Instruction: Generate impression based on findings.

Input: Evaluate for small bowel narrowing and/or colitis. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology, size and signal intensity. No suspicious liver lesion biliary ductal dilatation or vascular abnormality. Several T2-weighted hyperintensities, probable cysts.Partially distended gallbladder without evidence of inflammation. Trace perihepatic ascites.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: The small bowel is well-distended with oral contrast. The terminal ileum is well seen and is normal in appearance.There are multiple short segments of jejunum which appear mildly thickened and hyperenhancing which may be in part due to underdistention and/or reactive inflammatory changes. There is mild distension without a transition point suggestive of an ileus. Moderate circumferential wall thickening and edema of the descending colon to the level of the rectosigmoid compatible with a non-specific colitis. The anorectum is relatively spared.BONES, SOFT TISSUES: Nonspecific mottled bone marrow signal intensity.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Bilateral peri-adnexal heterogeneous peripherally enhancing collections are significantly decreased in size from the CT dated 5/9/2016, currently measuring 2.2 x 2.2 cm on the right and 2.2 x 1.7 cm on the left.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Nonspecific mottled bone marrow signal intensity.OTHER: No significant abnormality noted.

Output: 1.Persistent moderate descending through sigmoid colon edema, enhancement and wall thickening compatible with a non-specific colitis which could be infectious, inflammatory (including Crohn's colitis) or ischemic in etiology, appearing similar to the prior.2.Interval (compared to initial outside hospital CT 05/09/16) decrease in size of the bilateral complex peri-adnexal fluid collections in the pelvis, compatible with drained abscesses.3.Probable mild reactive ileus and jejunitis. No evidence of bowel obstruction.


Instruction: Generate impression based on findings.

Input: 71-year-old female with gastroesophageal reflux disorder. Evaluate. ABDOMEN:LIVER, BILIARY TRACT: No suspicious hepatic lesion. No intra or extra hepatic biliary ductal dilatation. There is a perihepatic subcentimeter T2 hyperintense focus (posterior to segment 7) without evidence of enhancement, likely represents a cyst.SPLEEN: No significant abnormality noted.PANCREAS: Appropriate response to secretin stimulation. Normal intrinsic T1 hyperintensity without pancreatic ductal dilatation. Subcentimeter pancreatic body T2 hyperintense focus (series 3, image 21) without evidence of enhancement.ADRENAL GLANDS: Adrenal glands are normal in size and morphology bilaterally.KIDNEYS, URETERS: Kidneys enhance and excrete contrast symmetrically without evidence of hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small hiatal hernia.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Appropriate response to secretin stimulation. Subcentimeter pancreatic body cystic lesion may represent side branch type IPMN.2.No intra or extra hepatic ductal dilation.


Instruction: Generate impression based on findings.

Input: Nontraumatic intracerebral hemorrhage in the brainstem. Follow-up of pontine hemorrhage. This is a motion degraded exam. There is redemonstration of T1 and T2 hyperintense hemorrhage with surrounding rim of hypointense signal along the left posterior aspect of the pons, which extends to the brachium pontis and measures up to 2.5 cm. There is further interval decrease in compression of the fourth ventricle, consistent with decreased mass effect from the hemorrhage. No new hemorrhage is apparent. The previously demonstrated small foci of dependent intraventricular hemorrhage in the occipital horn is no longer apparent, although artifacts limit assessment. There is mild brain parenchymal volume loss. There are patchy and confluent intracerebral white matter T2 hyperintensity, which are stable and likely represent chronic small vessel ischemic disease. There is an unchanged punctate focus of susceptibility effect in the right thalamus, which may represent a chronic microhemorrhage. There is no midline shift or herniation. There is interval appearance of fluid in the right frontal, right ethmoid and near complete opacification of the right maxillary sinus, with interval progression from prior. There is probable small retention cyst as well as mild mucosal thickening in the left sphenoid sinus. There is bilateral mastoid air cell fluid, which has increased since the previous exam. The orbits, skull, and scalp soft tissues are grossly unremarkable.

Output: 1. Expected evolution of the left subacute pontine and middle cerebellar peduncle hemorrhage with further interval decrease in mass effect upon the fourth ventricle. No evidence of acute intracranial hemorrhage.2. Stable moderate chronic small vessel ischemic disease, but no evidence of acute infarction.3. Increased fluid within the right maxillary, ethmoid, and frontal sinuses may relate to sinusitis. 4. Progression of bilateral mastoid mucosal thickening, which may represent mastoiditis. 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: 62 year-old female with neck pain, limited head mobility, paresthesia down to arm. Signs and symptoms: Paresthesia, arm weakness, pain. Nonenhanced brain MRI:Negative diffusion weighted images.Examination demonstrates an enlarged pituitary gland which results in expansion of sella. Finding is consistent with a pituitary macroadenoma measuring 14.5-mm in height. There is no extension into the basal cistern or the cavernous sinuses on this nonenhanced non-dedicated study.The anatomical morphology and the signal intensity of brain parenchyma otherwise remains within normal on all MRI sequences.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and mild herniation of brain.Signal void the major intracranial arterial branches is identified.The signal intensity of intracranial venous sinuses remain within normal. Unremarkable images through the orbits, paranasal sinuses and mastoid air cells.Nonenhanced cervical MRI: There is normal anatomical alignment of the vertebral column however with mild reversal of the cervical lordosis.There is mild-to-moderate disk disease throughout the cervical spine and uniform hypertrophy of the posterior longitudinal ligament extending from C2 to T1 level. This finding results in near complete effacement of ventral subarachnoid space from C3 -- C4 disk to C5 -- C6 disk level.Foramen magnum is unremarkable.C2 -- C3 is unremarkable.C3 -- C4 demonstrate moderate disk disease and loss of disk height, show no broad-based bulging disk and with resultant moderate central spinal stenosis, significant left and mild right neural foraminal compromise.C4 -- C5 demonstrate mild to moderate disk desiccation and loss of height, no significant degenerative/hypertrophic changes posterior elements. A tiny central and right paramedian disk protrusion is present. Constellation of degenerative changes at this level results in moderate right neural foramina compromise, mild to moderate central spinal stenosis and patent left neural foramina.C5 -- C6 demonstrate advanced degenerative disk and loss of disk height, mild bilateral facet and ligamentum flavum hypertrophy. Constellation of changes results in mild to moderate central frontal stenosis, significant right and moderate left neural foraminal compromise.C6 -- C7 demonstrate moderate disk disease and loss of disk height, mild bilateral facet and ligamentum flavum hypertrophy. Constellation of findings results in mild to moderate central spinal stenosis, significant left and moderate right neural foraminal compromise.C7 -- T1 demonstrate minimal degenerative disk disease and mild (left greater than right) ligamentum flavum hypertrophy. No central spinal stenosis or neural foraminal compromise.The signal intensity of the cord remains within normal.Uppermost visualized thoracic spine and cord to T4 level is unremarkable.No detectable perispinal soft tissue abnormalities.

Output: 1.Nonenhanced brain MRI demonstrate a pituitary macroadenoma measuring 14.5 mm in height and entirely within the sella. Unremarkable exam otherwise.2.Nonenhanced MRI of cervical spine demonstrate mild to moderate disk disease, significant posterior longitudinal ligament hypertrophy and minimal hypertrophic changes of posterior elements and mild reversal of cervical lordosis. Findings results in multilevel central spinal stenosis of mild to moderate degree extending from C 3 -- C4 through C6 -- C7 levels. There are also multilevel neural foraminal compromise (some significantly) as detailed per level. Normal signal intensity of cervical and uppermost visualized thoracic cord


Instruction: Generate impression based on findings.

