 cm (804/204), also suspicious.Central Gland: No significant abnormality notedSeminal Vesicles: No extension.Extracapsular Extension: No extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No lymphadenopathy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Three small foci in the right apex, right central gland peripheral zone and left central gland peripheral zone with signal characteristics suspicious for prostatic adenocarcinoma.2.No lymphadenopathy.


Instruction: Generate impression based on findings.

Input: Male, 14 years old, with neurofibromatosis type II, presenting with unsteadiness, right leg pain, and coordination problems. Brain and IACs:Solid enhancing tumors within both internal auditory canals are redemonstrated. Both lesions demonstrate a mild interval increase in size. For reference purposes, the lesion on the right measures approximately 10 x 6 mm, and previously measured approximately 6 x 4 mm.Thickening and abnormal enhancement of the cisternal segments of the bilateral fifth cranial nerves is also seen, right side more than left. These lesions have also become more conspicuous when compared to the prior examination. On the right this abnormal thickening and enhancement involves the cavernous sinuses as well.Patchy T2 hyperintensity and dysmorphism within the right lateral cerebral hemisphere is again seen without significant interval change. Smaller areas of signal abnormality are also unchanged within the left cerebellar in the superior. The cerebellar lesions are associated with foci of susceptibility which could reflect either mineralization, vascular structures or chronic hemosiderin deposition.A small focus of abnormal T2 hyperintensity and mild dysmorphism is seen within the left superior temporal gyrus. This region also shows minimal susceptibility effect and there is a small amount of ill-defined enhancement as well.No evidence of significant generalized mass effect is seen. No abnormal extra-axial fluid collections are detected. The ventricular system remains normal in size and morphology.A plaque-like enhancing lesion is evident along the left intraorbital optic nerve. This lesion was present on the prior examination and does not appear to have changed substantially.Spine:A large intradural extramedullary tumor is evident at the T4 level measuring up to 30 mm CC and 15 x 12 mm transaxial. The lesion enhances homogeneously and is relatively T2 hypointense. This lesion occupies nearly the entire spinal canal causing severe canal stenosis and severe cord compression. The cord is markedly flattened and displaced to the left anterior aspect of the spinal canal.At the C4 level, there is an enhancing intradural extramedullary tumor within the left lateral aspect of the spinal canal measuring up to 9 x 7 mm transaxial. This lesion exerts mild mass effect upon the spinal cord but without obvious cord edema.Numerous scattered small nodules ranging in size from punctate to 5 mm are seen along the conus and nerve roots of the cauda equina.Multiple foci of abnormal spinal cord signal, thickening and pathologic enhancement are seen including at the C2 and C3 levels and at the T2 and T3 levels.A few scattered areas of questionable foraminal and extraforaminal nerve root thickening are seen though none of these is large or discrete enough to allow for confident diagnosis of tumor.Allowing for a mild scoliotic curvature of the thoracic spine, alignment is anatomic. Vertebral body height and morphology are within normal limits. No concerning marrow signal abnormality is detected.

Output: 1.A large intradural extramedullary tumor is evident at the T4 level occupying nearly the entire spinal canal and causing a severe canal stenosis and severe cord compression. The signal characteristics of this lesion favor meningioma over nerve sheath tumor.2.A smaller intradural extra medullary tumor is evident within the left lateral aspect of the spinal canal at C4. This lesion causes only mild mass effect upon the spinal cord. The differential would include both nerve sheath tumor and meningioma.3.Numerous small enhancing nodules are seen along the conus and nerve roots of the cauda equina, likely representing small nerve sheath tumors.4.Multiple areas of abnormal cord thickening and enhancement are seen in the cervical and upper thoracic regions. These lesions are compatible with primary spinal cord neoplasms and statistically are most likely to represent ependymomas.5.Bilateral internal auditory canal nerve sheath tumors have mildly increased in size when compared to the prior examination.6.Nerve sheath tumors involving the bilateral fifth cranial nerves have also increased in size. Thickening and abnormal enhancement centered on the right cavernous sinus has also increased and may represent continuation of the nerve sheath tumor or meningioma.7.Scattered areas of parenchymal signal abnormality with mild dysmorphism of the overlying cortex and evidence of susceptibility are seen in both cerebellar hemispheres and in the left superior temporal gyrus. These lesions have not significantly changed from the prior examination and could represent areas of hamartomatous or dysplastic tissue. Low grade neoplasm is considered less likely.8.A small plaque-like enhancing lesion is evident along the intraorbital component of the left optic nerve. This lesion has not significantly changed and the differential would include meningioma versus nerve sheath tumor.


Instruction: Generate impression based on findings.

Input: 66 year old female with headache. Is there a bleed? There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Normal brain CT.


Instruction: Generate impression based on findings.

Input: 5-year-old male patient with seizures. Evaluate temporal lesion on right. There is a 5.8 x 2.5 x 6.4 cm extra-axial lesion along the right frontal convexity which follows cerebrospinal fluid signal characteristics on all sequences and does not enhance on post-contrast imaging. This lesion is associated with remodeling of the overlying calvarium and causes mass effect on the underlying right frontal lobe and right superior temporal gyrus, but there is no underlying vasogenic edema or gross dysplasia within the brain. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: A large extra-axial lesion along the right frontal convexity with mass effect upon the underlying brain parenchyma and remodeling of the overlying calvarium most consistent with an arachnoid cyst.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Clinical question: Suspected NMO, vs necrotizing paraneoplastic myelitis. Please evaluate brain for involvement.Signs and Symptoms: severe transverse myelitis, abnormal VEP The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: Periventricular and subcortical white matter signal changes of a mild degree are present which are nonspecific. They could be vascular related, related to demyelination, trauma, vasculitis, sarcoid. They are nonspecific.


Instruction: Generate impression based on findings.

Input: Chiari malformation with syrinx: 1 year follow up. Brain: There are postoperative findings related to foramen magnum decompression with an unchanged configuration of the cerebellar tonsils. There is biphasic CSF flow across the foramen magnum, although the flow stream anteriorly remains mildly constricted due to retroclination of the dens. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration.Spine: There has been slight interval decrease in size of the syringohydromyelia at C6-7, which measures 2 x 3 mm in axial cross section, previously also 2 x 3 mm. Likewise, the trace syringohydromyelia in the thoracic spine is unchanged. The vertebral column alignment is unchanged, with reversal of the usual lordosis. The vertebral body heights are preserved. There is no significant spinal canal stenosis. The paraspinal soft tissues are unchanged.

Output: 1. Postoperative findings related to foramen magnum decompression with biphasic CSF flow across the foramen magnum, although the flow stream anteriorly is mildly constricted due to retroclination of the dens2. No significant change in size of the syringohydromyelia within the cervical and thoracic spinal cord.


Instruction: Generate impression based on findings.

Input: Female, 50 years old, with abnormal gait and falls. Assess for myelopathy. Spinal alignment is anatomic. Vertebral body height, morphology and signal characteristics are within normal limits. The visualized spinal cord shows normal caliber and is free of any definite signal abnormality. A small apparent focus of T2 hyperintensity overlying the cord at the T2 level, seen only on the sagittal T2 sequence, is favored to be artifactual as it is not duplicated on sagittal T1 or STIR imaging.C2-3: Right facet hypertrophy. No significant spinal canal or foraminal stenosis. C3-4: Right facet hypertrophy. Mild uncovertebral hypertrophy. No significant spinal canal or foraminal stenosis. C4-5: Mild uncovertebral hypertrophy. No significant spinal canal or foraminal stenosis. C5-6: Mild uncovertebral hypertrophy. No significant spinal canal or foraminal stenosis. C6-7: Mild posterior disc-osteophyte complex formation and uncovertebral hypertrophy. No significant spinal canal or foraminal stenosis. C7-T1: Facet hypertrophy. No significant spinal canal or foraminal stenosis.

Output: 1. No significant spinal canal or foraminal stenosis. No definite abnormalities of the spinal cord are seen.2. A small focus of signal abnormality overlying the cord at the T2 level is favored to be artifactual as it is seen on only one sequence. If clinical concern for a lesion at this level exists, further evaluation with dedicated thoracic imaging can be considered.


Instruction: Generate impression based on findings.

Input: 60 year-old female with pain and weakness, rule rotator cuff tear ROTATOR CUFF: There is signal abnormality within the distal supraspinatus tendon consistent with tendinosis, with full thickness tear along its anterior fibers. No significant tendinous retraction is noted. Fluid extends within the subacromial, subdeltoid bursa. The remaining rotator cuff muscles and tendons are intact.SUPRASPINATUS OUTLET: Moderate AC joint osteoarthritis with fluid noted in the joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is degeneration and likely degenerative tearing of the labrum, incompletely evaluated on this non-arthrogram examination.BICEPS TENDON: Normally situated within the bicipital groove.ADDITIONAL

Output: Full-thickness tear of the supraspinatus tendon as described above without significant retraction.


