Instruction: Generate impression based on findings.

Input: 43 year old with known left breast cancer, evaluate response to therapy. There is heterogeneous amount of fibroglandular tissue in both breasts. Numerous bilateral high T2 signal cysts are seen. Mild parenchymal enhancement is noted bilaterally.The index mass in the left upper inner breast measures 3.1 x 2.7 x 2.7 cm, minimally changed compared to prior measurements of 3.2 x 3.0 x 2.7 cm. A Hydromark clip is noted from the additional benign biopsy performed further anterior to the index cancer, but there is no significant enhancement near this clip. Several enlarged left axillary lymph nodes are seen, though these are decreased in size compared to baseline. The previously measured representative node measures 1.3 x 0.9 cm, previously 1.7 x 1.3 cm. No suspicious enhancement is seen in the right breast. Many of the foci previously seen in the right breast are less enhancing now, though there is persistent enhancement of a right retroareolar focus. This may represent an inflamed cyst. No abnormal lymph nodes are identified in the right axillary region.Large hepatic mass again noted.

Output: 1. Small interval change in measurements of the left breast index mass.2. Multiple left axillary lymph nodes are decreased in size.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: History of horseshoe kidney and renal mass versus cyst in the lower pole of the right kidney. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology, size, signal intensity and enhancement without a focal suspicious lesion, biliary ductal dilatation or vascular abnormality. Minimally distended gallbladder.SPLEEN: The spleen is normal in size without a focal lesion.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Stable nonspecific mild left adrenal gland thickening.KIDNEYS, URETERS: Supernumerary kidneys which are fused at the midline.Stable size of the 2 right inferior pole cystic lesions, one of which contains a thin septation without abnormal enhancement. The more exophytic lesion demonstrates intrinsic T1 weighted hyperintensity without postcontrast enhancement compatible with a proteinaceous/hemorrhagic cyst.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: Supernumerary kidneys fused at the midline with right inferior minimally complex cysts.


Instruction: Generate impression based on findings.

Input: Leg pain and swelling Within the subcutaneous tissues of the proximal right thigh is an ill-defined collection measuring approximately 11 x 2 x 7.5 cm in the greatest transaxial and craniocaudal dimensions. A distinct fluid/fluid level is identified on the axial sequences with the more superficial/anterior portion demonstrating high T1 signal reflecting hemorrhagic contents. Following contrast administration, there is no central or solid enhancement identified. These findings most likely represent a resolving subcutaneous hematoma. There is a mild amount of subcutaneous edema tracking inferiorly along the thigh.The underlying marrow signal of the femur is normal. There is a small amount of increased T2 signal involving the proximal and posterior aspect of the vastus lateralis.On the large field-of-view images, there is subcutaneous edema along the lateral portion of the left thigh although this is incompletely characterized on this exam.

Output: Subcutaneous mass within the right thigh represents a resolving hematoma. Continued follow-up to resolution either clinically or via imaging is recommended.


Instruction: Generate impression based on findings.

Input: Lower extremity pain and weakness Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is grade 1 retrolisthesis of L5 on S1. Alignment of the lumbar spine is otherwise maintained. Bone marrow signal is benign. The conus medullaris is normal in position.There is developmental narrowing of the lumbar spinal canal with superimposed degenerative changes as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: There is disc desiccation, ligamentum flavum thickening, and moderate bilateral facet arthropathy. There is moderate to severe spinal canal stenosis including effacement of the lateral recesses. There is also moderate bilateral neural foraminal stenosis. L4-L5: There is disc desiccation with dorsal annular fissure and central protrusion component, which along with facet arthropathy and ligamentum flavum thickening contribute to severe spinal canal stenosis. There is also moderate bilateral neural foraminal stenosis.L5-S1: There is disc bulge with dorsal annular fissure and central protrusion component, bilateral facet arthropathy, and ligamentum flavum thickening. There is effacement of the lateral recesses and moderate central canal stenosis. There is also moderate right and mild to moderate left neural foraminal stenosis.Paraspinous soft tissues are within normal limits.

Output: 1. Developmental narrowing of the lumbar spinal canal with superimposed degenerative changes contribute to severe spinal canal stenosis at the L4-L5 level and to a slightly lesser degree at the L5-S1 and L3-L4 levels.2. Moderate degree of neural foraminal stenoses at L3-L4, L4-L5, and L5-S1, as above.


Instruction: Generate impression based on findings.

Input: Left knee pain, evaluate for lateral meniscus tear or chondral injury. MENISCI: There is attenuation of the posterior horn of the medial meniscus with branching intrasubstance signal extending to both articular surfaces, indicating complex tearing. The tear extends into the body of the medial meniscus, which is extruded medially. There is a small amount of increased signal in the lateral meniscus, suggesting intrasubstance degeneration but we see no discrete tear.ARTICULAR CARTILAGE AND BONE: There is moderate degeneration of the articular cartilage of the medial tibiofemoral compartment with a focal full-thickness defect along the medial tibial plateau with underlying subchondral cyst formation and marrow edema (series #801/17).There is moderate degeneration of the articular cartilage of the patellofemoral joint, particularly affecting the lateral portions of the joint where there is full-thickness degeneration along the femoral trochlea with underlying cyst formation (series #301/23).The articular cartilage of the lateral component appears relatively spared. There are small tricompartmental osteophytes. There is mild osteoarthritis of the proximal tibiofibular articulation.LIGAMENTS: The MCL, LCL, ACL, and PCL are intact. EXTENSOR MECHANISM: There is mild intermediate signal intensity in the patellar tendon proximally and distally with prominence of the patella at the insertion of the patellar tendon, which may represent tendinosis.ADDITIONAL

Output: 1. Tearing of the medial meniscus but no lateral meniscus tear is evident.2. Osteoarthritis as described above predominantly affecting the medial and patellofemoral compartments.


Instruction: Generate impression based on findings.

Input: Clinical question: 76-year-old male with prostate cancer with dural metastases. Signs and symptoms: Dural metastases. Pre and post enhanced brain MRI:Negative diffusion weighted series.Examination demonstrates stable focus of encephalomalacia and gliosis in the left posterior temporal/occipital lobe with associated ex arcuate dilatation of left temporal horn and trigone of lateral ventricle consistent with chronic ischemic stroke.Stable diffuse foci of marrow signal changes and subtle enhancement involving the left temporal and left parietal calvarium. Findings represent a constellation of postoperative changes and/craniotomy site and metastases/treated metastatic changes without appreciable change since prior exam.Stable patchy foci of FLAIR and T2 hyperintensity primarily in the periventricular white matter of bilateral cerebral hemispheres highly suggestive of chronic small vessel ischemic strokes.More confluent foci of FLAIR hyperintensity in the periventricular white matter of bilateral cerebral hemispheres surrounding the trigone of lateral ventricles (left greater than right) is likely secondary to treatment/radiation changes and overlapping small vessel ischemic strokes.Ventricular system remains stable in size and maintain midline.There is no detectable parenchymal abnormal enhancement or evidence of parenchymal vasogenic edema.Unremarkable signal intensity of the calvarium and without enhancement other than the above-mentioned changes in the left temporal/parietal region.Unremarkable images through the orbits. All visualized paranasal sinuses and bilateral mastoid air cells and middle ear cavities demonstrate normal pneumatization signal patterns.

Output: 1.No evidence of an acute intracranial process and no convincing evidence of new findings since prior study. 2.Marrow signal changes of left temporal and parietal calvarium with faint enhancement representing constellation of postoperative/craniotomy and metastatic/treated metastatic lesion without interval change. Unremarkable signal intensity of the calvarium otherwise and without abnormal enhancement.3.Stable patchy foci of periventricular T2/FLAIR hyperintensity representing post treatment/radiation change and chronic small vessel ischemic strokes.4.Stable foci of encephalomalacia and gliosis in the left posterior temporal-parietal without abnormal enhancement as detailed.


Instruction: Generate impression based on findings.

Input: 81 years, Female, metastatic breast cancer. There is extra-axial enhancing soft tissue along the dorsum sella and posterior aspect of the clivus measuring approximately 8 x 21 x 18 mm in the AP, transverse, and craniocaudal dimensions. The soft tissue lesion abuts the ventral aspect of the pons. No mass effect on the pituitary gland or optic chiasm.Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but likely represent mild chronic small vessel ischemic disease and/or posttreatment-related changes. Brain parenchyma is otherwise unremarkable for age. No evidence of acute ischemia or intracranial hemorrhage. No abnormal parenchymal enhancement to suggest intraparenchymal metastatic disease. Major flow-voids are preserved.Multiple small lesions are seen throughout the calvarium are consistent with osseous metastases. Several these lesions violate the inner table of the calvarium without significant intracranial mass effect associated with any of the lesions. Evidence of remote small right medial wall orbital fracture again seen.

Output: 1. As seen on recent neck CT from 9/1/2015, there is a dural-based enhancing lesion along the dorsum sella and upper aspect of the clivus measuring 8 x 21 x 18 mm. The lesion fills the left prepontine cistern and abuts the left aspect of the pons with minimal if any local mass effect. This finding is very subtle on prior neck CT in retrospect from 4/3/2015 and does not appear to be present on 10/20/2014. Findings are highly suspicious for enlarging metastasis. No intraparenchymal metastatic lesions are appreciated.2. Numerous osseous metastases throughout the calvarium as seen on prior bone scans. Several of these lesions are seen to violate the inner table without significant associated mass effect on the parenchyma.


Instruction: Generate impression based on findings.