Input: Compression of brain. Cord edema. MRI thoracic spine:There is accumulation of a collection behind and around the cord which is high signal on T1 and T2 STIR throughout the thoracic spine but predominantly along the upper thoracic spine. This is associated with the diffuse enhancement. There is effacement of spinal fluid ventral and posterior to the spinal cord especially at the T3 vertebral body level. There is abnormal signal within the spinal cord centrally from the cervical cord down to T8 level.The thoracic vertebral bodies are appropriate in the overall alignment and height. There are bilateral pulmonary opacities with pleural effusions. Lumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. No abnormal enhancing lesions are appreciated in the lumbar spine.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.Suspect combination of epidural lipomatosis, epidural venous engorgement and possibly epidural fluid in the thoracic spine (predominantly upper thoracic) associated with compression of the thecal sac.2.Extensive central cord signal abnormality (C3-T8). Differential considerations include pre-syrinx and venous congestion. The distribution of the cord signal abnormality does not match the vascular distribution of a specific spinal artery. Thus cord infarct is less likely here.3.Bilateral pulmonary opacities with pleural effusions. Please correlate with chest x-ray findings.


Instruction: Generate impression based on findings.

Input: 61-year-old female with recently diagnosed left 1 o'clock breast cancer and metastatic axillary lymph node. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.There are bilateral saline breast implants.LEFT BREAST: In the left breast, 2-3 o'clock position there is a large irregular mass with irregular margin and heterogeneous enhancement that measures 3.4 x 2.6 x 5.4 cm and correlates with the biopsy-proven breast cancer. This mass measures 3.4 x 2.6 x 5.4 cm (AP x transverse x CC). Superolateral to the index mass, there are two additional smaller masses, measuring 1.1 x 1.2 x 1.3 cm (AP x transverse x CC) and 0.5 x 0.7 x 0.5 cm (AP x transverse x cC). There is extensive non-Mass enhancement extending anterior and posterior to the index mass. Total extent of non-mass enhancement and the three masses measures 9 x 3 x 7.5 cm (AP x transverse x CC). Non mass enhancement extends to the nipple, measuring 5 mm from the nipple. Non mass enhancement and index mass abuts and cause medial displacement of the saline implant. There is overlying skin thickening in the left upper outer quadrant.Four abnormal lymph nodes are identified in the left axillary region. The largest measures 2.1 x 2.0 x 2.6 cm.RIGHT BREAST:No abnormal enhancement is seen in the right breast. No abnormal lymph nodes are identified in the right axillary region.

Output: 1.Multicentric left breast cancer more extensive than seen on mammogram. Large left 2 to 3 o'clock position irregular mass corresponds with biopsy proven breast cancer. Superolateral two additional smaller masses also correlate with additional masses seen on outside ultrasound. Extensive non-mass enhancement extends anterior and posterior to the index mass.2.Four abnormal left axillary lymph nodes.3.No abnormal enhancement in the right breast.4.No abnormal lymph nodes in the right axilla. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: history of seizure No evidence of acute ischemic or hemorrhagic lesion.There is evidence of right PCA territorial encephalomalacia with susceptibility artifacts within the lesion indicating chronic ischemic infarction with prior hemorrhage. Multifocal bi hemispheric scattered high signal intensities on FLAIR images indicate non specific age indeterminate small vessel ischemic lesions. 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: 1. No evidence of acute ischemic or hemorrhagic lesion2. Chronic ischemic infarction with encephalomalacia on the right PCA territory.3. Minimal non specific small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: Other complicated headache syndrome [G44.59], Reason for Study: ^Reason: HA x 3 months, worsening x 3 wks History: as above Brain MRINo evidence of acute ischemic or hemorrhagic lesion.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear. Mucosal thickening of the sphenoid sinusBrain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal. No intracranial arterial luminal stenosis. No intracranial arterial aneurysm.

Output: 1. Normal brain MRI.2. Normal brain MRA.


Instruction: Generate impression based on findings.

Input: Ewing sarcoma with residual pelvic mass Again noted is the residual pelvic mass situated between the bladder and rectosigmoid colon measuring 6 x 5.5 x 5.5 cm in the greatest transaxial and craniocaudal dimensions. The mass is stable in size and signal intensity compared to the prior examination and there is no evidence of enhancement following contrast administration. There is a peripheral rim of low signal intensity on T1 and T2-weighted images which may represent calcification. No additional enhancing mass lesions are identified. There is heterogeneous bone marrow signal abnormality within the lumbar spine which may represent residual islands of red marrow. A focus of low T1 and low T2 signal intensity is again seen in the left iliac bone which is unchanged. No abnormally enhancing foci are identified within the marrow.

Output: Unchanged size and appearance of residual pelvic mass reflecting known Ewing's sarcoma. No findings to suggest disease progression.


Instruction: Generate impression based on findings.

Input: Male 64 years old s/p combined liver/kidney transplant in June 2013. Evaluate for changes in known IPMN. ABDOMEN:LIVER, BILIARY TRACT: Stable postsurgical changes of liver transplant. There is again mild narrowing at the level of the biliary duct anastomosis and mild intrahepatic biliary ductal dilatation. The proximal hepatic artery, portal venous system and hepatic veins appear patent. The distal branches of the hepatic artery are not well visualized as on previous exams. The liver parenchyma is normal signal intensity. There is a new 18 x 16 mm focus of arterial phase enhancement in hepatic segment 7 that normalizes on later phases of contrast with no washout consistent with perfusion abnormality. No suspicious liver lesion.SPLEEN: No significant abnormality noted.PANCREAS: Stable 8 mm T2 hyperintense focus within the pancreatic head (series 901, image 11) remains nonspecific but compatible with a side branch intraductal papillary mucinous neoplasm. The pancreatic duct is nondilated. Normal pancreatic parenchymal signal intensity and enhancement.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Atrophic native kidneys. No change in a 2 cm left lower pole renal cyst and mild left greater than right perinephric stranding.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Mild bilateral gynecomastia, unchanged.

Output: 1.Stable postsurgical changes of liver transplant.2.No change in mild narrowing of the biliary anastomosis.3.Stable nonspecific 8 mm cystic pancreatic head lesion likely represents a sidebranch IPMN.


Instruction: Generate impression based on findings.

Input: 53-year-old with aphasia and left-sided weakness. Evaluate for ischemia or hemorrhagic conversion of chronic left PICA infarct. MRI brain:There is cystic encephalomalacia of the inferior left cerebellar hemisphere compatible with a chronic infarct. The adjacent remaining cerebellar white matter has increased T2 signal compatible with gliosis. There are punctate foci along the border of the infarcts that have restricted diffusion indicating some foci of acute to subacute ischemia. No evidence of hemorrhagic conversion.Numerous additional foci of subcortical and periventricular white matter T2 hyperintensity compatible with chronic small vessel ischemic changes.There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration. The paranasal sinuses are clear. There is trace opacification of the mastoid air cells bilaterally. The orbits are unremarkable.MRA head:Mild atherosclerotic irregularity of the cavernous internal carotid arteries. There is a complete circle of Willis, but the right P-comm is diminutive. Partial fetal morphology of the left posterior cerebral artery. Left dominant vertebrobasilar system. The left PICA is markedly attenuated. No significant intracranial aneurysm. No additional sites of high-grade steno-occlusive disease.MRA neck:Conventional arch anatomy. The origins of the carotid and vertebral arteries are widely patent. The carotid systems and vertebral arteries are normal in caliber and contour throughout.