Instruction: Generate impression based on findings.

Input: Disturbance of skin sensation [782.0], Reason for Study: ^Reason: lesions? History: patchy sensory loss. A couple scattered high signal intensity lesion on deep white matter bilaterally on FLAIR images indicate nonspecific small vessel ischemic disease.There is no evidence of acute ischemic or hemorrhagic lesion on the scan.There is about 12.7mm x 4.2mm sized dural based, well circumscribed, low signal intensity extraaxial lesion attached on the falx indicating meningioma.The ventricles, sulci and cisterns are symmetric and unremarkableThere is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear.There are retention cysts on bilateral maxillary sinuses.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. Minimal nonspecific small vessel ischemic disease.3. 12.7 mm x 4.2 mm sized meningioma on the falx.


Instruction: Generate impression based on findings.

Input: T8 -- T9 level mass. Possible vascular period recommended CTA for further evaluation. Examination demonstrates a dural based high density mass measuring approximately 22 mm in cranial cephalad access in 5-mm in AP access immediately anterior to the superior facet of T8 on the left. There is no evidence of increased vascularity to suggest arteriovenous malformation, dural aVF at this location. This lesion is primarily on the left side however a very small extension of the lesion across the midline to the right is noted. The finding is believed to represent a meningioma. A high density lesion on axial images is more suggestive of calcification rather than enhancement. Review of prior MRI examination demonstrates no abnormal edema of the cord. No definitive increased vascularity within the epidural dorsal fat pad is detected.3D reformatted images of the area of interest were also made.The lesion appears as a calcified intra dural lesion,likely a meningioma.

Output: Dural based intradural extra medullary high density (likely calcification and less likely enhancement) may represent an intracanalicular meningioma. No definitive evidence of increased vascularity to suggest vascular malformation and no evidence of edema of the cord on prior MRI examination from 4 -- 9 -- 2009 was noted.


Instruction: Generate impression based on findings.

Input: Female 28 years old with abdominal pain. Evaluate for choledocholithiasis. ABDOMEN:LIVER, BILIARY TRACT: The liver measures 17 cm in length and has a smooth contour. There is no enhancing hepatic lesion. The hepatic vasculature is patent.Cholelithiasis without gallbladder distention, wall thickening or pericholecystic edema. Correlating with the same-day ultrasound is a 5 mm T2 hypointense filling defect within the distal common duct at the level of the pancreatic head with resulting mild common duct dilation up to 1 cm. There is no significant intrahepatic biliary ductal dilatation or pancreatic ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: The pancreas enhances normally with no surrounding inflammatory changes. The pancreatic duct is not dilated.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No renal lesion or 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: Choledocholithiasis with mild common duct dilation up to 1 cm. No significant intrahepatic or pancreatic ductal dilatation.


Instruction: Generate impression based on findings.

Input: Suboccipital craniotomy changes are again seen. The previously demonstrated solid and cystic extra-axial mass measuring approximately 3.7 x 2.3 cm in greatest axial dimensions (series 7, image 25) is not significantly changed compared to prior examination. The mass encases the vertebral basilar arteries as well as extends into the Meckel's cave and right internal auditory canal. In addition, the tumor extends caudally along the dorsolateral aspect of the upper cervical spinal cord. The caudal spinal extent of the lesion is difficult to delineate. On postcontrast images, the tumor does not demonstrate significant enhancement, similar to prior examination. There is persistent significant mass effect upon the caudal brainstem and upper cord.There is a right posterior parietal approach ventriculostomy catheter stable position, with the tip of the catheter near the right foramen of Monro. The lateral and third ventricles are stable and decompressed. There is no evidence of acute infarct. There is no midline shift or herniation. The major cerebral flow voids are intact. Mucosal thickening of the sphenoid sinus has resolved.

Output: Stable appearance of predominantly extra-axial right posterior fossa mass with persistent mass effect on the caudal brainstem and upper cervical spinal cord.


Instruction: Generate impression based on findings.

Input: 12 year old male with intractable epilepsy, evaluate for structural abnormality A small focus of susceptibility-weighted artifact is seen within the right corona radiata (image 43, series 8). There is no other perilesional signal abnormality. A second subcortical focus is present in the inferior right temporal lobe (image 21, series 5) which is T2 hyperintense and T1 hypointense. Neither lesion demonstrates associated mass effect. No diffusion restriction is seen to suggest acute ischemia. The CSF spaces are appropriate for the patient's stated age with no midline shift. The ventricles are normal in size and shape. Normal vascular flow voids are present in the major intracranial vasculature. 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.Nonspecific focus of susceptibility artifact in the right corona radiata may represent prior micro-hemorrhage, residua from prior trauma, or a small cavernoma. Given the patient's age, hemorrhagic metastasis is considered unlikely.2.Right temporal lobe T2 hyperintense T1 hypointense focus is favored to represent a neuroglial cyst or prominent perivascular space.3.Follow-up 3T MRI brain with contrast is recommended in 3 months to evaluate for stability.


Instruction: Generate impression based on findings.

Input: Female, 53 years old, with left lower extremity weakness and dizziness. A 5-mm focus of T2 hyperintensity is seen within the centrum semiovale just below the right pre-central gyrus. Although this lesion is bright on the diffusion images, there is no ADC correlate indicating likely T2-shine-through artifact. This lesion produces no mass effect. Approximately three additional punctate T2 hyperintense, non-diffusion restricting lesions are also seen in the periventricular white matter. No pathologic enhancement is seen. No intracranial hemorrhage or abnormal extra-axial fluid is seen. Ventricular size and morphology are normal.

Output: A 5-mm lesion is seen in the right centrum semiovale, just below the pre-central gyrus. The location of this lesion could potentially account for the patient's left lower extremity weakness. Several additional punctate periventricular lesions are also seen. The differential diagnosis would include demyelinating disease among other inflammatory processes. A vascular etiology such as vasculitis or ischemic disease if felt to be less likely.


Instruction: Generate impression based on findings.

Input: 59-year-old woman with right knee instability. Evaluate for ligamentous injury. MENISCI: There is marked degeneration of both menisci.ARTICULAR CARTILAGE AND BONE: Severe osteoarthritic changes affect the knee, most prominently affecting the medial tibial plateau. There is severe degeneration of the articular cartilage diffusely, affecting the articular surfaces of the femur, tibia and patella. Tricompartmental osteophytes are noted, most prominent in the medial tibiofemoral compartment.LIGAMENTS: Anterior and posterior cruciate ligaments are intact. Medial collateral ligament and lateral collateral complex are intact. Mild edema around the lateral collateral ligament may represent a mild sprain.EXTENSOR MECHANISM: The quadriceps tendon and patellar tendon are intact.ADDITIONAL

Output: Severe degenerative changes affect the knee. There is a small joint effusion.


Instruction: Generate impression based on findings.

Input: 88-year-old male with pain with movement of the right shoulder. Suboptimal examination secondary to patient motion artifact.ROTATOR CUFF: There is a full-thickness tear of the supraspinatus tendon at its insertion on the greater tuberosity measuring 16 mm in the dimension. There is approximately 2 cm of retraction. There is thickening and increased signal abnormality within the supraspinatus tendon consistent with moderate tendinosis. There is edema type signal abnormality within the supraspinatus muscle belly which may represent subacute denervation injury. No masses are identified in the suprascapular notch. There is mild fatty infiltration along the myotendinous junction of the supraspinatus and infraspinatus muscles. The subscapularis and teres minor muscles and tendons appear intact.SUPRASPINATUS OUTLET: There is fluid within the subacromial subdeltoid bursa. Moderate degenerative changes affect the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is heterogeneity and irregularity of the glenoid labrum, particularly along the posterior and inferior margins, consistent with degenerative tearing. There is increased bone marrow signal abnormality within the humeral head, likely degenerative in etiology.BICEPS TENDON: There is fluid within the tendon sheath of the long head of the biceps which may reflect fluid extension from the glenohumeral joint ADDITIONAL

Output: 1. Full-thickness rotator cuff tear as described above.2. Edema type signal abnormality within the supraspinatus muscle may represent subacute denervation injury. No masses are identified in the suprascapular notch.3. Other findings as described above.


Instruction: Generate impression based on findings.