Input: 15-year-old female with knee pain during sports MENISCI: Increased signal intensity extending to the articular surface of the posterior horn and body of the medial meniscus indicates an undersurface longitudinal meniscal tear. No other meniscal tears are identified.ARTICULAR CARTILAGE AND BONE: Articular cartilage is intact. Increased T2 signal along the posterior tibial condyles extending into the metaphysis indicates a bone contusion.LIGAMENTS: There is disruption of the midportion of the ACL indicating a tear. The PCL is intact. The MCL and lateral collateral complex is intact.EXTENSOR MECHANISM: Extensor mechanism is intact. Mildly increased T2 signal within the medial retinaculum indicating sprain. Medial retinaculum appears intact. The lateral retinaculum is intact.ADDITIONAL

Output: 1.Complete ACL tear.2.Undersurface longitudinal tear of the posterior horn and body of the medial meniscus.3.Mild medial retinaculum sprain.4.Small joint effusion.


Instruction: Generate impression based on findings.

Input: A patient submitted outside study for review. Submitted for review are bilateral screening/diagnostic mammography 3/4/2015, bilateral breast MRI and MRI guided biopsy 3/14/2015, and right diagnostic mammography 3/25/2015 performed at Northwestern Memorial Hospital. For comparison, bilateral screening mammography 4/14/2011 are available. 46 year old female per report referred to outside diagnostic mammography for left breast symptoms. Patient was reportedly breast feeding and suddenly stopped from the left breast. Family history of ovarian cancer in aunts and cousins. Patient believes she underwent genetic testing in the past with negative results. 3/4/2015 SCREENING/BILATERAL DIAGNOSTIC MAMMOGRAPHY AND POSTPROCEDURAL MAMMOGRAM Two standard views of both breasts, additional right ML and four spot magnification views were provided. The breast parenchyma is heterogeneously dense, unchanged in pattern and distribution. Cluster of calcifications in the right upper outer breast, posterior depth, have developed. On spot magnification, they are pleomorphic and measure 0.5 cm. Additional scattered benign calcifications are stable.These calcifications were biopsied reportedly under stereotactic guidance (no images available). Post-procedural orthogonal mammogram of the right breast demonstrate post biopsy change including foci of gas and X shaped clip in the previous location of the cluster of calcifications in the 9 o'clock position. No residual calcifications are visualized.3/14/2015 DIAGNOSTIC BILATERAL BREAST MRI AND 3/25/2015 MRI GUIDED BIOPSY:Exam is limited by motion artifact, more so on the right. A vitamin E marker was placed along the right upper outer breast. Postbiopsy hematoma is noted in the 9 o'clock position with only thin peripheral enhancement around the cavity. In the 11 o'clock position, there is non-mass enhancement measuring 2.3 x 1.4 x 1.8 cm, which was subsequently biopsied under MRI guidance. MRI images from the biopsy were not submitted, however the MRI biopsy clip placement on 3/24/2015 mammogram is accurate for the findings on MRI.3/24/2015 DIAGNOSTIC RIGHT MAMMOGRAM:Two standard views of the right breast were provided. X shaped biopsy clip from stereotactic guided biopsy of cluster of calcifications with reported pathology of DCIS is located in the 9 o'clock position posterior depth. Previously seen post biopsy change have resolved. No residual calcifications are noted. Trimark clip from MRI guided biopsy is located in the 11 o'clock position with reported benign results. Postbiopsy change including foci of gas and small hematoma are noted.

Output: 1.Right 9 o'clock 5 mm cluster of calcifications with reported biopsy results of DCIS after stereotactic guided biopsy. X-shaped clip with no residual calcifications are visualized on subsequent mammogram. 2.Right 11 o'clock non-mass enhancement with reported benign biopsy results after MRI guided biopsy. Trimark clip is visualized on subsequent mammogram. Benign pathology is concordant. 3.No mammographic or MRI abnormality in the left breast.4.No abnormal lymph nodes.5.Recommend submission of outside pathology materials and surgical consultation.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Leg and arm weakness, severe back pain shooting to legs Cervical: Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. There is loss of cervical lordosis with mild kyphotic angulation of the apex at the C3-C4 level. There is minimal anterolisthesis of C3 on C4. Bone marrow signal is benign. Examination is motion degraded but demonstrates no convincing cord signal abnormality. Degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: There is disc osteophyte complex and uncovertebral hypertrophy with partial effacement of the ventral thecal sac. No significant spinal canal stenosis. There is moderate right neural foraminal stenosis. Mild left neural foraminal stenosis. Prominent facet arthropathy on the right.C4-5: No significant spinal canal stenosis. Mild uncovertebral hypertrophy on the left with mild left and no significant right neural foraminal stenosis. C5-6: Uncovertebral hypertrophy with mild to moderate left and mild right neural foraminal stenosis. No significant spinal canal stenosis. C6-7: Disc osteophyte complex and uncovertebral hypertrophy. There is no significant spinal canal stenosis. There is mild bilateral, left worse than right, neural foraminal stenosis. Facet arthropathy, worse on the left.C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.Lumbar: 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 with T1 hyperintense lesion at L1 compatible with hemangioma. The conus medullaris is normal in position.Multilevel degenerative changes are seen, as described below:L1-L2: Minimal disc bulge. No spinal canal or neural foraminal stenosis.L2-L3: Minimal disc bulge. No spinal canal or right neural foraminal stenosis. Minimal left neural foraminal narrowing.L3-L4: Mild disc bulge. No spinal canal stenosis. Mild right and minimal left neural foraminal stenosis.L4-L5: Mild disc bulge. There is bilateral facet arthropathy. No significant spinal canal stenosis. There is mild left neural foraminal stenosis.L5-S1: Mild disc bulge. There is advanced facet arthropathy on the left. There is moderate to severe left neural foraminal stenosis where there may be impingement of the left L5 nerve root. No significant right neural foraminal narrowing.Paraspinous soft tissues are within normal limits. Bilateral renal cysts are noted.

Output: 1. Multilevel degenerative changes in the cervical spine without high-grade spinal canal stenosis at any level. No cord signal abnormality. Multilevel neural foraminal stenosis, worst at the right C3-C4 level. Additional levels as above.2. Multilevel degenerative changes in the lumbar spine. There is moderate to severe left L5-S1 neural foraminal stenosis where there is suspected impingement of the left L5 nerve root. No significant spinal canal stenosis. Additional levels as above.


Instruction: Generate impression based on findings.

Input: 14-year-old male with neurofibromatosis and new hearing loss, evaluate for vestibular schwannomas. Redemonstrated is an enhancing extra-axial mass within the right internal auditory canal extending into the adjacent cerebellar pontine angle measuring 12 x 9 mm in axial dimension (previously 11 x 7 mm). A similar-appearing, yet smaller, lesion is present within the internal auditory canal without extension into the adjacent cerebellopontine angle measuring 8 x 4 mm (previously 7 x 4 mm). As before, there is no associated mass effect upon the brain parenchyma. Redemonstrated is lace-like FLAIR hyperintensity signal in the subcortical white matter of the left middle frontal gyrus which does not enhance, has no mass effect, and appears similar to the prior study. There is also a much smaller similar-appearing focus in the right which is also stable in appearance. These are felt to most likely represent stable appearing prominent perivascular spaces with mild surrounding high T2 signal. There is no evidence of acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift. There are unchanged mildly low-lying cerebellar tonsils. Expected vascular flow-voids are demonstrated. The orbits, skull, and scalp soft tissues are unremarkable. Previously demonstrated mucosal thickening in the paranasal sinuses has mostly resolved. Mastoid air cells are clear.

Output: 1. The bilateral presumed vestibular schwannomas have slightly increased in size.2. Unchanged prominent perivascular spaces in the bilateral middle frontal gyri, left greater than right. 3. Unchanged mildly low-lying tonsils.


Instruction: Generate impression based on findings.

Input: 4 year-old Male. Reason: Hx Autism History: developmental delay. There is no evidence of intracranial mass. The brain parenchyma and pituitary gland appear unremarkable. Myelination is appropriate for patient's stated age, with mild expected ill-defined FLAIR hyperintensity remaining in the terminal zones of myelination. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact.There is moderate mucosal thickening of the left maxillary sinus, the left posterior ethmoid air cells, and bilateral sphenoid sinuses with trace scattered opacification of the left greater than right mastoid air cells.

Output: Unremarkable noncontrast MRI brain. Mild sinus inflammation, predominantly on the left side.


Instruction: Generate impression based on findings.

Input: Assess cyst burden in the kidney and liver. History of polycystic kidney disease. ABDOMEN:LIVER, BILIARY TRACT: There are several scattered subcentimeter hepatic cysts involving less than 5% of the hepatic parenchyma. No focal suspicious lesion within the limitations of an unenhanced study. No biliary ductal dilatation. Normally distended gallbladder.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: The right kidney measures 11.3 x 5.4 cm and contains numerous simple and minimally complex cysts replacing less than 25% of the renal parenchyma. The largest is an upper pole cyst measuring 1.4 x 1.1 cm.The left kidney measures 11.8 x 5.5 cm and contains numerous simple and minimally complex cysts replacing less than 25% of the renal parenchyma. The largest cyst measures 3.2 x 3.1 cm in the upper pole.No hydronephrosis or suspicious renal lesion. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Small perineural cysts are noted.1.OTHER: No significant abnormality noted.

Output: 1.Findings of polycystic kidney disease with numerous bilateral renal cysts involving less than 25% of the renal parenchyma.2.Multiple hepatic cysts affecting less than 5% of the hepatic parenchyma.


Instruction: Generate impression based on findings.