Output: 1. 2 punctate foci of acute to subacute ischemia in the left cerebellar lobe adjacent to a large chronic left PICA infarct.2. No evidence of intracranial hemorrhage as clinically queried.3. Diminutive left PICA. Otherwise no high-grade steno-occlusive disease in the head and neck. No intracranial arterial aneurysm.


Instruction: Generate impression based on findings.

Input: 45-year-old female with a headache status post tumor resection. Epic: History of thyroid and breast cancer status post suboccipital craniotomy 5/3/16 for resection of posterior fossa tumor with microsurgical technique and the intraoperative microscope. Resection of 2 dominant cerebellar masses: 1 near the left inferior cerebellar tonsil and 1 towards the right superior cerebellar hemisphere. Preliminary pathology reveals likely breast adenocarcinoma as the source of metastases. Redemonstrated are post-surgical changes of a recent suboccipital craniotomy for resection of cerebellar metastatic lesions with persistent edema, mass effect on the fourth ventricle, foramen magnum herniation and compression of the brainstem. The enlargement of the lateral ventricles appear are unchanged in size to the prior MRI exam. There is expected post-surgical enhancement along the resection bed involving both the right and left cerebellar hemispheres with expected blood product and small amount of fluid. There is likely residual tumor along the lateral-most aspect of the left cerebellar hemisphere resection cavity, which measures 9 x 13 mm (series 1601, image 88). The multiple remaining additional enhancing lesions are unchanged in size, including a superolateral left cerebellar lesion, which measures 13 x 19 mm, pontine lesion which measures 10 x 16 mm, medial right occipital lobe lesion which measures 8 x 7 mm, right centrum semiovale lesion which measures 6 x 5 mm, middle frontal gyrus lesion which measures 7 x 11 mm, and left inferior frontal gyrus lesion, which measures 4 x 5 mm diameter. There are old post-surgical changes of a left frontal craniotomy. A developmental venous anomaly is again noted in the right frontal lobe. The calvarium has a persistent mottled appearance with foci of the marrow replacement.There is soft tissue swelling along the left fronto-temporal region adjacent to the old left frontal craniotomy site with a skin defect not present on the prior MRI.The major cerebral flow voids are intact. The orbits, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1.Expected post-surgical changes of a suboccipital craniotomy for resection of cerebellar metastatic lesions with persistent edema, mass effect on the fourth ventricle, foramen magnum herniation and compression of the brainstem. There is some residual tumor in the lateral left cerebellar region. 2.The size of the lateral ventricles are unchanged compared to the prior exam.3.Additional multiple lesions compatible with metastatic disease scattered within the brain parenchyma including the pons and supratentorial brain are unchanged.4.Findings consistent with a calvarial marrow replacement for which the possibility of bone metastases cannot be excluded. A bone scan may be helpful.5.Soft tissue swelling along the left temporal scalp adjacent to the old left temporal craniotomy site associated with a skin defect was not present on the prior MRI. Please correlate with clinical exam findings.


Instruction: Generate impression based on findings.

Input: Reason: B27 spa EROSIVE ARTHRITIS OFF TNF History: EROSIVE JOINT DSIEASE? PROGRESSION OFF TNF The degree of midfoot edema is much less conspicuous on the current study compared to the prior exam with only mild residual edema remaining within the cuneiform bones. There has also been a marked decrease in the degree of bone marrow edema seen within the talus. A small amount of fluid is seen within the joint however there is no frank effusion. No fracture or malalignment.

Output: Marked decrease in the degree of bone marrow edema seen on the previous exam. There are no specific radiographic features of inflammatory arthritis.


Instruction: Generate impression based on findings.

Input: Reason: evaluate for osteomyelitis History: R buttock tunneled ulceration Suboptimal evaluation secondary to patient motion artifact.There is made of diffuse bone marrow signal abnormality which is nonspecific and can be seen in anemia or myeloproliferative disorders. There is a large soft tissue ulceration along the posterior aspect of the left hemipelvis which extends to the level of the posterior margin of the coccyx. There is increased signal abnormality and T2-weighted sequences and decreased signal abnormality on T1-weighted images indicating osteomyelitis of the first and second coccygeal segments. There is also increased signal abnormality within the third and fourth coccygeal segments on fluid sensitive sequences without corresponding decreased T1 signal abnormality. This likely represents reactive osteitis. There is diffuse subcutaneous and soft tissue edema about the pelvis which is nonspecific.A rectal tube is in place. Mild degenerative disc disease affects the imaged lower lumbar spine. A large amount of abdominopelvic ascites is incompletely imaged. Although this examination was not protocoled for detailed evaluation of the pelvic viscera, there are multiple presumed uterine fibroids which are incompletely characterized. There is marked fatty atrophy of the imaged musculature of the pelvis as well as the imaged paraspinal musculature. Metallic susceptibility artifact from the patient's orthopedic fixation of the left femur limits evaluation of the left hip.

Output: Large soft tissue ulceration extending to the level of the coccyx with findings indicating osteomyelitis of the first and second coccygeal segments and reactive osteitis of the third and fourth coccygeal segments. Other findings as described above. These findings were relayed to Dr. Podolej by phone at 9:53 AM on 1/29/2016.


Instruction: Generate impression based on findings.

Input: Brain MRI: There are extensive patchy areas of T2 hyperintensity within the supratentorial and infratentorial white matter, as well as in the bilateral basal ganglia and thalami. There are also areas of susceptibility effect in the left cerebellar hemisphere, vermis, left insula, and bilateral basal ganglia, with what may represent mild vasogenic edema. However, there is no evidence of acute infarction. There is no evidence of abnormal enhancement or tumors within the brain. There is no midline shift or herniation. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. Brain MRA: There is no evidence of significant steno-occlusive lesions. There is no evidence of aneurysms.Neck MRA: There is no evidence of significant steno-occlusive lesions.

Output: 1. Extensive supratentorial and infratentorial white matter abnormality, as well as abnormality involving the bilateral deep grey nuclei, along with what appears to be hemorrhage within the left cerebellar hemisphere, vermis, left insula, and bilateral basal ganglia. These findings may represent acute upon chronic hypertensive encephalopathy and perhaps hemorrhagic encephalitis from other causes.2. No specific evidence of nonhemorrhagic acute infarcts or tumors.3. No evidence of significant steno-occlusive lesions in the head and neck arteries.


Instruction: Generate impression based on findings.

Input: Male 65 years old with elevated psa. Evaluate for lesion suggestive of prostate cancer. PELVIS:PROSTATE:Prostate Size: 4.3 x 3.6 x 3.3 cmPeripheral Zone: There is a 4 x 3 mm focus of signal abnormality in the left mid gland (series 401/105) and a 4 x 4 mm focus in the right mid gland (series 401/104). These lesions are hypointense on T2 weighted images and ADC demonstrate early contrast enhancement.On the right near the transition zone is a focus of signal abnormality that is hypointense on ADC and moderately T2 hypointense (series 508/304) which most likely represents a BPH nodule.Central Gland: Benign prostatic hypertrophy.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: None.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small periumbilical hernia.

Output: A 4 x 3 mm lesion in the left mid gland and a 4 x 4 millimeter lesion in the right gland are of both of high suspicion for prostate adenocarcinoma. PIRADS 4.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: Reason: r/o medial meniscus tear History: lef knee pain MENISCI: The medial and lateral menisci are intact. ARTICULAR CARTILAGE AND BONE: Multiple bone islands are seen within the distal femur. There is no evidence of fracture. The articular cartilage is intact.LIGAMENTS: The ligaments are intact.EXTENSOR MECHANISM: Edema is seen within the superolateral aspect of the femoropatellar articulation representing impingement. The tibial tuberosity trochlear groove distance is within normal limits.ADDITIONAL

Output: Edema is seen within the superolateral aspect of the femoropatellar articulation representing impingement. The menisci are intact.