Input: 65-year-old female with history of left thigh mass. Please evaluate for extent of disease and abnormalities. There is a large mass of predominantly fat signal intensity involving the posterior left thigh and extending into the left buttock. The superior extent of the mass is at the level of the origin of the left gluteus maximus muscle from the upper iliac wing. Here the mass lies between the gluteus maximus muscle and the gluteus medius muscle, deep to the iliotibial band. A small lobule of the mass extends beneath the left piriformis muscle into the sciatic notch. An additional small lobule extends medially just below the ischiofemoral space, with poor visualization of the quadratus femoris either due to infiltration or mass effect. Although the mass is of predominantly fat signal intensity, there are poorly defined whorls of nonadipose tissue within the mass, particularly anteriorly, some of which show enhancement following gadolinium administration. Several vessels are also noted within the mass. There is a bandlike focus of low signal intensity within the mass posteriorly that does not appear to enhance, perhaps representing fibrous tissue or mineralization.As the mass enters the upper thigh, it assumes a bilobed configuration. The smaller anterior lobe continues distally deep to the iliotibial band, tapering along the lateral margin of the vastus lateralis; it terminates approximately 4 to 5 cm below the level of the base of the greater trochanter. The larger posterior lobe extends inferiorly into the mid and distal thigh. It lies deep to the peripheral deep fascia, displacing the distal fibers of the gluteus maximus muscle laterally and the hamstring musculature medially. Within the proximal half of the thigh, the mass displaces the sciatic nerve medially, with a nerve coursing along the medial aspect of the mass. The mass terminates distally approximately 12 to 13 cm above the knee joint line. As in the pelvis, the mass is of predominantly fat signal intensity, but also containing thin septae and poorly defined nonadipose elements, some of which enhance following gadolinium administration. Small vascular structures also courses through the mass. Within the mid thigh, the mass is approximately 14 x 12 cm in greatest transverse dimension. The mass is not included on any single longitudinal image, which limits my ability to obtain an accurate measurement in this dimension; however, based on summative measurements, I estimate the mass to be between 35 and 40 cm in craniocaudal dimension.Pelvis: There is a mass of fat signal intensity at the level of the right hip joint situated between the proximal right sartorius muscle and the iliopsoas muscle. It measures no more than 6 cm in craniocaudal dimension and 2.5 cm in transverse dimension, and likely represents a benign lipoma. There also appears to be asymmetric fatty infiltration of the anterior half of the gluteus minimus muscle. I see no additional masses within the pelvis. Mild osteoarthritis affects both hips and sacroiliac joints. Bone marrow signal intensity is otherwise within normal limits. Although the study was not protocoled for detailed evaluation of the pelvic viscera, I see no gross abnormalities.Left femur/thigh: I see no additional masses within the left thigh. Bone marrow signal intensity of the left femur is normal. I see no edema within the musculature of the thigh. Osteoarthritis affects the left knee, particularly the patellofemoral joint with subchondral cyst formation and edema in the patella. There is also a small knee joint effusion, and enhancement of the synovium suggests mild synovitis of the knee. A few venous varicosities are noted within the soft tissues of the thigh.

Output: Large predominantly fatty mass of the left thigh extending into the left buttock as described above. Based on its size and signal characteristics, this most likely represents an atypical lipomatous tumor (well differentiated liposarcoma). Referral to orthopedic oncology is recommended. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Non-small cell lung cancer brain metastases A piously demonstrated right frontal operculum cystic T2 hyperintense lesion is again slightly smaller in size, measuring 10 x 14 mm in axial dimension (previously 10 m x 16 mm). The previously demonstrated daughter nodules along the enhancing rim also appear to be smaller in size comparing to prior study. Overlying smooth dural thickening is presumably secondary to craniotomy changes given stability and lack of nodularity. Associated T2 hyperintense edema is unchanged and may reflect a degree of underlying gliosis. Also stable is associated blood products along the periphery of the cystic portion as evidenced by susceptibility technique. A previously described small nodular enhancing lesion on the right middle frontal sulcus is better demonstrated and likely represents vascularity. No other abnormal enhancing lesion is seen.Scattered patchy FLAIR high signal intensity lesions on bilateral periventricular white matter are again seen, unchanged since prior scan.No evidence of acute ischemia, mass effect, or midline shift.Evidence of right fronto temporal craniotomy is seen, unchanged. The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. Fluid collections on the right mastoid air cells are again noted.

Output: 1.Continued interval decrease in size of right frontal operculum mass as well as daughter nodules.2.A previously described small nodular enhancing lesion on the right middle frontal sulcus is better demonstrated and likely represents vascularity.


Instruction: Generate impression based on findings.

Input: Reason: eval RT shoulder History: pain There is no evidence of acute fracture or malalignment. There is moderate degenerative change of the AC joint. There is mild degenerative change of the glenohumeral joint. There is redemonstration of mildly decreased acromiohumeral interval, consistent with rotator cuff tear seen on prior MRI. Bones appear demineralized.

Output: Moderate osteoarthritis of the AC joint and mild osteoarthritis of the glenohumeral joint appearing similar to prior study, other findings as above.


Instruction: Generate impression based on findings.

Input: 42 years Female (DOB:7/2/1974)Reason: s/p sinus surgery, now with headaches, eval for sinus disease History: HA worse at night, with associated nauseaPROVIDER/ATTENDING NAME: JAYANT M. PINTO JAYANT M. PINTO The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The cerebellar tonsils extend 1 mm below the level of foramen magnum.The visualized portions of the paranasal sinuses demonstrate mild mucosal thickening and status post antrectomies bilaterally and partial exenteration of ethmoid air cells.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: The patient is status post paranasal sinus surgery. There is no paranasal sinus outlet obstruction present. There is some mild mucosal thickening in the maxillary sinuses.Please note this is a limited exam for the purpose of treatment guidance.


Instruction: Generate impression based on findings.

Input: Thyroid cancer and skull metastasis: delineate bony and parenchymal processes. There is an expansile enhancing mass centered in the right parietal calvarium that measures 39 x 56 mm in axial cross section. There is epidural extension with mass effect upon the underlying right parietal lobe. Portions of the dura appear to be discontinuous, but there does not appear to be gross invasion of the underlying brain parenchyma and slight midline shift to the left, as well as slight effacement of the right lateral ventricle. There is also considerable extension of tumor into the overlying subgaleal space. There is an enhancing nodule that measures up to 5 mm in the right temporal scalp. There are mild nonspecific foci of cerebral white matter T2 hyperintensity, which may represent chronic small vessel ischemic disease. There is no evidence of intracranial hemorrhage or acute infarct. The major cerebral flow voids are intact. The orbits are grossly unremarkable. There is mild scattered paranasal sinus mucosal thickening and secretions.

Output: 1. A large metastasis centered in the right parietal calvarium with subgaleal and epidural extension with mass effect upon the underlying right parietal lobe. Portions of the dura appear to be discontinuous, but there does not appear to be gross invasion of the underlying brain parenchyma. 2. A nodule that measures up to 5 mm in the right temporal scalp is nonspecific, but may represent metastatic disease.


Instruction: Generate impression based on findings.

Input: 54-year-old male with a history of right-sided weakness. Evaluate for acute stroke. There is no evidence of intracranial hemorrhage, extra-axial fluid collection, mass or edema. There is no mass effect or midline shift. There is preservation of the gray-white matter interface. There is no evidence of acute territorial ischemia. Periventricular hypoattenuation is nonspecific, but most consistent with small vessel ischemic disease of indeterminate age, appearing similar to the prior study. Additionally, note is made of punctate foci of hypoattenuation in the left internal capsule, and right thalamus, likely representing age indeterminate lacunar infarcts. The focus of hypoattenuation in the left internal capsule appears more prominent when compared to the prior study. While this may be related to technique, if strong clinical concern for acute ischemia, further evaluation with MRI could be considered.The ventricles and basal cisterns are normal in size and configuration. There is no effacement of the basal cisterns. The calvaria and skull base are radiographically normal. The visualized mastoid air cells and paranasal sinuses are within normal limits.

Output: 1. No evidence of acute territorial ischemia or intracranial hemorrhage. It should be noted that CT is insensitive in detecting acute, nonhemorrhagic stroke. 2. Hypoattenuation in the left internal capsule, and right thalamus are nonspecific, but most consistent with age indeterminate lacunar infarcts. The focus of hypoattenuation in the left internal capsule appears more prominent when compared to the prior study. While this may be related to technique, if strong clinical concern for acute ischemia, further evaluation with MRI could be considered.3. Hypoattenuation in the periventricular and subcortical white matter, are nonspecific but most consistent with small vessel ischemic disease of indeterminate age, appearing similar to the prior study.