Input: 30 year old female with known congential AV block, MRI to evaluate for any underlying etiology Left VentricleThe left ventricle is normal in size and normal systolic function. The overall LV ejection fraction is 65%. The LVEDV is 176 ml (normal range 109+/-23), LV end diastolic volume index is 85 ml/m2 (normal range: 65+/-11), LVESV is 61 ml (normal range 31+/-10), and LV end systolic volume index is 30 ml/m2 (normal range 18+/-5). The LV mass is 85 g (normal range 114+/-24) and the LV mass index is 41 g/m2 (normal range 67+/-11). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.There is no myocardial iron overload. There is no LV thrombus. Left AtriumThe left atrium is normal.Right VentricleThe right ventricle is normal in size and function. The overall RV ejection fraction is 52%, the RV end diastolic volume index is 98 ml/m2 (normal range 69+/-14), the RVEDV is 202 ml (normal range 110+/-24), the RV end systolic volume index is 47 ml/m2 (normal range 22+/-8), and the RVESV is 96 ml (normal range 35+/-13). Right AtriumThe right atrium is normal. Aortic ValveThe aortic valve is trileaflet, opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Normal left ventricular structure and systolic function with EF at 65 %2. Normal right ventricular structure and systolic function with EF at 52 %3. No late gadolinium enhancement noted in ventricular myocardium to suggest an underlying myocardial fibrosing, inflammatory, or infiltrative process. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: For numbering purposes, there are a total of 5 lumbar type vertebral bodies. The conus medullaris is normal in signal and morphology and terminates at L1-L2 level. The filum appears to shift anteriorly on prone imaging. There is no evidence of fibrofatty filum. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The paravertebral soft tissues are unremarkable.

Output: No abnormalities of the lumbar spine. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: The lesion that was seen on the previous MRI in the left paramedian pituitary gland is not appreciated, even on dynamic post-contrast imagesThe visualized brain is unremarkable.

Output: The questioned left paramedian pituitary lesion on prior exam is no longer appreciated. No new finding.


Instruction: Generate impression based on findings.

Input: Female; 60 years old. Reason: patient w/ newly dx cervical cancer, please evaluate for cervical or uterine lesion and any other areas of abnormalities History: newly diagnosed cervical cancer, please evaluate for cervical/uterine lesion and any metastatic disease ABDOMEN:LIVER, BILIARY TRACT: Diffuse hepatic steatosis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Benign bilateral adrenal nodular thickening to adenomas.KIDNEYS, URETERS: Subcentimeter T2 hyperintense lesions in both kidneys are too small to characterize but likely due to cysts. Multiple focal cortical defects in the right kidney, suggestive of scarring from prior infection, with resultant chronic-appearing dilation of the right renal pelvis. No hydroureter.RETROPERITONEUM, LYMPH NODES: Mild retroperitoneal lymphadenopathy. For future reference, a left para-aortic lymph node measures 20 x 11 mm (series 2901/33).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Enhancing cervical mass with central necrosis measuring up to 3.6 x 2.8 cm (series 2602/267). Mild anterior parametrial invasion at the level of the cervix is seen, right greater than left (series 2201/25). There is superior extension of the tumor into the uterus. No bladder or rectal invasion is evident.BLADDER: No significant abnormality noted.LYMPH NODES: Mildly bilateral pelvic sidewall lymph lymphadenopathy. For future reference, a left pelvic sidewall lymph node measures 14 x 10 mm (series 2604/364). BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Cervical cancer as detailed above with retroperitoneal and pelvic lymphadenopathy.


Instruction: Generate impression based on findings.

Input: Clinical question: CVA, TIA, hemorrhage. Signs and symptoms: Aphasia. Nonenhanced head CT:Examination again demonstrates as was noted on prior brain MRI of 24 hours earlier multiple foci of vasogenic edema consistent with multiple intracranial complement the study lesions. The lesion in the basal cistern demonstrate high density and likely representing known hemorrhagic component of tumor. The larger metastatic lesion in the left anterior frontal lobe demonstrates slightly higher than gray matter density also consistent with minimal internal hemorrhage. Mildly high density of vermian metastatic focus is also like lesion sulcal minimal internal hemorrhage.The rest of metastatic foci are evident only by edema without evidence of hemorrhage.There is evidence of regional mass effect at the level of metastatic lesions and without detectable mass effect on the ventricular system or midline shift.

Output: 1.Multiple foci of vasogenic edema consistent with patient's known intracranial metastatic lesions not significantly changed since prior exam from 24 hours earlier.2.Several of the lesions demonstrate slight increased density consistent with hemorrhage within the metastatic lesions as was noted on prior MRI.


Instruction: Generate impression based on findings.

Input: Diagnosis: Altered mental status, unspecifiedClinical question: seizure etiologySigns and Symptoms: seizures There are multiple foci of the diffusion restriction scattered throughout the brain including both hemispheres of the brain and the posterior fossa. One in the right cerebellar hemisphere measures 31 x 30 mm. One in the left cerebellar hemisphere measures 19 x 22 mm axial dimensions One at the anterior tip of the left temporal lobe measures 30 x 30 mm. A more patchy focus in the posterior aspect of the left temporal lobe extending to the adjacent occipital lobe measures 44 x 20 mm. One in the left middle frontal gyrus measures 34 x 20 mm. One in the left paracentral lobule measures 30 x 13 mm. Small patchy foci of diffusion restriction are present in the occipital poles. A number of punctate lesions are scattered throughout the brain basal ganglia, left cerebral peduncle and pons.There is redemonstration of a foci of encephalomalacia in the left temporal lobe and the left precuneus.There are punctate foci of susceptibility effect present in the brainstem and basal ganglia with patchy foci of susceptibility effect in foci of the encephalomalacia and acute infarction.There is a mild degree of periventricular and subcortical confluent hyperintense white matter lesions present identified on the FLAIR and T2 images. Additional patchy areas of FLAIR and T2 signal hyperintensity are present in the basal ganglia, internal capsules, brainstem and cerebellar hemispheres. The large degree these were present on the 3/16/2015 exam.Postcontrast imaging demonstrates some gyral type contrast enhancement along the left middle frontal gyrus and some smaller foci of enhancement in the basal ganglia.The visualized portions of the paranasal sinuses demonstrate mucosal thickening and partial opacification status post intubation.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.There are multiple foci of the subacute infarction scattered in both hemispheres of the brain and the cerebellum is detailed above. Some of these represent lacunar infarcts and others are larger. Some of these are associated with the petechial blood. Some associated contrast enhancement may represent a reaction of the blood brain barrier to subacute infarction.2.There is redemonstration of multiple foci of encephalomalacia predominantly involving the left temporal lobe and left parietal lobe. Smaller foci of encephalomalacia are present elsewhere.3.There is redemonstration of a periventricular and subcortical white matter lesions which are suspected to be vascular related but are nonspecific.4.Multiple non-diffusion restricting lesions in the brainstem likely represent older lacunar infarcts5.Multiple microhemorrhages are present in a pattern suggestive of microhemorrhages related to hypertension


Instruction: Generate impression based on findings.

Input: Other phakomatoses, not elsewhere classified [Q85.8], Reason for Study: ^Reason: With Von Hippel Lindau Syndrome and resection of cerebellar Hemangioblastomas in 4/2016 abd 2000. Evaluate for lesions. History: With Von Hippel Lindau Syndrome and resect.Additional history from Epic. Patient was initially diagnosed with right cerebellar mass in 2000 which was resected. Patient underwent additional resection for left cerebellar mass on April 4, 2016. MRI of the spine in June 20, 2016 demonstrated multiple lesions. MRI BRAIN:There is encephalomalacia in the bilateral cerebellar hemispheres related to lesion resection. There is a new enhancing 6 mm lesion in the posterior inferomedial left cerebellum (series 5, image 26). Additionally, there is a new 7 mm lesion in the superior left cerebellum (series 5, image 46). There is an approximately 4 mm enhancing lesion in the right putamen, increased since prior examination.The cortical sulci are in proportion to cerebral ventricles. There are numerous foci of T2/FLAIR hyperintensity in the periventricular and subcortical white matter without enhancement or restricted diffusion. No midline shift or mass effect is appreciated. There is no diffusion abnormality identified. There is no acute intracranial hemorrhage. There is a partially empty sella. Bilateral staphyloma are noted. There is a small retention cyst in the right maxillary sinus. Small amount of fluid is present in the left mastoid air cells.MRI CERVICAL SPINE:There is mild reversal of the cervical lordosis centered at C4-5. The vertebral heights and intervertebral disc spaces are maintained. The spinal cord demonstrates normal caliber and signal intensity. The C7-L4 vertebral bodies demonstrate diffusely new increased T1 hyperintensity, suggesting interval radiation treatment. No worrisome focal marrow signal is identified. No abnormal enhancing lesions are identified in the cervical spine.There are small disc bulges with posterior disc osteophyte complex is present at C4-5, C5-6, and to a lesser degree C6-7. There is mild effacement of the ventral thecal sac at C4-5 and C5-6. No significant cervical central or neural foraminal stenosis is noted.MRI THORACIC SPINE:The thoracic kyphosis is preserved. The vertebral bodies and intervertebral disc spaces are maintained. No worrisome focal marrow signal is identified. There is an approximately 6 x 5 mm (AP by CC) enhancing lesion intrathecal lesion abutting the left anterior spinal cord at T1-2 level, not significant changed since prior examination. A 4 mm enhancing lesion in the dorsal thecal sac at T7 level appears similar to prior examination (series 32, image 7). Additionally, in the inferior left intrathecal space there is a 3 mm enhancing lesion at the T12 level (series 31, image 2). This lesion is probably similar to prior MRI although was not well delineated on prior examination due to technique. No additional enhancing thoracic lesions are identified. No significant degenerative changes are demonstrated in the thoracic spine.LUMBAR SPINE:The lumbar lordosis is preserved. The lumbar vertebral body heights and intervertebral disc spaces are maintained. The conus terminates at L1. The cauda equina appear unremarkable. No significant degenerative changes are demonstrated in the lumbar spine. There is a 4 mm enhancing lesion present in the left intrathecal space within the cauda equina at L1-2 level which does not appear significant changed compared to prior examination.Multiple bilateral lesions are noted.