Instruction: Generate impression based on findings.

Input: Clinical question: 49-year-old female with history of breast cancer and headaches, concern for mass effect versus pseudotumor cerebri. Signs and symptoms: Pulsatile headaches. Pre and post enhanced brain MRI:No diffusion-weighted abnormalities.Examination demonstrates small scattered foci of FLAIR hyperintensity in the subcortical and periventricular white matter of bilateral cerebral hemispheres and minimally in the basal ganglia. Findings are not hemorrhagic and demonstrates no enhancement. Although nonspecific this appearance is often represent chronic microvascular ischemic changes. Considering patient's provided age less likely possibility of demyelinating disease cannot be entirely excluded.The cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination is otherwise normal on all MRI sequences. Post enhanced images are also negative for any detectable abnormal enhancement of brain parenchyma, leptomeninges or the calvarium to suggest metastatic disease.Unremarkable images through the orbits and including axial fat sat post enhanced series.Unremarkable signal intensity of the calvarium and soft tissues of the scalp without abnormal enhancement.All paranasal sinuses are well-pneumatized and without evidence of disease.

Output: 1.Negative diffusion weighted series.2.Findings suggestive of mild chronic small vessel ischemic strokes.3.Unremarkable pre and post enhanced brain MRI.


Instruction: Generate impression based on findings.

Input: Reason: Optic disc swelling - rule out intracranial process History: central visual blurrying MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated within the brain parenchyma. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses and demonstrate small mucus retention cysts. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI orbits:The eyeballs are intact. No intraconal or extraconal space mass is identified. The extraocular muscles are intact. The lacrimal glands are symmetric and within normal limits in size and configuration. There is no optic nerve enhancement appreciated. The suprasellar cistern is intact .

Output: MRI of the brain and orbits is within normal limits.


Instruction: Generate impression based on findings.

Input: Female, 61 years old, with headache for one month, history ALL with CNS disease currently in remission. A 15 x 8 mm oval T2 hyperintense lesion within the right corona radiata is unchanged relative to the immediate prior examination, but is more conspicuous when compared to the examination of 8/2015. This lesion is associated with no significant mass effect, restricted diffusion or pathologic enhancement.One or two additional small T2 hyperintense lesions are seen within the cerebral parenchyma. No evidence of significant edema or mass effect is seen. No pathologic parenchymal or extra-axial enhancement is detected. There are no findings to suggest acute intracranial hemorrhage. The ventricular system is stable in size and morphology.

Output: 1.No acute intracranial abnormality and no definite changes from the immediate prior examination.2.No pathologic intracranial enhancement is seen to suggest neoplastic involvement of the CNS.3.An oval lesion in the right corona radiata is stable relative to the immediate prior examination but more conspicuous when compared to an older exam. Given absence of enhancement or edema, this lesion is nonspecific.


Instruction: Generate impression based on findings.

Input: Acute onset of vertigo, persistent nystagmus when looking left. Dizziness and giddiness, evaluate for underlying pathology. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are few scattered foci of T2 hyperintense signal within the periventricular white matter, predominantly in the parietal lobe, right more than left and right frontal lobe. The pituitary gland appears 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 a small midline cystic lesion in the nasopharynx, which may represent a Thornwaldt cyst. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. No evidence of acute intracranial hemorrhage, mass, or acute infarct.2. A few cerebral white matter lesions are nonspecific, but may represent a demyelinating process, prior inflammation, migrainous headache, or vasculitis.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Metastatic tonsil squamous cell carcinoma to the brain status post resection and post-operative SRS: surveillance MRI. There are post-treatment findings in the left temporal region with minimal residual enhancement and confluent T2 hyperintensity in the left lateral temporal lobe. However, there are new 5 mm enhancing lesion sin the left occipital lobe and right precentral gyrus. There is a small area of high T2 signal and restricted diffusion in the right middle frontal gyrus. There are otherwise unchanged scattered nonenhancing foci of cerebral white matter T2 hyperintensity. There is an unchanged punctate focus of susceptibility effect in the right centrum semiovale. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. Post-treatment findings in the left temporal region without evidence of measurable tumor.2. New subcentimeter lesions in the left occipital lobe and right precentral gyrus may represent metastases. 3. A small area of high T2 signal and restricted diffusion in the right middle frontal gyrus may represent a recent infarct.


Instruction: Generate impression based on findings.

Input: Male, 41 years old, with history of medulloblastoma presenting with worsening back pain and lower extremity weakness. Cervical:Postoperative findings are demonstrated in the posterior fossa including evidence of suboccipital craniotomy, encephalomalacia of the cerebellum and prominence of the fourth ventricle. A small pseudomeningocele in the posterior midline operative bed is unchanged measuring up to 7 mm in thickness.The visualized spinal cord demonstrates normal signal intensity and morphology. No evidence of pathologic intracanalicular enhancement is seen.Spinal alignment is anatomic. Vertebral body morphology and signal characteristics are within normal limits. Minimal disk bulging at C6-7 is seen. Otherwise, no evidence of significant degenerative disk disease, spinal canal stenosis or neuroforaminal narrowing is detected.Thoracic:The visualized spinal cord demonstrates normal signal intensity and morphology. No evidence of pathologic intracanalicular enhancement is seen.As before, a T2 hyperintense oval structure along the left second rib is unchanged and may represent a nerve root sleeve cyst or schwannoma.Spinal alignment is anatomic. Vertebral body morphology and signal characteristics are within normal limits. Small paracentral protrusions are redemonstrated on the left T6-7, bilaterally at T7-8 and on the right at T9-10, unchanged. No significant spinal canal or neuroforaminal stenosis is demonstrated.Lumbar:The conus and cauda equina are unremarkable. No pathologic intracanalicular enhancement is seen.Grade 1 anterolisthesis of L5 relative to S1, and bilateral L5 pars interarticularis defects, are redemonstrated. Otherwise, vertebral body morphology and signal characteristics are within normal limits. Disk uncovering and disk bulging at L5-S1 is unchanged. No significant spinal canal stenosis is seen. The L5-S1 neural foramen are mildly narrowed.

Output: 1. No evidence of metastatic disease in the spine.2. No significant spinal canal stenosis or other findings are seen which would account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Headache and history of meningioma. There are postoperative findings related to parietal craniotomy. There is interval increase in size of the posterior falcine meningioma, which now measures 25 x 43 x 28 mm, previously 19 x 34 x 25 mm. However, there is no significant interval change in the extent of confluent T2 hyperintensity in the bilateral posterior cerebral hemisphere white matter, which likely represents vasogenic edema. There is also unchanged left parieto-occipital encephalomalacia. There are unchanged foci of susceptibility effect in the brain parenchyma surrounding the tumor, which may represent chronic blood products. The ventricles are unchanged in size and configuration. There is no midline shift or herniation. The posterior superior sagittal sinus is obliterated. There is a partially-empty sella. There is mild mucosal thickening in the left sphenoid sinus. There is new right tympanomastoid fluid.

Output: 1. Interval increase in size of the posterior falcine meningioma.2. New right tympanomastoid fluid may represent otomastoiditis.


Instruction: Generate impression based on findings.