Instruction: Generate impression based on findings.

Input: A patient submitted outside study for review. Submitted for review are breast MRI (2/17/15) performed at Northwestern Memorial Hospital. Breast MRI was performed with a protocol outlined in the outside radiology report.An enhancing lobulated mass is demonstrated in the left breast at 2 o'clock position measuring 26 x 23 x 25 mm (AP x LR x CC). This is a biopsy proven carcinoma. A large metallic artifact is present at lower posterior portion of the mass. No additional lesions are seen in the left breast.In the right breast, there is a small enhancing mass, measuring 9 mm at posterior 9 o'clock position. This is benign appearing and possibly an intramammary lymph node, although it is not well visualized on the other non-contrast images.A few cysts in both breasts.No abnormal axillary lymph nodes are identified in either axillary region.

Output: 1. Biopsy proven unifocal carcinoma in the left breast.2. Likely benign enhancing mass in the right breast. Follow up MRI in 6 months is recommended.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Left lobe nodule was biopsied and revealed still suspicious for capillary thyroid cancer. Please assess lymph nodes laterally and thyroid gland. RIGHT LOBE MEASUREMENTS: 6.2 x 2.7 x 1.8 cmLEFT LOBE MEASUREMENTS: 4.5 x 2.0 x 2.2 cmISTHMUS MEASUREMENTS: 0.4 cmRIGHT LOBE: Cystic appearing nodule measuring 1 cm and is located posteriorly in the upper pole. A few subcentimeter hypoechoic nodules are also present.LEFT LOBE: Complex irregular shaped nodule in the left lobe with microcalcifications measures 1.4 x 1.8 x 0.9 cm.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Subcentimeter lymph nodes with the benign appearance. No enlarged, suspicious appearing lymph nodes identified.OTHER: No significant abnormality noted.

Output: Complex irregular nodule in the left lobe of thyroid compatible with history of papillary thyroid cancer. No significant adenopathy identified in the neck.


Instruction: Generate impression based on findings.

Input: 47-year-old woman with history of Crohn's disease and liver lesions on MR from 2010. ABDOMEN:LIVER, BILIARY TRACT: Multiple T2 bright, lobular lesions with discontinuous and gradual peripheral enhancement on perfusion sequences have increased in size compared to the prior examination. The previously seen indeterminate lesion in the right hepatic lobe is not reliably seen on today's examination. There are no new suspicious focal hepatic lesions.Gallbladder is normal and there is no intra or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No pancreatic ductal dilatation. The pancreatic parenchyma appears normal.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: Left breast cyst noted.OTHER: No significant abnormality noted.

Output: 1.Multiple benign hemangiomas, increased in size from the prior exam.2.Previously indeterminate lesion seen in the right hepatic lobe not reliably seen on today's exam.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for evidence of herniated disc or spinal stenosis at L2-L3 area. Signs and symptoms: Radicular pain L2-L3 dermatomes and bilateral hip flexor weakness. Nonenhanced lumbar MRI:Examination demonstrates severe levoscoliosis of lumbar spine centered at L2 level. There is also significant dextroscoliosis of lower thoracic spine.The visualized lower thoracic spine from T9 inferiorly demonstrate mild degenerative changes however without evidence of spinal canal compromise or stenosis. The signal intensity and caliber of thoracic cord and conus remains within normal.T12-L1 demonstrate no spinal stenosis or neural foraminal compromise.L1-L2 demonstrate mild degenerative changes without central spinal stenosis or neural foraminal compromise.L2-L3 demonstrate asymmetric right-sided hypertrophic changes of posterior elements with subtle mass effect and deviation of the thecal sac to the left however without spinal stenosis or neural foraminal compromise.L3-L4 demonstrates asymmetric right-sided facet hypertrophic changes resulting in mild right neural foraminal compromise and no central spinal stenosis.L4-L5 demonstrate no spinal stenosis or neural foraminal compromise mild to moderate asymmetric right-sided facet and ligamentum flavum hypertrophy however is present.L5-S1 demonstrate no spinal stenosis or neural foraminal compromise.Unremarkable images through the sacral spine.

Output: 1.Severe levoscoliosis of lumbar spine and dextroscoliosis of thoracic spine is noted.2.There is no evidence of spinal stenosis at any level.3.There is no significant neural foraminal compromise at any level.4.Normal signal intensity and caliber of the lower most visualized thoracic cord, conus and cauda equina and unremarkable paraspinal soft tissues.5.Mild to moderate asymmetric hypertrophic changes of posterior elements correlating with the scoliosis as detailed above.


Instruction: Generate impression based on findings.

Input: 43-year-old male with mucormycosis fungal infection, assess depth and character of left abscess over scapula There is increased T2 signal and decreased T1 signal with enhancement of the body and inferior angle of the scapula suggestive of osteomyelitis. There is a thin rim of surrounding fluid measuring approximately 1 cm in width with peripheral enhancement which likely represents an abscess. Extensive edema and enhancement is seen within the surrounding soft tissues inferiorly, involving the adjacent latissimus dorsi which likely represents extension of infection. The lesion does not appear to extend within the chest wall, however there is focal T2 signal within the left third rib which corresponds to a hypermetabolic focus on PET of the same day that appears separate from the scapular process.There is additional enhancement and increased T2 signal involving the glenoid and proximal humerus which also likely represents osteomyelitis.A large loculated left pleural effusion with consolidation and multifocal opacities is seen within the lungs.

Output: 1.Osteomyelitis of the scapula with surrounding abscess. No extension into the chest wall is evident.2.Enhancement and edema of the left glenoid and proximal humerus also likely represents osteomyelitis.


Instruction: Generate impression based on findings.

Input: 40 year old female with a solid mass in the left breast detected by recent ultrasound study (1/30/15) presents for research MRI. Known multiple cysts in both breast. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.There are multiple cysts in both breasts.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Clinical question: History of brain tumor resection. Follow-up 3 months to evaluate for change. Signs and symptoms: None surveillance imaging. Pre and post enhanced brain MRI:No diffusion-weighted abnormalities.Examination demonstrate interval significant decreased size of a dural-based thick enhancement along the left greater wing of the sphenoid at the site of previously resected meningioma. On current exam the remaining enhancement along the left greater wing of the sphenoid has a uniform and very smooth appearance and measuring at 5.3 mm in thickness. Finding is highly suggestive of postoperative change. There is no convincing evidence of residual tumor however further follow-up is recommended.A focus of FLAIR/T2 hyperintensity in the left anterior temporal lobe at the surgical site demonstrate interval evolution to encephalomalacia and with resultant widening of subarachnoid space at this site. Signal intensity of brain parenchyma is otherwise within normal. Ventricular system remain within normal size and with maintain midline.Examination also again demonstrate a thin uniform enhancement along the left frontal and temporal craniotomy site consistent with postoperative change.

Output: 1.Negative diffusion weighted series.2.Interval significant decreased thickness on the dural based enhancement along the left greater wing of the sphenoid and likely representing post operative change. Further follow-up is recommended however.3.Encephalomalacia and gliosis in the left anterior temporal lobe at the site of resected tumor.


Instruction: Generate impression based on findings.

Input: There are skip-like T2 hyperintense abnormalities involving the dorsal midline cervical cord, in the expected location of the dorsal columns, which appear globular and extend from the C3 level to the C7/T1 level. At its maximum size, it measures 2 x 2 mm at C5/6.Alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.C2/3: Mild degenerative changes without stenosisC3/4: Bilateral uncinate hypertrophy causes mild bilateral neural foraminal stenosis.C4/5: Bilateral uncinate hypertrophy causes minimal bilateral neural foraminal stenosis.C5/6: Posterior osteophyte disc complex and bilateral uncinate hypertrophy. There is mild-to-moderate left and mild right neural foraminal stenosis.C6/7: Mild degenerative changes without stenosisC7/T1: UnremarkableDegenerative changes are noted of the upper thoracic spine without significant resulting stenosis.

Output: 1.There are skip-like T2 hyperintense abnormalities involving the dorsal midline cervical cord, in the expected location of the dorsal columns, which appear globular and extend from the C3 level to the C7/T1 level. The differential diagnosis for this would most likely include subacute combined degeneration, infectious myelitis, inflammatory demyelination (multiple sclerosis, ADEM), or acute transverse myelitis. Recommendations are made to obtain MR imaging of the complete spinal axis with gadolinium enhancement for further characterization of the visualized cervical lesions as well as extent of spinal cord involvement.2.Mild degenerative changes throughout the cervical spine resulting in mild or mild to moderate stenoses as described in detail above.3.Findings were discussed with Dr. Issa on 12/28/2016 at 8:20 AM.