Output: BRAIN:1.There are 2 new small enhancing lesions in the left cerebellum measuring up to 7 mm. Additionally, there is an enlarging 4 mm lesion in the right putamen.2.Bilateral cerebellar encephalomalacia related to lesion resection is again seen.3.Scattered foci of white matter T2/FLAIR hyperintensity appears similar to prior examination, related to chronic microvascular ischemic change.SPINE:1.Subcentimeter enhancing lesions in the thoracic and lumbar spine do not appear significantly changed from prior examination.2.There are radiation treatment related changes at C7-L4. 3.There are mild degenerative changes of the cervical spine without significant neuroforaminal or spinal stenosis.


Instruction: Generate impression based on findings.

Input: Knee pain. Question of meniscal tear. MENISCI: The medial and lateral menisci are intact.ARTICULAR CARTILAGE AND BONE: Bone marrow signal is within normal limits. The articular cartilage of all three compartments is intact.LIGAMENTS: The collateral and cruciate ligaments are intact. The popliteus muscle and tendon are intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Intact menisci and ligaments. No specific findings to account for the patient's knee pain.


Instruction: Generate impression based on findings.

Input: Tremor, unspecified [R25.1], Reason for Study: ^Reason: assess for disease of basal ganglia History: new onset tremors. No evidence of acute ischemic or hemorrhagic lesion on the scan.Multifocal high signal intensity lesions on FLAIR/T2 are seen at bilateral frontal lobes, parieto-temporal lobes, periventricular white matter and centrum semiovale indicating non specific small vessel ischemic disease, unchanged in their extent and distribution since prior scan.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. Mucosal thickening on sphenoid sinus and bilateral maxillary sinuses.Right mastoid air cells show opacification.

Output: No change of non specific FLAIR/T2 high signal intensity lesions since prior scan, indicating non specific small vessel ischemic disease.No evidence of acute ischemic or hemorrhagic lesion.


Instruction: Generate impression based on findings.

Input: Syncope and collapse No evidence of acute ischemic or hemorrhagic lesion.Especially on gradient echo technique, there are small multiple scattered signal lordosis on cortical and subcortical white matter indicate possibility cerebral amyloid angiopathy. However, there is no evident local signal void area indicating acute or chronic hemorrhage lesion.There is no evidence of acute ischemic lesion either.On FLAIR imaging, skeletal somewhat patch high signal intensity lesions on bilateral periventricular white matter indicating nonspecific small vessel ischemic disease.Right eyeball is a prosthesis.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, 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 paranasal sinuses and mastoid air cells are clear.

Output: No evidence of acute ischemic or hemorrhagic lesion.Multifocal skeletal small cortical and subcortical distributed signal voids indicating possibility of cerebral amyloid angiopathy.Mild on to minimal nonspecific small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: There is normal alignment of the vertebral bodies. The height of the vertebral bodies and the disks is normal. There is normal marrow signal. The conus is normal in signal and morphology and terminates at an appropriate level. The visualized paraspinal contents are unremarkable.Disc desiccation with mild disc height loss is present at L4/5 and L5/S1, unchanged.T12-L1: No evidence of disc bulge. No spinal or foraminal compromise. These findings are unchanged.L1-L2: No evidence of disc bulge. No spinal or foraminal compromise. These findings are unchanged.L2-L3: No evidence of disc bulge. No spinal or foraminal compromise. These findings are unchanged.L3-L4: No evidence of disc bulge. No spinal or foraminal compromise. These findings are unchanged.L4-L5: There has been interval progression of a previously demonstrated left paracentral/foraminal shallow disc protrusion abutting the descending left L5 nerve root, now resulting in new mild left neural foraminal stenosis with new abutment of the adjacent foraminal L4 nerve root. L5-S1: Redemonstrated is a broad-based central disc protrusion with annular tears. This abuts and flattens bilateral S1 nerve sheath origins. There is minimal right foraminal narrowing and mild central spinal stenosis. These findings are unchanged.Incidental note is made of ovarian cysts.

Output: 1.L4-L5: There has been interval progression of a previously demonstrated left paracentral/foraminal shallow disc protrusion abutting the descending left L5 nerve root, now resulting in new mild left neural foraminal stenosis with new abutment of the adjacent foraminal L4 nerve root. 2.L5-S1: Redemonstrated is a broad-based central disc protrusion with annular tears. This abuts and flattens bilateral S1 nerve sheath origins. There is minimal right foraminal narrowing and mild central spinal stenosis. These findings are unchanged.


Instruction: Generate impression based on findings.

Input: 64 years, Female, Reason: eval for progression of toxic metabolics lesions and hemorrhage There has been mild evolution of the multiple previously seen acute infarcts involving the bilateral cerebral hemispheres, left pons and left cerebellar hemisphere on recent MRI brain study dated 1/2/2016. There are however new foci of restricted diffusion consistent with new infarcts including the right frontal lobe involving the right superior frontal gyrus as well as the right paracentral lobule and in the right parietal lobe involving the periventricular white matter as well as the right splenium. There is continued evolution of the left thalamic intraparenchymal hematoma. Multiple patchy areas of T2/FLAIR hyperintensity in the periventricular and subcortical white matter as well as in the pons which are likely reflective of chronic small vessel ischemic disease are also again noted. Chronic infarct with encephalomalacia in the right occipital lobe is also again seen as well as additional chronic infarcts including the right corona radiata, right cerebellar hemisphere, left pons, and bilateral thalami which were seen on exam dating back to 3/7/2015. Multiple scattered foci of susceptibility related to chronic microhemorrhages are again seen.No evidence of intracranial mass effect, midline shift, or herniation. No hydrocephalus. Minimal mucosal thickening involving the paranasal sinuses. Partial mastoid air cell opacification bilaterally is similar to prior.

Output: 1. Compared to MRI brain dated 1/2/2016 there has been evolution of multiple previously seen acute supratentorial and infratentorial infarcts and development of multiple new punctate infarcts in the right frontal and right parietal lobes.2. Continued evolution of the left thalamic intraparenchymal hemorrhage with surrounding vasogenic edema.3. Mild diffusion restriction with FLAIR hyperintensity in the bilateral middle cerebellar peduncles appears similar to prior. Finding is favored to represent Wallerian degeneration along the pontocerebellar tracts although toxic metabolic injury remains an alternative possibility.4. Background of chronic small vessel ischemic disease as well as multiple chronic infarcts as described above. Dr. Ali discussed findings of new infarcts with Dr. Buerki at 1020 hours on 1/10/2016


Instruction: Generate impression based on findings.

Input: Recurrent neuroblastoma recently completed MIBG therapy; assess for response to therapy. Brain: The treated anterior and central skull base tumor is no longer discernible. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is scattered paranasal sinus mucosal thickening.Orbits: There is no longer discernible signal abnormality in the left optic nerve. The bilateral globes and ocular adnexa are unremarkable. There is no evidence of abnormal intraorbital enhancement or mass lesions.

Output: 1. The treated anterior and central skull base tumor is no longer discernible.2. No residual signal abnormality in the left optic nerve.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for structural/enhancing lesions. Signs and symptoms: Had a second episode of severe headache with nausea and vomiting. Has embolic strokes on prior MRI exam. May have vasculitis. Pre and post enhanced brain MRI:There is no detectable acute intracranial process and diffusion weighted images are negative.Examination demonstrate multiple tiny foci of FLAIR hyperintensity at the site of previously known acute ischemic stroke is without evidence of hemorrhagic changes. Findings are noted in the right occipital, right basal ganglia, right and left posterior temporal lobes. Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and gray-white matter differentiation. There is mild prominence of cerebellar and vermian folia for patient's stated age similar to prior exam.The signal void of major intracranial arterial branches are identified and unremarkable.Post contrast images demonstrate no abnormal parenchymal, leptomeningeal, calvarial or retro-orbital enhancement. There is normal signal intensity and enhancement of intracranial venous sinuses.All paranasal sinuses and bilateral mastoid air cells and middle ear cavities demonstrate normal pneumatization signal pattern.

Output: 1.No acute intracranial process and negative diffusion weighted series.2.Tiny foci of FLAIR hyperintensity at the sites of previously known multiple embolic strokes are noted and without evidence of mass effect or hemorrhagic changes.3.Unremarkable pre and post enhanced brain MRI otherwise.4.Unremarkable calvarium, orbits, paranasal sinuses and mastoid air cells.


Instruction: Generate impression based on findings.

Input: Reason: assess for deterioration of cervical spinal stenosis History: neck pain, camptocormia. Cervical spine alignment is within normal limits. Vertebral body heights are maintained. The cervical cord demonstrates normal morphology and signal intensity. There is multilevel degenerative cervical spondylosis with level specific findings as follows:C2-3: No significant central canal or neuroforaminal stenosis. C3-4: Mild disk bulge without significant central stenosis. No significant neuroforaminal stenosis. C4-5: Degenerative disk disease and bilateral uncovertebral hypertrophic changes, without significant central spinal stenosis. There is moderate to severe bilateral neural foraminal narrowing, right greater than left.C5-6: Degenerative disk disease with disk-osteophyte complex resulting in mild central spinal stenosis and moderate bilateral neural foraminal narrowing, right greater than left. C6-7: Mild degenerative disk disease and mild hypertrophic changes of posterior elements without evidence of central spinal stenosis. There is mild left neuroforaminal narrowing. C7-T1: Minimal degenerative disk disease without central canal or neuroforaminal stenosis. The imaged upper thoracic spine and thoracic cord to the T5 level is unremarkable.