Input: History of mesenteric fibromatosis/desmoid tumor 24 x 20 x 14.5 cm resected 2014. ABDOMEN:LIVER, BILIARY TRACT: The faintly T2 hyperintense enhancing segment 6 lesions are not significantly changed in size with the more superior lesion measuring approximately 1.0 x 1.0 cm (series 4/65) and the more inferior lesion measuring approximately 1.7 x 1.3 cm (series 4/58). No biliary ductal dilatation. Scattered small cysts. No new suspicious liver lesion.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right renal simple appearing cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postsurgical changes of the duodenum and jejunum from prior mass resection without evidence of local recurrence or residual disease. Colonic diverticulosis.BONES, SOFT TISSUES: Midline incisional hernia containing mesenteric fat and a loop of small bowel without evidence of complication.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Colonic diverticulosis.BONES, SOFT TISSUES: 1.5 cm right-sided Bartholin cyst. Otherwise, no significant abnormality noted.

Output: 1.No evidence of recurrent fibromatosis.2.Stable appearance of the right hepatic lobe enhancing 1-2 cm lesions. The appearance and stability suggests benign etiology such as focal nodular hyperplasia or adenoma.


Instruction: Generate impression based on findings.

Input: Male, 16 years old, status post C2 spinal cord tumor resection, assess resection. Laminectomy has been performed at C1 and C2. A collection is evident in the operative bed containing a mixture of fluid, blood product, and bubbles of air. Air is also evident scattered through the thecal sac.The previously demonstrated intramedullary cystic lesion at C2 has been significantly decompressed. A small area of residual T2 hyperintensity is seen at the site of the cyst measuring 8 mm in length and up to 4 mm in width. Ill-defined cord T2 hyperintensity at and above the level of the lesion is relatively unchanged, perhaps representing edema. A small focus of susceptibility is seen in the ventral cord at the cranial edge of the lesion which may represent blood product or some other post-operative change.On post-contrast images, two small foci of enhancement along the ventral cord at C2 are redemonstrated, appearing minimally more prominent. However, decompression of the cyst may contribute to this apparent change. A focus of enhancement seen previously along the dorsal cord at C2 is no longer appreciated. A focus of enhancement in the left cerebellar tonsil, and faint enhancement along the dorsal cord at T1, are also unchanged. No new enhancing lesions are seen.

Output: Findings are seen compatible with C1-2 laminectomy and decompression of a cystic intramedullary lesion at C2. A small area of T2 hyperintensity at the site of the cyst may represent sequela of resection or minimal residual cyst. Two foci of enhancement associated with the prior cyst along the ventral cord at C2 may be minimally more prominent than on the prior study, although altered cord geometry secondary to decompression of the cyst may contribute to this appearance. An enhancing focus along the dorsal cord at C2 is no longer appreciated. Other small enhancing foci are unchanged as above.


Instruction: Generate impression based on findings.

Input: Status post right frontal craniotomy and mass resection. Again seen are expected postoperative changes related to right frontal craniotomy and mass resection, including pneumocephalus, a small amount of hemorrhage, and persistent vasogenic edema. There is a rim of restricted diffusion in the resection cavity, compatible with cytotoxic edema. There is persistent mild leftward midline shift and partial effacement of the right lateral ventricle, similar to recent CT. No uncal herniation.There is no definite evidence of residual tumor. However, there is minimal residual enhancement which is questioned along the medial aspect of the resection cavity.Normal vascular flow voids are present in the major intracranial vessels. The visualized portions of the paranasal sinuses and mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin.

Output: 1.Status post right frontal craniotomy and right frontal lobe mass resection with expected postsurgical changes, including a small amount of hemorrhage in the resection cavity. 2.Persistent vasogenic edema, regional mass effect, and mild leftward midline shift, not significantly changed from recent CT. 3.No definite evidence of residual tumor. There is question of minimal residual enhancement along the medial aspect of the resection cavity, which can be further assessed on follow-up imaging.


Instruction: Generate impression based on findings.

Input: 60-year-old male presents with confusion. Markedly motion degraded examination.There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild periventricular and subcortical cerebral white matter T2 hyperintensity. Chronic appearing infarcts in the left cerebellar hemisphere. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is a T1 hyperintense and T2 hypointense focus in the right anterior ethmoid air cells which likely reflects a proteinaceous retention cyst.

Output: 1. No evidence of intracranial hemorrhage, mass, or acute infarct. 2. Periventricular and subcortical cerebral white matter T2 hyperintensity which is nonspecific, but likely reflects mild chronic small vessel ischemic disease.3. Chronic infarcts in the left cerebellum.


Instruction: Generate impression based on findings.

Input: 31 years Female (DOB:7/19/1984)Reason: Evaluate for etiology of fatigue and head drop or demyelinating disease History: Head drop, fatigue, hyprereflexiaPROVIDER/ATTENDING NAME: THOMAS J KELLY THOMAS J KELLY The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: MRI of the brain is within normal limits. No evidence for demyelinating disease.


Instruction: Generate impression based on findings.

Input: Male, 21 years old, with seizures and developmental delay. Evaluate for seizure focus. A small area of gray matter thinning with underlying T2 hyperintensity is seen within the right frontal lobe (see key images). There is no associated mass effect or pathologic enhancement.No other areas of cortical irregularity, pathologic signal or abnormal enhancement are seen. Diffusion-weighted images are unremarkable. No intracranial hemorrhage or any abnormal extra-axial fluid collection is detected. The ventricular system is normal in size and morphology.Bone marrow signal characteristics are within normal limits. Mild paranasal sinus mucosal inflammation is seen.

Output: A small area of gray matter thinning and underlying parenchymal T2 hyperintensity is seen within the right frontal lobe. This is favored to represent a cortical dysplasia, though the differential would also include sequelae of prior parenchymal injury. A neoplastic etiology is considered unlikely, though follow-up imaging is advised.


Instruction: Generate impression based on findings.

Input: Low back pain for 3 years. Hyperextension. Evaluate for spondylolysis. There is no spondylolisthesis. The vertebral bone marrow signal is unremarkable, without discernible edema or sclerosis involving the pars interarticularis at any of the lumbar spine levels. There are unchanged mild disc bulges in the lumbar spine at L3-4, L4-5, and L5-S1 with slight encroachment upon the bilateral neural foramina, but no significant spinal canal stenosis. There is no fatty filum or dysraphism. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: 1. No definite evidence of spondylolysis, within the limits of MRI.2. Unchanged mild disc bulges at L3-4, L4-5, and L5-S1, with mild bilateral L5-S1 neural foramen stenosis, but no significant spinal canal stenosis. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 18-year-old male with past surgical history of total colectomy secondary to motility disorder with right lower quadrant ileostomy Limited evaluation of the right lower quadrant structures due to artifact caused by right lower quadrant ileostomy.PELVIS:MRA/MRV: There is near complete stenosis of the left common iliac vein due to compression from the right common iliac artery. The left external iliac vein is distended with a thrombus that extends to the inferior most image. There is wall thickening and mild inflammatory signal surrounding the distal external iliac vein compatible with a component of thrombophlebitis.PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Status post total abdominal colectomy with right lower quadrant end ileostomy. Inflammatory changes to the mesenteric fat may be related to surgery. No evidence of small bowel obstruction.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Gastrostomy tube is noted.

Output: 1.Findings compatible with May Thurner syndrome as described above. Surrounding inflammatory changes and wall thickening of the distal external iliac vein may represent a component of thrombophlebitis.2.Inflammatory changes within the mesentery may postsurgical.


Instruction: Generate impression based on findings.