Instruction: Generate impression based on findings.

Input: Possible new stroke. There is restricted diffusion on the mid pons left side (series #4, image #10/64) indicating perforator infarct.There is no evidence of hemorrhagic conversion.There is a focal tissue loss on the left thalamus and basal ganglia especially around the left side internal capsule posterior limb extended to the left periventricular white matter indicate prior lacunar infarct.Multifocal patch high signal intensities on periventricular white matter on FLAIR images indicate nonspecific small vessel ischemic disease.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Acute ischemic infarct, likely represent perforator infarct on the left side of mid Pons without evidence of hemorrhagic transformation.2. Non specific small vessel ischemic disease as described above.


Instruction: Generate impression based on findings.

Input: A patient submitted outside study for review. Submitted for review are MRI dated February 21, 2015, bilateral breast ultrasound dated February 24, 2015, and images from ultrasound guided left breast biopsy dated February 25, 2015, performed at SAAD Medical Services. No studies are available for comparison. MRI (2/21/2015): MRI was performed without and with gadolinium as per outside hospital protocol.There is diffuse skin thickening and edema of the left breast. Multiple enhancing masses with intervening non-mass enhancement are present within the outer slightly upper left breast, extending along the approximate two o'clock radian from the level of the nipple to the posterior breast. The largest mass is noted posteriorly, approximately 4 cm anterior to the pectoralis muscle, measuring 3.3 x 2.3 x 2.7 cm. Additionally, multiple dilated, enhancing ducts are present within this region of non-mass enhancement in the upper outer quadrant of the left breast. Total area of enhancement in the upper outer left breast is 10.5 x 4.4 x 8.3 cm. This enhancement extends to the nipple and involves skin anteriorly. No areas of abnormal enhancement are present in the right breast.Two enlarged, enhancing left axillary lymph nodes are present, with the largest identified measuring 3.0 x 1.7 cm.BILATERAL BREAST ULTRASOUND (2/24/2015):Images labeled right upper outer, lower inner, and upper inner quadrants of the right breast were submitted. No solid or cystic mass is identified. Images labeled scar demonstrate a subtle area of irregular hypoechogenicity within the lower outer quadrant. Images labeled right axilla demonstrate no solid or cystic mass. No abnormal lymph nodes are identified on this single image.Images labeled left axilla demonstrate two abnormal morphology lymph nodes, with the largest identified measuring 2.6 x 1.4 cm with effacement of the hilum and cortical thickening. Left whole breast ultrasound was performed revealing multiple masses within the last lateral breast, two o'clock position. Conglomerate mass measures 4.5 x 1.7 cm. The two additional hypoechoic masses are present on images labeled left lower outer quadrant measuring 1.1 x 1.3 cm and 1.2 x 1.4 cm. Images labeled left upper outer quadrant demonstrate an irregular hypoechoic mass measuring 1.6 x 1.3 x 1.0 cm. multiple images demonstrate dilated ducts measuring up to 0.6 cm within the left upper outer quadrant.IMAGES FROM ULTRASOUND GUIDED LEFT BREAST BIOPSY (2/25/2015): Images from left breast ultrasound guided biopsy were submitted, however evaluation is limited as no labeling is present on the images. Biopsy needle appears to be traversing a hypoechoic lesion on a few of these images. It is unclear whether a clip was placed at the time of biopsy.

Output: 1.Multiple enhancing masses, dilated, enhancing ducts, and non-mass enhancement involving the upper outer and lateral aspects of the left breast with associated skin thickening with axillary lymphadenopathy suspicious for inflammatory breast cancer. Total area of enhancement extends to the level of the nipple, and involves skin anteriorly, measuring 10.5 x 4.4 x 8.3 cm.2. Two enlarged left axillary lymph nodes. The largest measuring 2.6 cm.3. Images from left breast ultrasound guided biopsy were submitted, but unlabeled, limiting evaluation.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Please evaluate calcified left parietal mass on CT scan. There is a T2 hypointense minimally enhancing extra-axial mass along the left parietal convexity that measures up to 8 mm without significant mass effect upon the brain. A similar punctate lesions is present in the left frontal convexity as well. There are a few scattered foci of T2 hyperintensity in the cerebral white matter. There is no evidence of acute intracranial hemorrhage. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There are bilateral lens implants.

Output: 1. An extra-axial mass along the left parietal convexity that measures up to 8 mm without significant mass effect upon the brain may represent a meningioma, osteoma, or calcifying pseudotumor of the neuraxis, for example. 2. A few scattered patchy areas of cerebral white matter signal abnormality may be related to chronic small vessel ischemic disease, but no evidence of acute cerebral infarct.


Instruction: Generate impression based on findings.

Input: 92 year-old male left retro-orbital mass. Lymphoma is suspected please. CT soft tissues of the neckimages at the level of skull base are unremarkable. The cavernous sinuses are within normal limits. Retention cyst within the left maxillary sinus is detected.Images through the soft tissues of the neck demonstrate no evidence of any masses or adenopathy. Extensive degenerative disk disease is noted. The bony density of area of the study is otherwise unremarkable.Limited images through the apices of the lung demonstrate a very small focal area of anemia are and loculated soft tissue density in the left lung field that may represent a focal area of scarring.CT of the maxillofacial region. Image is through the orbit demonstrate no evidence of any abnormality. Specifically no definitive evidence of any left-sided retro-orbital mass is identified. The retro-orbital contents including optic nerves, extraocular musculature and retro-orbital fat remains entirely within normal limits. The morphology and density of both globes in anterior and posterior chambers are normal. The lacrimal glands are within normal size. The bony structure of the orbits are also normal.The paranasal sinuses demonstrate a small retention cyst within the left maxillary sinus and are otherwise unremarkable. No abnormality within the nasal cavity or nasopharynx is detected.Previously described abnormality within the left orbit on prior MRI is likely an artifactual finding.

Output: 1.Unremarkable CT examination of soft tissues of the neck and in particular no evidence of any masses or pathologic adenopathy is detected.2.Unremarkable CT of the maxillofacial region and in particular no evidence of masses within the retro-orbital space is detected.


Instruction: Generate impression based on findings.

Input: There are post-surgical findings related to Chiari decompression. There remains a residual partially-septated extradural cerebrospinal fluid signal intensity fluid collection that measures up to 5 mm in thickness and extends less inferiorly than previously. The inferior cerebellum displays an unchanged configuration. There still appears to be narrow biphasic cerebrospinal fluid flow anteriorly across the neo-foramen magnum, but somewhat blunted cerebrospinal fluid flow posteriorly. The vertebral body heights and alignment are unchanged. There is no evidence of syringohydromyelia. The bone marrow signal is unremarkable. There is a posterior disc-osteophyte complex at C5-6 and ligamentum flavum thickening that results in spinal canal stenosis, which appears to have progressed from previous exam. However, there is no definite abnormal signal within the spinal cord parenchyma.

Output: 1.Post-surgical findings related to related to Chiari decompression with a small residual pseudomeningocele. 2.No evidence of cervical syringohydromyelia.3.Increase in the degree of spinal canal stenosis at the C5-6 level related to a disc-osteophyte complex and ligamentum flavum thickening without definite associated spinal cord signal abnormality.


Instruction: Generate impression based on findings.

Input: Lung cancer with brain metastases, status post whole brain RT and SRS: restaging, poor memory. There is a minimal residual enhancing lesion in the right cuneus. Other previously demonstrated lesions are not conspicuous. There is diffuse patchy nonspecific cerebral white matter T2 hyperintensity. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are unchanged. There is mild scattered paranasal sinus mucosal thickening.

Output: Minimal residual treated enhancing lesion in the right cuneus. Other previously demonstrated and treated lesions are not conspicuous. The skull appears unchanged.


Instruction: Generate impression based on findings.

Input: Female, 62 years old. Reason: Right nodule biopsied and shows cell suspicious for PTC, please assess lateral and central lymph nodes. RIGHT LOBE MEASUREMENTS: At 0.5 x 2.2 x 1.7 cmLEFT LOBE MEASUREMENTS: 7.0 x 2.4 x 1.5 cmISTHMUS MEASUREMENTS: 0.2 cmRIGHT LOBE: Heterogeneous echotexture. A heavily calcified nodule in the mid right lobe measures 1.7 x 1.1 x 2.4 cm, unchanged from prior.LEFT LOBE: A nodule in the mid left lobe measures 1.5 x 1.4 x 1 .0 cm, heterogeneous and isoechoic, with a hypoechoic rim, predominantly solid, nonvascular.ISTHMUS: Heterogeneous echotexture.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No cervical lymphadenopathy noted.OTHER: No significant abnormality noted.