Output: Multilevel cervical spondylosis as detailed above without acute interval change compared with prior studies.


Instruction: Generate impression based on findings.

Input: Nontraumatic intracranial hemorrhage, unspecified [I62.9], Reason for Study: ^Reason: right midbrain hemorrhage History: weakness, ptosis Brain MRIThere is focal susceptibility lesion on the right thalamus which extends toward right side cerebral peduncle with surrounding edema indicating focal parenchymal hemorrhage.There are, however, multifocal scattered bihemispheric susceptibility lesions without associated surrounding edema indicating possible chronic hemorrhagic foci.There is tissue loss at the left side of lower pons and part of middle cerebellar peduncle.The ventricles, sulci and cisterns are symmetric and unremarkable. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate elongated and ectatic basilar artery with luminal irregularities of distal bilateral vertebral arteries indicate "dolichoectatic changes of vertebrobasilar system" suggesting intracranial atherosclerosis.Some irregularities are seen on bilateral MCA M1 segments but no evidence of major vessel occlusion.There is no intracranial arterial aneurysm seen.There is no MRA evidence of arteriovenous shunt, however, MRA cannot rule out possibility of arteriovenous shunting. Therefore, if clinically indicated, diagnostic catheter angiography for further imaging evaluation can be considered.

Output: 1. Acute ICH on the right mesial inferior thalamus which extends toward right side cerebral peduncle as described above.2. Multifocal chronic petechial hemorrhages as well as focal tissue defect on the left side lower pons.3. No evidence of acute ischemic lesion.4. Atherosclerotic changes of intracranial arterial system without evidence of arterial luminal stenosis, nor intracranial arterial aneurysm.


Instruction: Generate impression based on findings.

Input: Primary CNS lymphoma with recent biopsy showing monomorphic post-transplant lymphoproliferative disorder, status post MTX therapy. There are interval left transparietal biopsy findings. There is decreased patchy T2 hyperintensity in the left parietal and right temporal lobe white matter and no evidence of residual enhancing lesions in the brain. Otherwise, there are unchanged scattered foci of cerebral white matter T2 hyperintensity, but no evidence of acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable. There is cosmetic filler material in the bilateral nasolabial fold regions.

Output: Interval regression of the brain lesions, indicating treatment response.


Instruction: Generate impression based on findings.

Input: 83 year old man with history of urothelial cancer and recent lung lesion with biopsy positive for amyloid presence. Also with recent history of SVT and bradycardia. He was referred for cardiac MRI to evaluate for possible cardiac involvement of amyloid. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 60%, the LV end diastolic volume index is 94 ml/m2 (normal range: 74+/-15), the LVEDV is 174 ml (normal range 142+/-34), the LV end systolic volume index is 37 ml/m2 (normal range 25+/-9), the LVESV is 69 ml (normal range 47+/-19), the LV mass index is 33 g/m2 (normal range 85+/-15), and the LV mass is 62 g (normal range 164+/-36). The wall thickness is within normal limits. There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. There is no evidence for myocardial iron overload.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 51%, the RV end diastolic volume index is 85 ml/m2 (normal range 82+/-16), the RVEDV is 156 ml (normal range 142+/-31), the RV end systolic volume index is 35 ml/m2 (normal range 31+/-9), and the RVESV is 64 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely. There is trace aortic regurgitation noted.Mitral ValveThe mitral valve opens widely. There is mild mitral regurgitation noted. There is mild calcification on the mitral leaflet tip.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a bovine brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease. Epicardial fat is noted.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Normal size LV with normal systolic function (LV EF 60%) without evidence of underlying myocardial fibrosis, inflammation, or infiltration. No evidence of cardiac amyloidosis.2. Normal size RV with normal systolic function (RVEF 51%).3. Mild mitral regurgitation.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:? Hemorrhage. Signs and symptoms: Facial droop Nonenhanced CT of brain:There is no evidence of intracranial hemorrhage, edema, mass effect, midline shift or hydrocephalus. Heavy vascular calcification of intracranial right vertebral. There is also high density of bilateral middle cerebral arteries in the sylvian fissures and basilar artery. Above findings are believed to represent vascular calcification and atherosclerotic disease.There is prominence of the folia of cerebellum and vermis for patient stated age which are concerning for underlying cerebellar parenchymal volume loss. Note should be made that acute early stroke can be missed on CT. If patient's symptoms persist follow-up CT or an MRI is recommended.

Output: 1.No evidence of acute intracranial findings.2.Suspect the parenchymal volume loss of cerebellum.3.If clinical symptoms persist an MRI or follow-up CT is recommended


Instruction: Generate impression based on findings.

Input: Left knee pain. MENISCI: The majority of the anterior horn of the lateral meniscus is not visualized. The medial meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is near full thickness to full-thickness loss of the articular cartilage of the weight-bearing portion of the lateral femoral condyle. There is also near full-thickness to full-thickness cartilage loss of the lateral tibial plateau between the meniscal horns with underlying bone edema. There is thinning of the articular cartilage of the weight-bearing portion of the medial femoral condyle. The extensor articular cartilage is intact.Small osteophytes are noted in the bilateral tibiofemoral compartments.LIGAMENTS: The collateral and cruciate ligaments are intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Absent anterior horn of the lateral meniscus.2. Chondromalacia of the lateral and medial compartments as described above.


Instruction: Generate impression based on findings.

Input: 52 yo F with leg numbness, weakness. Please evaluate for lumbar spinal stenosis, disc herniation Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is a small right lateral recess disc protrusion at this level which does not appear to significantly impact the nerve roots within the neural foramen nor the nerve root within the right lateral recessAt L4-5 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.No compromise to lumbar spinal canal or neural foramina. There is a small right lateral recess disc protrusion at L5-S1 which does not appear to significantly impact the adjacent nerve roots on the basis of this exam.


Instruction: Generate impression based on findings.

Input: 85 year-old female with aphasia. Evaluate for CVA. Nonspecific, patchy areas of moderate hypoattenuation in periventricular and subcortical white matter. These changes were present on 2009 MRI.Intracranial vertebral artery calcifications.There is no evidence of intracranial hemorrhage, mass or edema. The gray-white matter differentiation is normal.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: 1.Patchy areas of white matter hypoattenuation most likely vascular related at this age. These changes were present on 4/29/2009 MRI. No evidence of acute ischemia, however CT is not sensitive in detecting early acute ischemia.2.No evidence for intracranial hemorrhage, edema, or mass.


Instruction: Generate impression based on findings.

Input: Bilateral lower extremity weakness. Lumbar spine from September 29, 2015 indicated foraminal stenosis. History of bladder cancer treated with neoadjuvant chemotherapy and then radical cystectomy/ileal conduit in Feb 2015. This is a limited examination performed only in the sagittal plane with T1 and STIR sequences to rule out spinal cord compression. The alignment is anatomic. The vertebral bodies are preserved in height. There is a focus of T1-hypointense, STIR-hyperintense signal in the inferior aspect of T9 vertebral body which is nonspecific. This was not included on the recent lumbar spine MRI examination. Other than degenerative mild to moderate narrowing of the spinal canal at C5-C6, the spinal canal is preserved. Apparent high T2-STIR signal along the cervical spinal cord extending from C3 through C6 is likely artifactual. The spinal cord otherwise displays normal morphology and signal. There is multilevel lumbar spondylosis, including bilateral L5-S1 neural foraminal narrowing caused by a disc-osteophyte complex and facet arthropathy. There is a partially-imaged heterogeneous and lobulated mass in the right side of the pelvis. There is presacral edema.

Output: 1.No evidence of spinal cord compression. 2. Partially-imaged large pelvic mass likely represents recurrent tumor. Please refer to the separate pelvis and abdomen CT report for additional details.3. A lesion in the T9 vertebral body is nonspecific, but may represent a metastasis.4. Multilevel degenerative spondylosis in the lumbar spine and cervical spine is otherwise incompletely assessed on this examination.


Instruction: Generate impression based on findings.

Input: 56-year-old male with history of C6 radiculopathy. The cranial-cervical junction is normal. There is normal cervical lordosis. There is minimal retrolisthesis at C4-5. The cervical spine alignment is otherwise anatomic. The vertebral body height is preserved. Bone marrow signal is benign with degenerative endplate marrow changes. Artifact slightly limits evaluation; no definite cord signal abnormality. The paraspinal soft tissues are unremarkable.Degenerative changes are specified by the intervertebral level as follows: C2-C3: No significant disc disease. No neuroforaminal narrowing or spinal stenosis. C3-C4: No significant disc disease. No neuroforaminal narrowing or spinal stenosis. C4-C5: There is a small disc-osteophyte complex, mild uncovertebral hypertrophy, and ligamentum flavum thickening resulting in mild spinal canal narrowing and mild bilateral neural foraminal narrowing, worse on the right.C5-C6: There is disc space narrowing, disc-osteophyte complex, uncovertebral hypertrophy and ligamentum flavum thickening resulting in moderate spinal canal narrowing. There is mild to moderate left and mild right neural foraminal narrowing.C6-C7: There is disc space narrowing, disc-osteophyte complex, uncovertebral hypertrophy and ligamentum flavum thickening resulting in mild spinal canal narrowing. There is moderate left and mild to moderate right neural foraminal narrowing.C7-T1: No significant disc disease. No neuroforaminal narrowing or spinal stenosis.