Input: History of lung cancer status post resection with liver nodule. ABDOMEN:LIVER, BILIARY TRACT: Liver demonstrates normal parenchymal signal intensity. Within the anterior segment of the right hepatic lobe (series 8, image 29), there is an 11 x 11 mm T2 hyperintense structure which demonstrates peripheral nodular enhancement and is compatible with a hemangioma. Along the posterior margin of segment 2 (series 8, image 29), there is an 11 x 13 mm T2 hyperintense structure with suggestion of peripheral nodular enhancement also compatible with hemangioma. There is an additional subcentimeter lesion along the hepatic dome (series 10, image 162) which is too small to characterize but appears similar to the 2012 examination and is likely benign. No suspicious focal hepatic lesions are identified. No biliary ductal dilatation. The gallbladder appears unremarkable.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: 11 mm left adrenal nodule unchanged in size compared to 11/21/2012 and thus likely benign.KIDNEYS, URETERS: A few subcentimeter renal cysts are present bilaterally. No suspicious renal lesions are identified.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Two hepatic hemangiomas and additional subcentimeter lesion too small to characterize but likely benign not significantly changed compared to 11/21/2012.2.11 mm left adrenal nodule unchanged in size compared to 11/21/2012 and thus likely benign.


Instruction: Generate impression based on findings.

Input: Reason: eval sacrum for occult fracture History: persistent tenderness over sacrum x 2 months BONE MARROW: No bone marrow signal abnormality is identified. No findings to suggest acute fracture.SOFT TISSUES: Although this examination was not protocoled for detailed evaluation of the pelvic viscera, no acute abnormalities are identified. Note is made of multiple low signal intensity foci within the uterus which presumably represent uterine fibroids although these are incompletely characterized on this noncontrast examination. JOINTS: The alignment is anatomic.ADDITIONAL

Output: No acute fracture is evident. No findings to account for the patient's point tenderness.


Instruction: Generate impression based on findings.

Input: Ms. O'Hara is a 52 year old female with known left breast cancer. She presents for MRI evaluation as part of the I-SPY2 protocol. There is scattered fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.In the left upper inner breast, there is no significant residual enhancement at the site of proven malignancy. Susceptibility artifact from biopsy marker clip continues to be seen. A stable punctate benign appearing focus is present in the lateral left breast.There is no abnormal enhancement in the right breast. No abnormal lymph nodes are identified in either axillary or internal mammary region.

Output: (1) No significant residual enhancement at the site of index malignancy of the left breast. (2) No MRI evidence for malignancy in the right breast. BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: 73-year-old male with elevated PSA of 2.5 after prostatectomy in 2011. Please evaluate for recurrent disease. Patient has an artificial urinary sphincter. PELVIS:PROSTATE:Prostate Size: Status post prostatectomy. No suspicious lesion is identified.Peripheral Zone: Not applicable.Central Gland: Not applicable.Seminal Vesicles: Not applicable.Extracapsular Extension: Not applicable.BLADDER: Periurethral cuff is noted.LYMPH NODES: No pelvic lymphadenopathy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Status post prostatectomy. No specific evidence of recurrent disease.


Instruction: Generate impression based on findings.

Input: Male, 33 years old, with history of epilepsy, status post left temporal lobectomy, surveillance imaging. Postoperative findings are seen compatible with resection of a portion of the left anterior temporal lobe. Previously seen acute postoperative findings including blood in the surgical cavity and extra-axial fluid have resolved. A small resection cavity remains showing thin rim enhancement which likely reflects postoperative granulation. T2 hyperintensity within the adjacent temporal parenchyma is seen perhaps representing gliosis or mild residual edema.Postoperative findings are also redemonstrated compatible with prior laser ablation of the left mesial temporal structures. A small amount of enhancement at the ablation site is unchanged. Elsewhere, parenchymal morphology and signal characteristics are within normal limits. No evidence of acute intracranial hemorrhage is seen. Ventricular size and morphology are within normal limits.

Output: 1.Evolution of postoperative findings compatible with resection of a portion of the left anterior temporal lobe.2.Redemonstration of findings related to prior laser ablation of the left mesial temporal lobe.3.No new intracranial lesions are identified.


Instruction: Generate impression based on findings.

Input: Female 18 years old Reason: Evaluate the progression of hip AVN History: Chronic Hip Pain Femoral heads are well seated in normal acetabula. Again seen are oblong cystic areas, the largest of which is 5 mm, in the medial left femoral head. Areas of low T2 and T1 signal predominantly in the posterior femoral heads bilaterally do not enhance and are consistent with osteonecrosis. No significant edema in the femoral heads bilaterally. No flattening of the femoral heads. No fracture or joint effusion. The labrum and cartilage are intact.Unchanged abnormal signal in the proximal femoral diaphyses bilaterally consistent with bone infarcts, right worse than left. Abnormal bone marrow signal throughout the femurs and pelvis compatible with red marrow conversion in setting of sickle cell disease. Central vertebral body depression of the lower lumbar spine from sickle cell disease.Subcutaneous edema posterior to the to the lower lumbar spinous processes. Atrophy/increased fat in the paraspinal musculature.

Output: 1.Bilateral avascular necrosis of the femoral head without collapse or fracture. 2.Bone infarcts of the proximal femoral diaphysis.


Instruction: Generate impression based on findings.

Input: History of left breast cancer status post mastectomy. There is scattered fibroglandular tissue in the right breast.Minimal parenchymal enhancement is noted in the right breast. The patient is status post left mastectomy with reconstruction. No suspicious enhancement is seen in either the right breast or left reconstruction. Stable oval mass in the left far lateral chest wall. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: 33-year-old asymptomatic female patient presents for screening MRI. Family history of breast cancer in sister diagnosed in 30s. There is heterogeneous amount of fibroglandular tissue in both breasts.Minimal parenchymal enhancement is noted bilaterally. There are subcentimeter cysts in the outer quadrants of the bilateral breasts.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. Recommend screening mammogram, as MRI does not replace screening mammography.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Routine Screening Mammogram.


Instruction: Generate impression based on findings.

Input: Male 17 years old Reason: History of PSC, MRCP to evaluate for worsening disease and biliary sludge involving the pancreatic neck as seen on outside ultrasound. History: History of PSC with elevated LFTs, abdominal pain. ABDOMEN:LIVER, BILIARY TRACT: There is marked dilatation of the common hepatic duct, with beaded appearance extending into the left and right hepatic ducts as well, increased from prior exam. Abrupt transition of dilatation, with no discrete mass or stone identified. Favor stricture as etiology. Gallbladder is distended, new from prior exam.SPLEEN: No significant abnormality noted.PANCREAS: No pancreatic ductal dilatation. Normal parenchymal appearance.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Interval development of marked intrahepatic biliary ductal dilatation and gallbladder distention, with abrupt transition in common hepatic duct. No mass or stone identified, favor stricture as etiology.


Instruction: Generate impression based on findings.