Output: Bilateral thyroid nodules, unchanged. No cervical lymphadenopathy.


Instruction: Generate impression based on findings.

Input: Mixed pathology lung cancer. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild scattered bilateral cerebral hemisphere white matter T2 hyperintensity, which may represent chronic small vessel ischemic disease, for example. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is a mega cisterna magna, which is an anatomic variant. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, mastoid air cells, and scalp soft tissues are grossly unremarkable. There are bubbly secretions in the left maxillary and ethmoid sinuses. There is a small right maxillary sinus retention cyst. There is a right lens implant.

Output: 1. No evidence of intracranial metastases. 2. Bubbly secretions in the left maxillary and ethmoid sinuses may represent acute sinusitis.


Instruction: Generate impression based on findings.

Input: 38-year-old male with knee pain and popping, question of chondromalacia. MENISCI: The menisci appear intact without significant pathology.ARTICULAR CARTILAGE AND BONE: There is a small defect of the medial patellar cartilage, presumably site of prior intervention. Further, there is scarlike infiltration of the medial Hoffa's fat pad, also presumably due to prior intervention. Otherwise, the remaining articular cartilage appears intact without significant abnormality.LIGAMENTS: The ACL, PCL, MCL, and LCL complex appears intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: Postoperative findings of the medial patellar cartilage, without specific findings of other sites of chondromalacia.


Instruction: Generate impression based on findings.

Input: 66-year-old male evaluate disease is status. Metastatic renal cancer. Limited lateral examination due to lack of contrast.Images through the skull base are within normal limits.Images through the soft tissues of the neck demonstrate no definitive evidence of pathologic adenopathy. No definitive evidence of any masses is detected. Limited images of the apices of the long demonstrate no definitive pathology however in please review dedicated CT of chest performed the same date. Bony density of the area of exam is unremarkable for metastatic disease. Significant degenerative disk disease with areas of significant central spinal stenosis is again identified and can be further evaluated with dedicated MRI. Extensive opacification of bilateral maxillary sinuses are consistent with chronic inflammatory sinus disease.

Output: 1.No evidence of any masses or pathologic adenopathy in the neck.2.Very advanced degenerative disk disease with compromise of the canal and neuroforamina.3.Extensive chronic inflammatory sinus disease of maxillary sinuses.


Instruction: Generate impression based on findings.

Input: History of renal cancer (2.5 cm left papillary renal carcinoma). Evaluate for recurrence. ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis without evidence of acute cholecystitis. No suspicious liver lesion, biliary ductal dilatation or vascular abnormality.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Status post left nephrectomy. No evidence of locoregional recurrent or residual disease. Punctate right renal hyperintensities are too small to characterize, likely cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted. IVC filter noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Scoliosis and mild degenerative changes of the spine.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Atrophic uterus.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Susceptibility artifact from right hip prosthesis.OTHER: No significant abnormality noted.

Output: Stable examination. Left nephrectomy without evidence of residual or recurrent disease.


Instruction: Generate impression based on findings.

Input: History of complicated pancreatitis. ABDOMEN:LIVER, BILIARY TRACT: Moderate intrahepatic and extra hepatic biliary ductal dilatation to the level of the pancreatic head. The common bile duct measures up to 1.5 cm. Susceptibility artifact from embolization coil limits evaluation at the level of the pancreatic head. Heterogeneous biliary system signal intensity suggestive of debris. No focal liver lesion.SPLEEN: The spleen measures 12.3 cm in length without focal lesion.PANCREAS: Between the pancreatic head and second portion of the duodenum is a 2.7 x 2.8 cm heterogeneous T1 weighted hyperintense nonenhancing collection most suggestive of a hematoma with associated mass effect on the distal common bile duct.Loss of intrinsic T1 weighted signal intensity of the pancreatic parenchyma which is mildly atrophic. It enhances relatively homogeneously. No new peripancreatic inflammatory changes.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Simple appearing left renal cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Loculated fluid collection centered about the left hepatic lobe with predominantly fluid signal intensity with some dependent debris. Complex heterogeneous fluid collections anterior to the liver measuring 9.0 x 6.3 cm, anterior to the pancreatic head measuring 6.8 x 5.1 cm and adjacent to the cecum measuring 10.1 x 6.3 cm in the coronal plane. These collections likely communicate, best seen on the coronal images and recent CT.BONES, SOFT TISSUES: Anasarca.OTHER: Small right-sided pleural effusion with adjacent atelectasis.

Output: 1. Increasing intrahepatic and extrahepatic biliary ductal dilatation likely due to the mass effect from a suspected 2.8 cm hematoma between the pancreatic head and second portion of duodenum. Debris in the biliary system is also noted.2. Multiple complex heterogeneous fluid collections adjacent to the pancreatic bed and extending into the right hemiabdomen, compatible with acute necrotic collections/walled off necrosis. Chronic pancreatitis.


Instruction: Generate impression based on findings.

Input: 61-year-old female with left knee pain for one year, pain is medial. History of breast cancer. Evaluate for meniscal tear versus chondral injury. MENISCI: There is linear increased signal abnormality within the posterior horn of the medial meniscus which extends to the tibial and femoral articular surfaces consistent with a complex tear, with a horizontal component, that extends into 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 medial femoral condyle, posteriorly, with a small amount of degenerative underlying subchondral signal abnormality. There is subjective thinning of the articular cartilage the medial and lateral tibiofemoral compartments. There is partial-thickness articular cartilage degeneration along the medial facet of the patella. There are tiny tricompartmental osteophytes.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Tearing of the medial meniscus as described above.2. Small joint effusion and Baker's cyst.3. Articular cartilage degeneration as described above. Other findings as described above.


Instruction: Generate impression based on findings.

Input: 51 years Male (DOB: 12/10/1964)Reason: r/o herniated disk left side History: pain radiating to left shouldPROVIDER/ATTENDING NAME: SCOTT STERN SCOTT STERN The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina. Small endplate osteophytes are present at this level.At C5-6 there is no significant compromise to the spinal canal. There are bilateral uncovertebral osteophytes present at this level associated with narrowing of the neural foramina and encroachment of the exiting nerve roots. This appears relatively stable compared to the prior exam.At C6-7 there is no significant compromise to the spinal canal or neural foramina. There are bilateral uncovertebral osteophytes present this level associated with disc material and some encroachment of the right-sided exiting nerve roots at this level. This appears to have mildly progressed when compared to the previous examAt C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.There are degenerative changes present in the cervical spine with encroachment of exiting nerve roots at C5-6 bilaterally which has not progressed significantly since prior exam. This is worse on the left compared to the right side.2.Since the prior exam the patient is developed some encroachment of right-sided exiting nerve roots at C6-7.


Instruction: Generate impression based on findings.

Input: Male, 18 years old, atypical migraine with neurologic symptoms. No evidence of restricted restricted diffusion, edema or mass effect is seen. No focal parenchymal signal abnormality is identified. There are no findings to suggest acute intracranial hemorrhage or any abnormal extra axial fluid collection. The ventricles are normal in size and morphology.

Output: Unremarkable evaluation of the brain.


Instruction: Generate impression based on findings.

Input: 62 years, Female, proximal weakness. Evaluate for transverse myelitis. Diplopia. BRAIN

Output: 1. There is abnormally increased enhancement along the surface of the cervical and thoracic cord and possibly also along the surface of the brainstem and proximal trigeminal nerves favored to be related to leptomeningeal inflammation or infection, less likely neoplasm. There is also suggestion of minimal intramedullary signal abnormality and enhancement at the T3-T4 level where the dorsal leptomeningeal enhancement along the surface of the cord is more prominent and demonstrates mild nodularity. Leptomeningeal neoplasm seems less likely but not excluded. Suggest lumbar puncture for further assessment. 2. There are postoperative changes of left sided vestibular schwannoma resection with grossly stable enhancement in the left internal auditory canal which may represent postoperative change or grossly stable minimal residual tumor. High-resolution MRI IAC can be considered for more detailed evaluation if clinically indicated. Images of the brain demonstrate no acute hemorrhage, infarct, or mass effect.3. No significant spinal canal stenosis in the cervical or thoracic spine to suggest extrinsic compression.


Instruction: Generate impression based on findings.