Output: Multilevel degenerative changes with disc osteophyte complexes from C4-5 to C6-7. There is up to moderate spinal canal stenosis at C5-6 without cord signal abnormality. There is up to moderate left neural foraminal narrowing at C5-6 and C6-7 as detailed above (relatively worse at C6-7) which may be impinging on the left C6 and C7 nerve roots, respectively.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 56-year-old male with prostate cancer; Prostate Biopsy - right lateral base Gleason grade 4+4=8 (Grade group 4 of 5). PELVIS:PROSTATE:Prostate Size: 4.0 x 3.0 x 4.2 cmPeripheral Zone: Focus of T2 hypointensity in the right mid and peripheral zone with corresponding restriction. Focus of T2 hypointensity in the left mid peripheral zone extending towards the apex with uncertain ADC restriction. These foci also demonstrate mild T1 hyperintensity which may represent hemorrhage from prior biopsy sites.Central Gland: Mild degree benign prostatic hypertrophy.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: There is no convincing evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Focus of T2 hypointensity in the right mid gland and left mid gland peripheral zone compatible with biopsy-proven sites of malignancy.


Instruction: Generate impression based on findings.

Input: 62-year-old male with prostate cancer. PSA 22.76 ng/mL on 3/29/2016Biopsy from 12/16/2016 showed:Right apex: Benign prostatic tissueRight mid gland: adenocarcinoma, Gleason 4+5Right base: Adenocarcinoma, Gleason 4+5Left apex: Adenocarcinoma, Gleason 4+5Left mid colon adenocarcinoma, Gleason 4+5Left base: Adenocarcinoma, Gleason 4+5 PELVIS:PROSTATE:Prostate Size: The prostate measures 6.3 cm in transverse, 4.4 cm in AP, and 4.9 cm in craniocaudal length.Peripheral Zone: In the right mid gland, there is a 7 x 3 mm ADC and T2 hypointense suspicious focus (series 408 image 264, series 701 image 15). Additional small 5 x 4 mm T2 and ADC hypointense focus in the right base also suspicious for malignancy (series 701 image 20, series 408 image 344).No dominant lesions on the left are identified to correlate with the biopsy history.Central Gland: In the posterior transitional zone, there is a 10 x 13 mm ADC hypointense focus (series 408 image 344) that could represent an additional site of disease.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: No definite extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: Right internal iliac lymph node measuring 1.5 x 1.4 cm (series 1501 image 107).BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Suspicious T2 and ADC hypointense foci in the right mid gland (PI-RADS 5), and right base (PI-RADS 4), and posterior transitional zone (PI-RADS 4).2.Mildly enlarged right internal iliac lymph node suspicious for metastatic disease.PI-RADS™ v2 Assessment Categories:PIRADS 1 – Very low (clinically significant cancer is highly unlikely to be present) PIRADS 2 – Low (clinically significant cancer is unlikely to be present)PIRADS 3 – Intermediate (the presence of clinically significant cancer is equivocal)PIRADS 4 – High (clinically significant cancer is likely to be present) PIRADS 5 – Very high (clinically significant cancer is highly likely to be present)https://www.acr.org/~/media/ACR/Documents/PDF/QualitySafety/Resources/PIRADS/PIRADS%20V2.pdf


Instruction: Generate impression based on findings.

Input: Diagnosis: Other specified disorders of muscleClinical question: history of old stroke, possible new strokeSigns and Symptoms: as above MRI of the brainNo diffusion weighted abnormalities are appreciated.There is a mild to moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Additional punctate foci of signal hyperintensity on T2 and FLAIR MRI are present in the left thalamus and ponsThere are small foci of susceptibility effect in signal loss present in the basal ganglia thalami and pons. The largest one is located in the right thalamus and can be identified on T2-weighted imaging root measures approximately 5 x 7 mm axial dimensions.The CSF spaces are appropriate for the patient's stated age with no midline shift. Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mucosal thickening. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is small.. The posterior communicating arteries are not readily identified. The vertebral arteries are similar in size.

Output: 1.There are multiple microhemorrhages present in the basal ganglia, thalami and brainstem was pattern is suggestive of hypertensive microhemorrhages. 2.There is a 1cm old hemorrhagic focus in the right thalamus. 3.Periventricular and subcortical white matter lesions of a mild to moderate degree are nonspecific. At this age they are most likely vascular related. 4.No evidence for intracranial cerebrovascular occlusive disease.5.No evidence for intracranial aneurysm.


Instruction: Generate impression based on findings.

Input: Female, 5 months old, ex full-term, with altered mental status, concern for seizure. Large bilateral subdural collections are seen along both cerebral hemispheres, most notably in the frontal and anterior temporal regions. Collections are fairly symmetric and measure up to 15 mm in thickness. The collections are T2 hyperintense, and on T1-weighted images are slightly hyperintense to CSF. Patchy areas of susceptibility effect are seen within the collections. There may also be trace T1 hyperintense subdural fluid along the bilateral occipital lobes and perhaps the cerebellum, but this fluid measures no more than 1 mm in thickness.The collections exert some degree of mass effect on the underlying brain with slight sulcal effacement. However, no herniation or midline shift is detected. Ventricular size and morphology are within normal limits. At most there may be minimal T2 hyperintense signal adjacent to the occipital horns, but this could be related to the normal terminal zones of myelination. No parenchymal edema is seen.No developmental or structural brain abnormalities are seen. The pattern of white matter myelination is appropriate for age. The pituitary region is unremarkable. The brainstem, cerebellar vermis and cerebellar hemispheres are normally formed. The corpus callosum is fully formed and intact.

Output: Large bilateral subdural collections are seen which, given their signal characteristics and the presence of susceptibility effect, likely represent chronic hematomas. Trace T1 hyperintense fluid is also seen along the occipital lobes and the cerebellum which could potentially represent minimal subacute subdural blood product. The brain otherwise appears to be normally formed and intact. No parenchymal edema is seen. The ventricles are normal in size. Findings were discussed with Dr. Khan at 5:00 PM on 12/2/16.


Instruction: Generate impression based on findings.

Input: Follow-up ACL repair 4 views of the left knee reveal hardware and osseous tunnel for ACL repair. The bones appear in anatomic alignment. There is a small joint effusion.

Output: Status post ACL repair. Bones are in anatomic alignment.


Instruction: Generate impression based on findings.

Input: Male 73 years old Reason: prostate cancer History: prostate cancer PELVIS:PROSTATE:Prostate Size: Prostate measures 5.9 x 4.2 x 4.1 cmPeripheral Zone: There is a broad-based lesion involving mostly the left mid gland near midline extending to the apex. The lesion surrounds urethra near the apex. The lesion extends across midline to the right mid gland and right apex. Small foci of signal abnormality are present in the left mid to apex gland capsule with areas of suspected extracapsular extension.Central Gland: Enlarged central gland with multiple nodules.Seminal Vesicles: No significant abnormality notedExtracapsular Extension: Suspected small foci of extracapsular extension in the left mid gland.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Suspected prostate cancer involving the left mid to apex with suspected small foci of ECE in the left mid gland.


Instruction: Generate impression based on findings.

Input: Female, 81 years old, with right-sided tingling. TIA workup. No restricted diffusion is seen. Numerous scattered small foci of periventricular and subcortical T2 hyperintensity are demonstrated in both cerebral hemispheres. No evidence of significant parenchymal edema or mass effect is seen. No intracranial hemorrhage or abnormal extra-axial fluid is detected. The ventricles are normal in size and morphology.

Output: 1.No evidence of acute ischemia or any other acute intracranial abnormality.2.Findings most likely representing moderate chronic microvascular ischemic disease.


Instruction: Generate impression based on findings.

Input: Female, 27 years old, with right frontal epilepsy since age 11, medically intractable. Presurgical valuation. No evidence of parenchymal signal abnormality, restricted diffusion, edema or mass effect is seen. No intracranial hemorrhage or abnormal extra-axial fluid collection is seen. Ventricular size and morphology are within normal limits. The mesial temporal lobe structures are symmetric and free of signal abnormality. No structural abnormalities are suspected. A pineal cystic lesion is evident measuring up to 15 mm in diameter, unchanged from prior.

Output: 1.No specific findings to account for the patient's seizures.2.A pineal cystic lesion is noted incidentally, unchanged and likely benign.


Instruction: Generate impression based on findings.

Input: 30-year-old female with left groin pain. ACETABULAR LABRUM: There is linear increased signal abnormality traversing the anterior superior acetabular labrum consistent with a labral tear. ARTICULAR CARTILAGE AND BONE: No articular cartilage defects are identified. No bone marrow signal abnormality is seen.SOFT TISSUES: The musculature of the hip is normal in appearance. ADDITIONAL

Output: Findings consistent with a left acetabular labral tear as described above.


Instruction: Generate impression based on findings.

Input: 45-year-old woman with worsening daily left frontal headaches. Please evaluate for intracranial/anatomic etiology. A large, isodense, apparently extra-axial mass is seen in the right frontal region which measures 31 x 48 mm (image 17/36). The peripheral aspect of the mass appears low density which probably represents multiple superficial cysts. The overlying bony cortex is slightly irregular and appears to be partially absorbed. Findings are most consistent with a cystic meningioma however, the associated bony irregularity is atypical for a meningioma and further evaluation with MRI is recommended to exclude primary brain malignancy or metastases. There is significant associated vasogenic edema in the right frontal parenchyma with minimal, approximately 2 mm, midline shift at the level of the septum pellucidum. No additional mass lesions are seen. No intracranial hemorrhage is present. The ventricles and basal cisterns are normal in size and configuration. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Large, probable extra axial mass with significant associated vasogenic edema which may represent a cystic meningioma, however further evaluation with MRI is necessary to exclude primary brain malignancy or metastases. Findings were discussed with Dr. M. Glather at 10:30am on 3/25/2008.


Instruction: Generate impression based on findings.