Input: 69 year old female with aortic stenosis referred to assess for viability. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. There is severe hypokinesis of the basal inferior, inferoseptum, and inferolateral walls; there is hypokinesis of the mid inferior and inferolateral walls; there is hypokinesis of the apical lateral wall. The overall LV ejection fraction is 23%, the LV end diastolic volume index is 149 ml/m2 (normal range: 65+/-11), the LVEDV is 286 ml (normal range 109+/-23), the LV end systolic volume index is 115 ml/m2 (normal range 18+/-5), the LVESV is 222 ml (normal range 31+/-10), the LV mass index is 107 g/m2 (normal range 67+/-11), and the LV mass is 206 g (normal range 114+/-24). There are small transmural myocardial infarctions involving the apical anterior, inferior, and lateral walls. These small segments are unlikely to be viable. The remainder of the left ventricle is free of myocardial infarction and there is a large amount of myocardial viability.Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 51%, the RV end diastolic volume index is 63 ml/m2 (normal range 69+/-14), the RVEDV is 122 ml (normal range 110+/-24), the RV end systolic volume index is 31 ml/m2 (normal range 22+/-8), and the RVESV is 60 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve is trileaflet and significantly calcified. There is significant flow acceleration suggesting at least moderate aortic valve stenosis, correlation with echo to quantify severity suggested. There is mild aortic regurgitation. Mitral ValveThe mitral valve opens widely. There is tethering of the posterior leaflet with mild 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 pseudo-bovine brachiocephalic branching pattern. The aortic root is normal in size. The descending aorta has mild to moderate diffuse atherosclerosis. There is a small infra-renal aneurysm (26mm) with significant atheroma.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. Severe LV dilation with severely reduced systolic function (LVEF 23%). There is a large wall motion abnormality as described above.2. Small, transmural, myocardial infarctions are present in the apical anterior, lateral, and inferior walls.These small segments are not likely to be viable. The remainder of the myocardium is free of myocardial infarction and there is an overall large burden of myocardial viability.3. Normal RV size and systolic function (RVEF 51%).4. Severe left atrial dilation. 5. At least moderate aortic valve stenosis, correlation with echocardiography for better quantification of aortic valve stenosis suggested.6. Posterior leaflet of mitral valve is restricted with evidence of mild mitral regurgitation. 7. The descending aorta has mild to moderate diffuse atherosclerosis. There is a small infra-renal aneurysm (26mm) with significant atheroma.


Instruction: Generate impression based on findings.

Input: Pituitary tumor surveillance. There is no significant interval change in size of the pituitary mass with suprasellar and right cavernous sinus extension, measuring up to approximately 20 mm. The infundibulum is deviated superiorly and to the left. The tumor abuts the optic apparatus.

Output: No significant interval change in size of the pituitary mass with suprasellar and right cavernous sinus extension, which likely represents a macroadenoma.


Instruction: Generate impression based on findings.

Input: 32-year-old female patient with tuberous sclerosis and angiomyolipomas. Evaluate response of angiomyolipoma with afinitor. ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis without evidence of acute cholecystitis. No intra or extra hepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: The kidneys are enlarged and entirely replaced by fat containing lesions compatible with angiomyolipomas. No native parenchyma is definitively discerned. The kidneys as a whole measure approximately 23 cm on the left and 25 cm on the right in the craniocaudal dimension. They are significantly increased in size from 2006 study. For reference, an inferior component of the right angiomyolipoma measures approximately 12 cm in the craniocaudal dimension, previously 6 cm. There are interspersed T2 hyperintense cystic areas which may represent interspersed renal cysts or T2 bright components of the angiomyolipomas. Differentiation of different lesions within each kidney is difficult.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Marked levoscoliosis.OTHER: There is moderate ascites within the right hemiabdomen. There is an arcuate morphology of the uterus.

Output: 1.Enlarged, entirely replaced kidneys by angiomyolipomas with interspersed cystic components or renal cysts. These are significantly larger compared to 2006.2.Right abdominal ascites. 3.Cholelithiasis without evidence of cholecystitis.


Instruction: Generate impression based on findings.

Input: 44 year old with history of right breast DCIS status post lumpectomy and re-excisions with calcifications near the surgical site. Dense breasts. There is heterogeneous amount of fibroglandular tissue in both breasts.Moderate to marked parenchymal enhancement is noted bilaterally, somewhat of a limitation to the study. No abnormal enhancement is seen in either breast, including at the lumpectomy site. Post operative volume loss and low T2 signal scarring is noted at the site of right upper outer breast lumpectomy, though no nodular enhancement is seen at the site of scarring -- and in fact the degree of background enhancement is quite low near the area of scarring. No abnormal axillary lymph nodes are identified in either axillary region. Post surgical change noted in the right axilla.

Output: No MRI evidence for malignancy. No suspicious enhancement near the lumpectomy or elsewhere in either breast. The 6 month mammogram follow up should still be performed based on the appearance of the mammograms. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: 57-year-old male complaining of syncopal episode. Patient has history of CVA. Foci of hypoattenuation in the left cerebellar hemisphere compatible with known infarcts seen on MRI. Periventricular hypoattenuating foci are consistent with minimal ischemic small vessel disease, age indeterminate.There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration. The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: No acute intracranial abnormality.


Instruction: Generate impression based on findings.

Input: 51-year-old male with new onset right lateral thigh and calf pain, severe LBP. Evaluate for epidural hematoma status post L5-S1 revision laminectomy on 5/5/2016. Redemonstrated is mild developmental narrowing of the spinal canal. The vertebral body heights are within normal limits. There is loss of lumbar lordosis as well as minimal retrolisthesis of L5 on S1. Alignment is otherwise maintained. Bone marrow signal is benign. The conus medullaris is normal in position. There has been interval revision of a right L5-S1 discectomy, laminectomy and partial facetectomy. Residual tissue at the level of the L5-S1 posterior disc level and right lateral recess may represent disc protrusion and/or blood products and can be better assessed on follow-up studies. There are heterogeneous blood products at the right dorsal lateral L5-S1 laminectomy mostly in the paraspinous soft tissues.Heterogeneous T1/T2 signal involving the ventral epidural space beginning at the L4-5 level and extending to the S2 level is favored to represent engorged epidural venous plexus with superimposed blood products. There is resulting severe effacement of the thecal sac at the L5-S1 level which was not present on the previous MRI from 4/13/2016. More superiorly in the upper lumbar spine there is slight dorsal and leftward displacement of the cauda equina nerve roots which may be related to mild arachnoiditis although a CSF collection ventrally is not entirely excluded. There is no significant mass effect.Additional multilevel degenerative changes from L1-L2 through L4-5 are not significantly changed from the prior MRI, including disc desiccation, mild disc bulge, and central dorsal annular fissure at the L4-5 level without significant spinal canal or neural foraminal narrowing. Neural foraminal narrowing at the L5-S1 level is again noted bilaterally.Atrophic native kidneys with cysts noted. Left lower quadrant presumed transplant kidney partially imaged.

Output: 1.Postoperative changes of a right L5-S1 revision discectomy, laminectomy and partial facetectomy with some residual disc protrusion suspected involving the right lateral recess. Extent of residual disc can be better assessed on follow-up imaging, when immediate postoperative changes improve.2.Interval increasing heterogeneity of the anterior ventral epidural space at the L4-5 through S2 level which is favored to represent engorged epidural venous plexus with probable superimposed blood products. This results in severe effacement of the thecal sac at the L5-S1 level, which is new from the exam from 4/13/2016. If there remains suspicion for hematoma causing compression, recommend postcontrast imaging to better evaluate this lesion and confirm epidural venous plexus. 3.More superiorly in the lumbar spine there is slight dorsal and leftward displacement of the cauda equina nerve roots which may be related to mild arachnoiditis although a CSF collection ventrally is not entirely excluded. There is no significant mass effect and the significance of this finding is uncertain.


Instruction: Generate impression based on findings.

Input: 63 year old woman with history of left breast IDC, ER/PR positive, s/p mastectomy (2006) and reconstruction. There is scattered fibroglandular tissue in the right breast.Mild parenchymal enhancement is noted in the right breast.No abnormal enhancement is seen in either the right breast or left reconstruction. There are a few foci in the right breast that are stable to less enhancing compared to priors. The patient is status post left mastectomy and reconstruction with an intact retropectoral silicone implant.No abnormal lymph nodes are identified in either axillary region.High T2 signal within a mid thoracic vertebral body is unchanged, compatible with a benign hemangioma.

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


Instruction: Generate impression based on findings.