Input: 40 year-old female with trauma and neck pain. Evaluate for bleed. There is no evidence of intracranial hemorrhage or abnormal extra-axial fluid collections. There is asymmetric low attenuation within the left temporal lobe, which may represent contusion versus artifact from beam hardening. Repeat CT or MRI is recommended for further evaluation if clinically indicated.The remainder of the cerebral and cerebellar hemispheres and brain stem demonstrate normal morphology and attenuation. Ventricles are midline, with normal volume and morphology. The basilar cisterns are normal in appearance.The calvaria are intact, with no evidence of fracture. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Asymmetric low attenuation within the left temporal lobe, which may represent contusion versus beam hardening artifact. Repeat CT or MRI is recommended for further evaluation if clinically indicated.


Instruction: Generate impression based on findings.

Input: Migraine with aura, intractable, without status migrainosus [G43.119], Reason for Study: ^Reason: persistent headaches consistent with migraine - check for secondary causes - AVM? Exam normal History: see above Brain MRINo evidence of acute ischemic or hemorrhagic lesion.The quadrigeminal cistern is prominent without showing definitive mass effects toward adjacent brain, thus likely represent arachnoid cyst.The ventricles are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal.No intracranial arterial aneurysm. No definitive intracranial luminal stenosis or occlusion.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. Likely quadrigeminal cistern arachnoid cyst.3. Normal brain MRA


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for dorsal column dysfunction. Signs and symptoms: Neuropathy. Pre- and post enhanced cervical MRI:Examination demonstrates normal signal intensity and alignment of vertebral column.No significant degenerative disc disease or central spinal/neural foraminal compromise present.There is tiny linear T2 STIR hyperintensity within the cord which traverses the entire cervical cord and extends into the thoracic cord and likely representing central canal. The finding is most conspicuous at C5 to T1 levels and measures at maximum of 1.9 x 3 mm in transaxial dimensions at C7 level and suggesting of a minimally expansile syrinx. There is no evidence of change in the caliber of the cord secondary to this finding. The signal intensity and anatomical morphology of the cord remains within normal on all MRI sequences otherwise. There is also no detectable abnormal enhancement of the cord or the leptomeninges. No detectable abnormal enhancement of the vertebral column.Pre- and post enhanced thoracic MRI:Similar to MRI of the cervical spine there is a tiny midline linear contiguous T2 STIR hyperintensity of the cord traversing thoracic cord however without extension into the lower most portion of the cord or the conus. The maximum measurement of this lesion is approximately at 1.6 mm at T8. The signal intensity and overall anatomical morphology of the cord is otherwise within normal. Post enhanced images demonstrate no detectable abnormal enhancement of the cord or the abdomen images. There is also no detectable abnormal enhancement of the vertebral column. No evidence of any appreciable degenerative disease, spinal stenosis or neural foraminal compromise at any level.

Output: 1.Pre- and post enhanced MRI of cervical spine demonstrate a tiny linear T2 STIR hyperintensity traversing the entire cervical cord. Minimal expansion is noted only at C5-T1 levels measuring maximum of 1.9 x 3 mm at C7 level. This finding likely representing the central canal however possibility of a small focal minimally expansile syrinx cannot be excluded. Unremarkable signal intensity, morphology and size of cervical cord otherwise and without abnormal enhancement. Unremarkable images of cervical spine without spinal stenosis, neural foraminal compromise or abnormal enhancement.2.Pre- and post enhanced thoracic MRI demonstrate a tiny linear T2 STIR hyperintensity extending from cervical spine inferiorly to T8 level without focal expansion, change in the size of the thoracic cord or abnormal enhancement. No spinal stenosis or neural foraminal compromise or abnormal enhancement of the vertebral column.


Instruction: Generate impression based on findings.

Input: Signs and symptoms: Headaches, neck pain C3 -- C4. Clinical question: Is there evidence of fracture/dislocation. Non-enhanced CT of brain:M. there is no evidence of intracranial hemorrhage, edema, mass-effect, midline shift or hydrocephalus. Cortical sulci, ventricular system and all CSF cisterns as well as gray -- white matter differentiation remains to be normal.Calvarium is intact.CT of the cervical spine:There is no evidence of fracture or subluxation. Very minimal degenerative changes of cervical spine is noted. Reformatted images demonstrate normal alignment the vertebral column. No definitive neural foramina compromise or central spinal stenosis. Limited images through the apices of the lungs demonstrate emphysematous pole I bilaterally. Multi-level subtle bulge of disk material is present. This is more pronounced at C3 -- C4 and apparent subtle mass effect on the cord. This findings can be better evaluated with an MRI exam.

Output: 1.Unremarkable nonenhanced CT of brain.2.No evidence of fracture or subluxation of cervical spine. Minimal degenerative disk disease.


Instruction: Generate impression based on findings.

Input: 62 years Male (DOB:9/10/1953)Reason: assess for stroke, mass, and/or seizure focus History: AMSPROVIDER/ATTENDING NAME: KATIE TATARIS JAMES A MASTRIANNI MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. There are several periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. This is not unusual at this age.No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate a mucous retention cyst in the right maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.Incidental note is made of partial empty sellaMRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is small in size. There is fetal origin of the posterior cerebral arteries bilaterally. The right vertebral artery ends in the right posterior inferior cerebellar artery. The right posterior inferior cerebellar artery has an extracranial origin.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the left vertebral artery. The left vertebral artery origin is tortuous. The right vertebral artery is small and appears narrowed at its origin.

Output: 1.There is no evidence for intracranial cerebrovascular occlusive disease.2.There is narrowing at the origin of the right vertebral artery which is relatively small and dominant and supplies the right posterior inferior cerebellar artery.3.There is no evidence for acute ischemic cerebral infarction.


Instruction: Generate impression based on findings.

Input: History of suprasellar lesion for surveillance. Redemonstrated is a large sellar and suprasellar mass measuring 22 x 35 mm (TR x CC), previously 22 x 40 mm. There is interval decrease in T1 signal hyperintensity at the superior aspect of the mass with a minimal residual curvilinear rim. This mass again extends into the left cavernous sinus, surrounding the left carotid artery with superior displacement of the anterior cerebral arteries and optic chiasm. It insinuates itself into the interhemispheric fissure and abuts and displaces the adjacent right frontal lobe including the right gyrus rectus and olfactory trigone. At the right aspect of the mass, there is a small T2 hyperintense, nonenhancing, cystic focus, which may represent trapped fluid versus a true cystic component of the mass. The right A1 segment is located behind the mass. The pituitary stalk is again deviated towards the right. The partially imaged brain demonstrates parenchymal volume loss and a mild degree of periventricular and subcortical punctate T2 hyperintense white matter lesions.

Output: Slight interval decrease in size of the sellar and suprasellar mass with decreased and evolving hemorrhage along its superior aspect.


Instruction: Generate impression based on findings.

Input: Ms. Segev is a 60-year-old female with personal history of right breast lumpectomy with re-excision in 2008 for ILC status post chemotherapy, radiation therapy and hormonal therapy. Personal history of benign left breast biopsies. Family history of breast cancer in sister, diagnosed at the age of 49. She has no current breast related complaints. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.Postsurgical changes are reidentified in the right lower inner breast with complete resolution of seroma cavity, compatible with provided history of right breast lumpectomy.As on previous studies, there are several scattered foci of enhancement throughout the left breast, predominantly inferiorly, which appear stable compared to prior studies. In the medial left breast in the 9 o'clock position there is a stable lobulated enhancing mass which measures up to 1 cm in length.No abnormal enhancement is seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: Right-sided back and leg pain, evaluate for herniated disc, spinal stenosis Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position. There is no abnormal enhancement.Multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: Mild disc bulge with no significant spinal canal or neural foraminal stenosis.L3-L4: Mild disc bulge with no significant spinal canal stenosis. Mild bilateral neural foraminal narrowing. L4-L5: No significant disc disease. No spinal canal or right neural foraminal stenosis. There is bilateral facet arthropathy. Minimal left neural foraminal narrowing.L5-S1: Mild disc bulge eccentric to the right with mild right neural foraminal narrowing. There is contact of the right L5 nerve root without clear impingement. No significant spinal canal or left neural foraminal narrowing. There is facet arthropathy, worse on the right.Paraspinous soft tissues are within normal limits. Mild degenerative changes at the sacroiliac joints are also noted, worse on the right.

Output: 1. Mild degenerative changes in the lumbar spine. There is no significant spinal canal stenosis at any level. There is mild neural foraminal stenosis including the bilateral L3-L4 and right L5-S1 levels as detailed above. No high-grade neural foraminal stenosis at any level.2. Moderate facet arthropathy at the L4-L5 and L5-S1 level, slightly worse on the right than the left, which may be contributing to patient's low back pain.