Input: Reason: please assess mass over right tbia; any evidence of vascular disease? History: young man with NF1 and moderate sized neurofibroma over tibia; he also has prominent varicose veins There is a focal well-defined ovoid mass abutting the anterior lateral aspect of the mid tibial metaphysis, which appears isointense to muscle on T1-weighted imaging and hyperintense on the STIR sequence. There is perhaps slight enhancement and the mass measures approximately 2.1 x 1.1 cm in its axial dimensions.

Output: Mass abutting the anterior lateral aspect of the mid tibial metaphysis consistent with a neurofibroma.


Instruction: Generate impression based on findings.

Input: Seizures, partial complex. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild scattered cerebral white matter T2 hyperintensity. The hippocampi are unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration, including a mild cavum septum pellucidum. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, mastoid air cells, and scalp soft tissues are grossly unremarkable. There is extensive mucosal thickening and secretions within the right maxillary and anterior ethmoid sinuses and to a lesser degree the left frontal and anterior ethmoid sinuses.

Output: 1. Nonspecific cerebral white matter lesions may represent chronic small vessel ischemic disease, demyelination, prior inflammation, for example. Otherwise, no evidence of intracranial hemorrhage, mass, or acute infarct. 2. Extensive right osteomeatal unit pattern of sinus disease.


Instruction: Generate impression based on findings.

Input: The ventricles and sulci are within normal limits. The basal cisterns remain patent. There is no midline shift or mass effect. Numerous foci of diffusion restriction are present in the bilateral frontal lobes, bilateral parietal lobes, left temporal lobes, and right pons. Many of these lesions demonstrate T2/FLAIR hyperintensity. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits.MRA HEAD

Output: 1. Multiple foci of acute subacute ischemia involving the anterior and posterior circulation in the bilateral cerebral hemispheres as well as brainstem is most likely related to embolic disease.2. Unremarkable MRA of the head.


Instruction: Generate impression based on findings.

Input: 66 years, Female, stroke, left-sided weakness sparing the face. Brain: There is restricted diffusion in the distal right anterior cerebral artery territory including the right paramedian frontal lobe extending into the paramedian parietal lobe with involvement primarily of the superior frontal gyrus and right paracentral lobule. There is associated T2/FLAIR hyperintensity without significant mass effect or evidence of hemorrhagic transformation. Additional punctate focus of diffusion hyperintensity in the right medial occipital cortex may be artifactual.There is an area of encephalomalacia involving the right anterior basal ganglia with susceptibility indicating chronic hemorrhage within this region. Additional chronic infarct involving the inferior medial aspect of the left cerebellar hemisphere is also noted. Foci of volume loss involving the anterior corpus callosum body and splenium are also evident. There is additional patchy T2/FLAIR hyperintensity in the periventricular and subcortical white matter compatible with mild to moderate chronic small vessel ischemic disease. No intracranial mass or mass effect. No hydrocephalus. No midline shift or herniation. Major flow-voids are preserved. Calvarium and extracranial soft tissue structures are grossly unremarkable. There are bilateral lens implants. Mild opacification of the left posterior ethmoid air cells also noted.Cervical spine: Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. There is mild reversal of cervical lordosis which may be partly positional. Alignment is otherwise maintained. Bone marrow signal is benign. Endplate edema on a degenerative basis is present at the C6-C7 level.Examination is motion degraded however no obvious cord signal abnormality is appreciated. Degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: Small disc osteophyte complex. No significant compromise to the spinal canal. There is mild left neural foraminal narrowing related to uncovertebral hypertrophy and facet arthropathy. Right neural foramen is patent.C4-5: Small disc osteophyte complex and uncovertebral hypertrophy. There is mild to moderate right neural foraminal narrowing. Left neural foramen is patent.C5-6: No significant spinal canal stenosis. There is mild right neural foraminal narrowing related to uncovertebral hypertrophy. There is minimal left neural foraminal narrowing related to facet arthropathy.C6-7: Small disc osteophyte complex with minimal left neural foraminal narrowing. Spinal canal and right neural foramen are patent. C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: 1. Acute infarct involving the right paramedian frontal and parietal lobes. No associated mass effect or hemorrhagic transformation.2. Chronic infarct with evidence of prior hemorrhage in the right anterior basal ganglia. Chronic left inferior cerebellar infarct also noted. There is also a background of mild to moderate chronic small vessel ischemic disease.3. Mild multilevel degenerative changes in the cervical spine without significant spinal canal stenosis at any level. No definite cord signal abnormality. Multilevel neural foraminal stenosis as described above without high-grade stenosis at any level.Findings were discussed with Dr. Fabiane at 1148 hours on 8/31/2016.


Instruction: Generate impression based on findings.

Input: Falls, weakness. Evaluate for cord compression. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is exaggerated lumbar lordosis as seen previously. There is grade 1 anterolisthesis of L4 and L5 which is grossly similar to prior. There is also minimal retrolisthesis of L2 on L3 which appears worse since 3/21/2006. Bone marrow signal is benign. The conus medullaris is normal in position.There are postsurgical changes of laminectomy from L2 to L5 as seen. Multilevel degenerative changes as detailed below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: There is a disc bulge and bilateral facet arthropathy. Disc bulge is larger than on prior study from 3/21/2006. There is evidence of prior laminectomy. No significant spinal canal stenosis. There is moderate bilateral neural foraminal stenosis. L3-L4: There is a disc bulge and bilateral facet arthropathy, as well as ligamentum flavum thickening. There is a prior laminectomy. There is mild degree of spinal canal stenosis. There is also effacement of the left lateral recess. There is moderate neural foraminal stenosis, left worse than right. L4-L5: Mild disc bulge and bilateral facet arthropathy. There is also ligamentum flavum thickening and evidence of prior laminectomy. There is mild degree of spinal canal stenosis. There is also mild to moderate bilateral neural foraminal stenosis.L5-S1: There is disc bulge which is again seen and vacuum phenomena involving the disc space which appears new since prior. There is effacement of the left lateral recess which is worse since prior. No significant central canal stenosis. Prior laminectomy. There is moderate to severe left and mild to moderate right neural foraminal stenosis. These findings are slightly worse in the interval.There is a lobulated mass with heterogeneous T2 hyperintensity involving the superior pole of the left kidney measuring approximately 4.2 cm in diameter and is partially imaged. Small cysts are additionally present in the bilateral kidneys.

Output: 1. Suspicious-appearing, partially imaged mass involving the upper pole of the left kidney. Recommend CT abdomen for further assessment. Dr. Ali discussed findings with Dr. Deshmukh at 1610 hours on 9/22/2016.2. Degenerative changes throughout the lumbar spine which have mildly progressed in the interval. Again seen is evidence of prior laminectomies from L2 to L5. There is mild spinal canal stenosis at L3-L4 and L4-L5. There is no high-grade spinal canal stenosis at any level. Additional details as above.


Instruction: Generate impression based on findings.

Input: Migraine and bipolar disorder with an acutely worsened headache over the past month. History of DVT and weight issues. MRI: There is a partially empty sella. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, and scalp soft tissues are grossly unremarkable. There are secretions in the right posterior ethmoid sinus.MRV: The right transverse sinus, sigmoid sinus and proximal intracranial jugular vein are asymmetrically enlarged with regional transosseous venous collaterals. There is narrowing of the internal right jugular vein more inferiorly in the upper neck, which is partially imaged, but possibly related to thrombosis. The left transverse sinus is hypoplastic. The remainder of the imaged cerebral venous drainage system is within normal limits, without evidence of intracranial venous thrombosis.

Output: 1.Nonspecific partially empty sella, which may be a manifestation of pseudotumor cerebri, but no evidence of intracranial hemorrhage, mass, or acute infarct. 2.Enlarged right transverse sinus, sigmoid sinus and right proximal jugular vein with right transosseous venous collaterals likely related to narrowing of the right extracranial internal jugular vein more inferiorly, which may be related to thrombosis. A venous Doppler ultrasound of the neck may be useful for further evaluation.


Instruction: Generate impression based on findings.

Input: Pain in left knee. MENISCI: Menisci appear intact.ARTICULAR CARTILAGE AND BONE: There is edema within the lateral femoral condyle above the anterior horn of the lateral meniscus as well as within the anterolateral tibial plateau, likely representing bone contusions. There is also a small curvilinear subchondral low intensity within the lateral femoral condyle in the vicinity of the aforementioned edema likely representing a nondisplaced subchondral fracture. Additional edema is noted within the anteromedial tibial plateau. We see no fluid-filled cartilage defects.LIGAMENTS: Cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: Extensor mechanism is intact.ADDITIONAL

Output: Bone contusions as described above with a small nondisplaced subchondral fracture of the lateral femoral condyle. We see no meniscal or ligamentous injury.


Instruction: Generate impression based on findings.

Input: 46-year-old male with +TB of 25, + DBILI, evaluate biliary tree for bile duct obstruction. ABDOMEN:LIVER, BILIARY TRACT: No evidence of intra- or extra-hepatic biliary ductal dilation. No focal mass lesion identified. Normal liver morphology, without evidence of cirrhosis. The gallbladder is decompressed without evidence of gallstones.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: No evidence of biliary ductal obstruction, as clinically questioned.


Instruction: Generate impression based on findings.