Instruction: Generate impression based on findings.

Input: Metastatic small cell lung cancer, brain metastases, on chemotherapy. There are postoperative findings related to right frontal craniotomy, with underlying confluent high T2 signal with encephalomalacia and susceptibility effect in the right frontal lobe, with an unchanged subcentimeter area of enhancement. There are also multiple other supratentorial and infratentorial metastatic lesions, some of which are stable and some of which are smaller. For example, a left middle frontal gyrus lesion measures up to 6 mm in diameter, previously also 6 mm, and a posterior medullary lesion measures 5 mm in diameter, previously 10 mm. Many of the lesions contain hemorrhagic components levels, some of which have evolved. There is no evidence of acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact.

Output: Postoperative findings related to right frontal craniotomy, with an unchanged nonspecific subcentimeter area of enhancement. Multiple other supratentorial and infratentorial metastatic lesions are stable or smaller and many contain hemorrhagic components.


Instruction: Generate impression based on findings.

Input: 9-month-old female ex-28 weeker with bleed, abnormal ultrasound, now with generalized tonic clonic seizure. There is susceptibility artifact along the lateral margin of the right lateral ventricle, in the dependent portions of the bilateral lateral ventricles and in the germinal matrix, left greater than right, consistent with hemosiderin deposition. There is mild prominence of the ventricles as well as prominence of the anterior subarachnoid spaces. The basal cisterns remain patent. There is no midline shift or mass effect. The pattern of myelination is appropriate for corrected age. There are no other areas of abnormal signal. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits.

Output: 1. Findings suggestive of germinal matrix-related intraventricular hemorrhage.2. Mild ventriculomegaly, which could be related to intraventricular hemorrhage and/or benign external hydrocephalus of infancy given the concomitant mild prominence of the anterior subarachnoid spaces, which should resolve by 2 years of age.


Instruction: Generate impression based on findings.

Input: 76 year-old female history of pelvic carcinomatosis. PELVIS:UTERUS, ADNEXA: Heterogeneous and thickened endometrial cavity measuring up to 14mm. Multiple small intramural uterine fibroids.10 mm calcified right ovarian lesion. The right ovary is slightly abnormal appearing measuring 2.8 x 1.4 cm and corresponds to an area of increased FDG uptake on recent PET CT. The left ovary measures 1.7 x 1.5 cm and appears unremarkable..BLADDER: The bladder is collapsed.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is mild thickening of the visualized bowel, likely related to ascites.BONES, SOFT TISSUES: Diffuse sclerotic osseous metastases.OTHER: Moderate volume ascites.

Output: 1. Thickened and heterogeneous endometrial canal measuring up to 14 mm concerning for endometrial neoplasm.2. Slightly abnormal-appearing left ovary with internal calcified cystic lesion which corresponds to an area of increased FDG uptake on recent PET. This is nonspecific and should be evaluated with dedicated ultrasound.3. Moderate volume ascites.


Instruction: Generate impression based on findings.

Input: There is an area of abnormal signal within the right paracentral lobule which demonstrates increased signal on DWI images, decreased signal on ADC images, and increased signal on T2-weighted images compatible with a subacute ischemic infarction. SWI demonstrate several patchy areas of susceptibility within this area compatible with associated microhemorrhage. There is mild local edema and sulcal effacement without significant mass effect. There is an additional punctate focus of restricted diffusion within the right post central gyrus. This area demonstrates associated only mildly increased T2 signal again suggesting subacute infarct, likely more recent than the infarct in the paracentral lobule. It is difficult to assess for associated hemorrhage in this area due to motion artifact on the GRE images.There is a large area of encephalomalacia involving the right parietal, posterior frontal, and posterior temporal lobes corresponding to the infarct seen on 8/31/2010 examination. Punctate and confluent foci of increased T2/FLAIR signal within the periventricular and subcortical white matter are compatible with chronic small vessel ischemic changes. Volume loss involving the right cerebral peduncle is compatible with expected Wallerian degeneration related to right chronic MCA distribution infarctionBurr holes are again seen in the posterior calvarium within an associated underlying focus of encephalomalacia in the right precuneus extending into the cuneus. There is mild ex vacuo dilatation of the right lateral ventricle without evidence of hydrocephalus. A partially empty sella is noted. There is patchy mucosal thickening within the maxillary sinuses, ethmoid air cells, and sphenoid sinuses.No evidence of intracranial mass or mass effect. No pathologic midline shift or herniation. The flow voids in the major intracranial vascular structures are grossly intact except for the right MCA due to chronic occlusion.

Output: 1.Multifocal, subacute ischemic infarction with small amount of associated hemorrhage involving the right paracentral lobule and right post-central gyrus. Given distribution, associated hemorrhage, and possibility of varying ages, venous infarct is a possibility. Recommend dedicated MRV to assess for venous sinus thrombosis.2.Chronic infarction/encephalomalacia involving the right parietal, posterior frontal, and posterior temporal lobes.3.Moderate chronic small vessel ischemic changes.Findings discussed with PULIMI, SANDEEP by Dr. David Kromrey at 9:30 a.m. on 9/9/2015.


Instruction: Generate impression based on findings.

Input: 2-year-old female patient with history of a perianal fistula. Question of resolution of infection/abscess and extent of fistula. PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Redemonstration of a tubular structure with more focal rounded, cystic components within the presacral space, some of which demonstrate intrinsic high T1 signal. A fistula is again seen extending from the distal rectum through the right levator ani complex, right ischioanal fossa, and to the right medial gluteal skin surface. This is similar in extent to the prior study, though with decreased surrounding edema type signal near the gluteal fold. There is no associated abscess. No new fistulous connection is identified. BONES, SOFT TISSUES: The right femoral head is irregular in contour and small. The fibrofatty pulvinar in the right acetabulum is larger than the left. OTHER: No significant abnormality noted.

Output: 1.Similar extent and appearance of a rectocutaneous fistula without abscess formation.2.Tubular structure within the presacral space is unchanged in appearance and may represent some kind of developmental cyst.3.Probable congenital dysplasia of the right hip.


Instruction: Generate impression based on findings.

Input: 16 years Female (DOB:7/18/1999)Reason: Bleeding or structure abnormal History: 2 weeks post MVA; HA 8/10 and dizziness not resolvingPROVIDER/ATTENDING NAME: YINGSHAN SHI YINGSHAN SHI The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: MRI of the brain is within normal limits


Instruction: Generate impression based on findings.

Input: 11-month-old female with infantile spasms. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma. No abnormal mass lesions are appreciated intracranially. The pattern of myelination is within acceptable limits for patient's age. The CSF spaces are appropriate for the patient's stated age with no midline shift. Major vascular flow voids are maintained. The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: MRI of the brain is within normal limits.


Instruction: Generate impression based on findings.

Input: 61 year old male with floor of mouth cancer. Please evaluate extent of disease and adenopathy. Rule out lung metastases. MRI CT of soft tissues of the neck.Images through the skull base are within normal limits. An enhancing mass in the left pleura the mouth is detected. The mass appears to contain a small air density which may be either secondary to necrosis or recent biopsy. The mass appears to minimally extend across the midline to the right side. The most anterior component of the mass measures approximately 3 mm by 17-mm. On coronal images the mass measures approximately 21 mm times 17-mm.The mass is essentially anterior in location and is not associated with any bony changes. Some dilatated of left submandibular gland duct may indicate partial obstruction.An enhancing lymph nodes on the left at the level of floor of the mouth measures approximately 14.7 x 8 0.6-mm. No evidence of any pathologic lymph nodes by size criteria is detected.The bony density of the area of exam is unremarkable for metastatic disease.Extensive emphysematous changes a limited view of the apices of the lung is noted. No definitive evidence of metastatic lesion in the lung is present.CT of brain with infusion.This examination is essentially unremarkable and in particular no evidence of metastatic lesion is detected.

Output: 1.Left-sided floor of the mass tumor as detailed.2.Unremarkable CT of brain.


Instruction: Generate impression based on findings.

Input: 33-year-old female with multiple sclerosis experiencing paresthesias, evaluate for progression Redemonstrated are innumerable foci of T2 hyperintensity within periventricular and to a lesser extent subcortical white matter, without definite new lesions.Ventricles and sulci retain normal size and configuration. No abnormal fluid collections are present. There is no intracranial mass lesion, midline shift, or basal cistern effacement. Visualized paranasal sinuses and mastoid air cells are grossly unremarkable.

Output: Innumerable cerebral supratentorial white matter lesions, consistent with stated diagnosis of multiple sclerosis. There are no definite new lesions.