Input: Female, 45 years old, with multiple sclerosis. Assess for progression. Brain:Numerous small foci of T2 hyperintensity are seen within the juxtacortical and to a lesser degree the periventricular white matter. The corpus callosum is involved only minimally. There may be a few small lesions in the posterior fossa but artifact limits the evaluation. No definite lesional enhancement is observed.The morphology of the brain is otherwise within normal limits. No significant edema or mass effect is seen. Parenchymal volume is preserved. No abnormal extra-axial collections are suspected. The ventricular system is intact and normal in size.Cervical spine:The spinal cord demonstrates normal morphology. No evidence of pathologic cord signal or enhancement is seen.Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. Minimal degenerative endplate signal abnormality is seen at C4-5.Minimal disc osteophyte formation is seen from C4-5 through C6-7 without significant spinal canal stenosis. The left neural foramen at C4-5 is mildly narrowed.Thoracic spine:A very small focus of cord signal abnormality is seen dorsally at T2. A larger focus of signal abnormality is seen dorsally and centrally at T6-7. Both lesions are less prominent than on the prior examination. No new lesions are suspected. The remainder of the spinal cord is unremarkable. No pathologic cord enhancement seen.The thoracic kyphosis is exaggerated. Alignment is otherwise unremarkable. Vertebral body height and morphology are within normal limits. No evidence of any significant disc degeneration, spinal canal or foraminal stenosis.

Output: 1.Multiple small white matter lesions are seen in the brain involving the juxtacortical and to a lesser degree the periventricular white matter. No enhancing lesions are identified.2.Focal nonenhancing spinal cord lesions are evident at T2 and T6-7. Both lesions are less conspicuous than on the prior examination. No lesional enhancement is seen.3.No cervical cord lesions are identified.


Instruction: Generate impression based on findings.

Input: ESRD status post renal transplant in 2005 who presents with PTLD in the CNS. There are postoperative findings related to left transfrontal biopsy. There is unchanged confluent T2 hyperintensity and susceptibility effect in the superior left frontal lobe without associated mass effect. There is also unchanged scattered cerebral white matter T2 hyperintensity, particularly in a periventricular distribution. 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. The orbits, skull, paranasal sinuses, and scalp soft tissues are unchanged, including a left occipital scalp lipoma.

Output: Unchanged areas of cerebral white matter signal abnormality that may represent treatment effects that are perhaps superimposed upon mild chronic small vessel ischemic disease, without evidence of recurrent PTLD, although the assessment is limited due to the lack of intravenous contrast.


Instruction: Generate impression based on findings.

Input: SLE/Sjogren's patient with neuropsychiatric disease, assess for progression: memory disorder, difficulty with speech and walking (disorganized thought). Some of the sequences are degraded by patient motion. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is unchanged minimal nonspecific cerebral white matter T2 hyperintensity. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Unchanged minimal nonspecific cerebral white matter signal abnormality. No evidence of intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: BRAIN: There is mild enhancement of the cisternal segment of the right trigeminal nerve (series 401 image 65 and series 4 image 86); the left trigeminal nerve is unremarkable in appearance. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is a linear focus of T2 hyperintensity oriented in the cranio-caudal direction within the posterolateral right pons and medulla. There is heterogeneous signal with possible mild enhancement and expansion of the central sphenoid bone most compatible with fibrous dysplasia. 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 paranasal sinuses and scalp soft tissues are unremarkable.MRA HEAD: The intracranial internal carotid arteries are normal in course and caliber. The middle and anterior cerebral arteries are unremarkable. The vertebral arteries, basilar artery, and posterior cerebral arteries are normal in course and caliber with a fetal origin of the right posterior cerebral artery. There is no evidence of flow-limiting stenosis or aneurysm.

Output: 1.No evidence of acute infarct or mass. 2.Mild enhancement of the cisternal portion of the right trigeminal nerve of uncertain significance. 3.Probably fibrous dysplasia of the sphenoid bone that could be confirmed with CT if clinically indicated. 4.Non-specific T2 linear hyperintensity within the right hemi-pons and medulla, likely corresponding to fiber tracts and of uncertain significance.


Instruction: Generate impression based on findings.

Input: 70-year-old male with elevated PSA. Biopsy is in the left medial base showed atypical small acinar proliferation adjacent to high-grade prostatic intraepithelial lesion with immuno staining concerning for carcinoma. Other biopsy sites were negative for carcinoma. PELVIS:PROSTATE:Prostate Size: 5.0 x 3.1 x 4.1 cmPeripheral Zone: There is nodular thickening (versus BPH nodule extension) of the surgical pseudocapsule demarcating the transition and peripheral zones on the right but no suspicious lesion. A feathery appearance of the peripheral zone may be related to sequelae of prostatitis.Central Gland: Multiple BPH nodules are noted.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: None.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Atherosclerotic calcifications involving partially imaged common iliac arteries.

Output: Multiple BPH nodules. No suspicious prostate lesion.


Instruction: Generate impression based on findings.

Input: Reason: Evaluate for persistent right shoulder pain , evaluate for bicipital tendinitis or adhesive capsulitis ROTATOR CUFF: The supraspinatus, infraspinatus, subscapularis, and teres minor tendons are intact without evidence of tearing.SUPRASPINATUS OUTLET: Degenerative changes affect the acromioclavicular joint with a small amount of fluid in the joint space. The coracohumeral ligament appears normal.GLENOHUMERAL JOINT AND GLENOID LABRUM: Mild degenerative changes affect the glenohumeral joint, with multiple small subchondral cysts in the humeral head.BICEPS TENDON: The long and short heads of the biceps tendon are intact without evidence of tearing. ADDITIONAL

Output: Mild degenerative changes as described above without focal tearing or specific evidence of adhesive capsulitis.


Instruction: Generate impression based on findings.

Input: L1 vertebral compression fracture Five lumbar type vertebral bodies are presumed to be present. There is compression fracture involving the L1 vertebral body with 80-90% loss of height grossly similar to prior radiograph from 6/16/2015. There is mild osseous retropulsion with effacement of the ventral thecal sac. No high-grade spinal canal stenosis. Remainder of the vertebral body heights are maintained. There is mild kyphotic angulation at the level of the compression fracture. Alignment of the lumbar spine is otherwise maintained. There is a lytic focus involving the posterior aspect of the superior endplate which may represent a Schmorl's node. No suspicious osseous lesion is definitively appreciated within the limits of the noncontrast study. There is minimal T2/STIR hyperintensity involving the L1 vertebral body. No signal abnormality involving the visualized spinal cord. Conus is borderline low at the L2-L3/upper L3 level which is of doubtful clinical significance. No evidence of filar lipoma or other lesions in the spinal canal.Mild degenerative changes are seen, as described below:L1-L2: No significant disc disease. No significant spinal canal or right neural foraminal stenosis. Minimal left neural foraminal stenosis.L2-L3: Minimal disc bulge and mild bilateral facet arthropathy. No significant spinal canal or neural foraminal stenosis.L3-L4: Minimal disc bulge and mild bilateral facet arthropathy. No significant spinal canal or neural foraminal stenosis.L4-L5: Minimal disc bulge and mild bilateral facet arthropathy. No significant spinal canal or neural foraminal stenosis.L5-S1: Minimal disc bulge and mild bilateral facet arthropathy. No significant spinal canal or neural foraminal stenosis.Paraspinous soft tissues are within normal limits.

Output: 1. Chronic L1 compression fracture with 80-90% height loss grossly similar to prior lumbar spine radiograph from June 20, 2015, allowing for differences in technique. There is mild STIR hyperintensity involving the bone marrow at this level. There is mild osseous retropulsion associated with the compression fracture which partially effaces the ventral thecal sac without high-grade spinal canal stenosis. Focal defect involving the posterior aspect of the superior L1 endplate may represent a Schmorl's node. No gross evidence of neoplastic disease in the lumbar spine; follow-up can be considered as clinically indicated.2. Minimal degenerative changes in the lumbar spine. Aside from the mild spinal canal stenosis related to compression fracture, there is no significant spinal canal or neural foraminal stenosis in the lumbar spine.


Instruction: Generate impression based on findings.

Input: Hepatitis C, liver lesions follow-up ABDOMEN:LIVER, BILIARY TRACT: There is a dominant focal hepatic lesion at the junction of segments 5 and 6 with reference measurements as below. The lesion demonstrates increased T2 signal, restricted diffusion, decreased T1 signal, and predominantly peripheral enhancement. There is an additional similar smaller lesion at the hepatic dome at the junctions of segments 7 and 8 with reference measurements below. This lesion mildly attenuates the right hepatic vein which remains patent. No additional focal hepatic lesions are identified.The gallbladder appears within normal limits. No biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Simple right renal cyst. RETROPERITONEUM, LYMPH NODES: Few mildly prominent nonspecific periportal lymph nodes. Small cardiophrenic lymph nodes are also seen.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.INDEX LESION MEASUREMENTS (Current exam date/time: 12/21/2016 14:57:21)HEPATIC SEGMENT 5/6 LESION: 4.3 x 3.7 cm (Image 154, Series 603); 3.5 x 4.1 cm on prior (11/29/2016) (Image 270, Series 10).HEPATIC SEGMENT 7/8 LESION: 1.9 x 1.3 cm (Image 250, Series 603); 2.1 x 1.9 cm on prior (11/29/2016) (Image 288, Series 10).

Output: Two focal hepatic lesions which are highly suspicious for neoplasm without significant change from prior study. The lesions do not meet diagnostic criteria for HCC. Top differential considerations include cholangiocarcinoma, mixed hepatocellular cholangiocarcinoma, metastatic adenocarcinoma, or undifferentiated carcinoma.


Instruction: Generate impression based on findings.

Input: Left knee pain, check for loose body or meniscal tear MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: No significant abnormality noted. See section "extensor mechanism"LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: Small focal abnormal signals observed at the origin of the patellar tendon level along with small focal fluid collection and mild thickening of the tendon, representing a small focal intrasubstance tear of the proximal 2 cm. Associated minimal suspected contusion along the inferior margin of the patella.ADDITIONAL

Output: Focal acute or subacute suspected intrasubstance tear of the proximal patellar tendon, see details provided. Please correlate with the patient's site of pain.