Input: Disorder of brain, unspecified [G93.9] / Encounter for other preprocedural examination [Z01.818] / Unspecified convulsions [R56.9], Reason for Study: ^Reason: MRI brain stealth for surgery planning, no fiducials needed. Brain mass, presurgery day of surgery Multiple fiducial markers attached to scalp for the preparation of planned surgery.There is about 20.6mm x 30mm sized intra axial mass with enhancement on the right parahippocampal gyrus.The lesion shows high signal intensity on the T2 weighted images and demonstrated irregular shaped enhancing portion especially posterior mesial aspect of the mass.Though limited sequence, there is no definitive surrounding edema.Differential diagnosis include ganglioglioma, pilocytic astrocytoma, and pleomorphic xanthochromcytoma.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: Right hippocampal gyrus intra axial mass with focal enhancement and subtle mass effects as described above.


Instruction: Generate impression based on findings.

Input: Diagnosis: Thoracic or lumbosacral neuritis or radiculitis, unspecifiedClinical question: lumbar radiculopathy, please compare to uploaded outside studySigns and Symptoms: lumbar radiculopathy bilaterally Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is a disc bulge present at this level which is unchanged since the previous exam. There is only partial effacement of the fat at the lateral recess bilaterally at this level. There is a right far lateral disc protrusion present at this level which was also present on the prior exam and is unchanged.At L4-5 there is loss of disc space height, disc desiccation and a diffuse disc bulge eccentric towards the left associated with mild ligamentum flavum hypertrophy. There is effacement of the fat surrounding the nerve roots at the left lateral recess and to a slightly lesser degree right lateral recess. These findings are stable compared to the prior exam.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is a moderate degree of facet hypertrophy present at this level associated with subtle 1 to 2 mm anterior subluxation of L3 and L4. These findings are stable compared to the prior exam.At L2-3 there is a moderate degree of facet hypertrophy present associated with subtle 1 to 2 mm anterior subluxation of L3 and L4. There is a diffuse disc bulge present at this level as well as ligamentum flavum hypertrophy. There is triangulation of the thecal sac. There is a 2 mm left-sided ligamentum flavum cyst present which is stable since the prior exam These findings are stable compared to the prior exam.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.There are multilevel degenerative changes present in the lumbar spine worse at L4-5 where there is a mild degree of spinal stenosis. These findings are stable compared to the prior exam.2.There is very mild anterior subluxation of L3 on L4 and L4 on L5 present related to degenerative changes. These findings are stable compared to the prior exam.


Instruction: Generate impression based on findings.

Input: 49-year-old female with known FNH. No please evaluate for any changes. ABDOMEN:LIVER, BILIARY TRACT: The known homogeneous arterially enhancing lesion of the right hepatic lobe (segment 5/6) measuring 3.4 x 3.5 cm (series 9 image 50) is stable in size. The previously described small hyperenhancing lesion of hepatic segment IVb is not clearly visualized on the current study and was best seen on the 1/13/2015 MRI exam. Short segment chronic thrombosis of the right portal vein is also unchanged (series 9 image 73).SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Stable size of the known arterially enhancing lesion of hepatic segment 5/6 with imaging characteristics most consistent with an FNH.2.The previously described small hyperenhancing lesion of hepatic segment IVb is not clearly visualized on the current exam using MultiHance contrast. This lesion was only visualized on the 1/13/2015 MRI liver exam using Eovist contrast. Eovist is suggested for future follow-up exams.3.Chronic short segment thrombus of the right hepatic vein is also unchanged.


Instruction: Generate impression based on findings.

Input: 41-year-old female patient with left elbow pain. Question of lateral epicondylitis. Some sequences are limited by patient motion artifact.LIGAMENTS: The radial and ulnar collateral ligaments are intact.TENDONS: There is mild increased signal intensity adjacent to/within the common extensor tendon which may reflect a mild tendinosis, but we see no discrete tear. There is also minimal increased signal intensity within the common flexor tendon perhaps representing minimal tendinosis. The biceps and triceps tendons are intact.ARTICULAR SURFACES AND BONE: We see no osteochondral defect and bone marrow signal intensity is within normal limits. A low T1 and T2 focus within the lateral radial head likely represents a bone island.SURROUNDING STRUCTURES: No significant abnormality noted.ADDITIONAL

Output: Increased signal intensity within/adjacent to the common extensor tendon is compatible with mild lateral epicondylitis.


Instruction: Generate impression based on findings.

Input: Clinical question: Rule out right lumbar root compression. Signs and symptoms: Radicular pain RLE. History of prior diskectomy. Nonenhanced lumbar MRI:Lowermost visualized thoracic spine demonstrate mild degenerative changes without spinal stenosis or neural foraminal compromise.T12 -- L1 is unremarkable.L1 -- L2 is unremarkable.L2 -- 3 demonstrate moderate disk disease and loss of disk height, minimal ligamentum flavum hypertrophy bilaterally and mild broad base bulging disk. There is mild interval progression of disease since prior exam. There is no spinal stenosis or neural foraminal compromise at this level.L3 -- L4 demonstrate moderate to advanced disk disease and loss of disk height, moderate bilateral ligamentum flavum hypertrophy and mild facet disease. No spinal stenosis however moderate right neural foraminal compromise secondary to degenerative changes is noted.L4 -- 5 demonstrate advanced disk disease with significant loss of disk height with interval progression since prior exam. There is interval placement of a left transpedicular screw. There is complete resolution of previously seen disk protrusion on the left. No evidence of central spinal stenosis. Mild left neural foraminal compromise is suspected however presence of metallic hardware artifact makes precise assessment difficult. Right neural foramina remains patent.L5 -- S1 demonstrate mild disk disease and degenerative changes of posterior elements. There is a left transpedicular screw placed since prior exam. There is a shallow broad-based disk protrusion in the midline and to the right which results in subtle flattening of thecal sac however without spinal stenosis, lateral recess or neural foraminal compromise.

Output: 1.Postoperative changes at L4 -- L5 and with complete resolution of disk protrusion on the left since prior study.2.Mild degenerative changes of lumbar spine however without evidence of spinal canal compromise at any level.3.Very shallow broad-based right sided disk protrusion at L5 -- S1 without spinal canal, neural foraminal or lateral recess compromise.4.Mild neural foraminal compromise as detailed per level above.


Instruction: Generate impression based on findings.

Input: Male, 13 months old, with seizure-like movements. The brain parenchyma shows normal signal intensity and morphology. No edema or mass effect is detected. No restricted diffusion is seen. There is no evidence of any cortical dysplasia or migrational anomaly. A normal variant mega-cisterna magna is suspected.The pituitary gland is within normal limits for age. The brain stem and cerebellar vermis are unremarkable. The cerebellar hemispheres are normally formed and the cerebellar tonsils terminate above the level of the foramen magnum.The pattern of white matter myelination is appropriate for age. No evidence of intracranial hemorrhage or pathologic extra-axial fluid collection is seen. Ventricular size and morphology are within normal limits.

Output: Unremarkable examination with no specific findings to account for the patient's seizures.


Instruction: Generate impression based on findings.

Input: For Research: GBM s/p resection with Ziopharm trial: surveillance. There are postoperative findings related to prior left temporal lobe tumor resection, with evolving blood products in the surgical bed. There is perhaps slight interval decrease in size of the heterogeneously enhancing nodular lesion in the posterior left temporal lobe, anterior to the resection cavity, measuring 15 x 18 mm, previously 18 x 20 mm. The is persistent extensive surrounding confluent T2 hyperintensity, with slight extension across the corpus callosum, but overall slightly decreased associated swelling. There is also persistent diffuse linear enhancement along the margins of the resection cavity. There is no significant midline shift or herniation. The ventricles are unchanged in appearance. There are postoperative findings related to sinonasal surgery and diffuse paranasal sinus mucosal thickening.

Output: Postoperative findings related to prior left temporal lobe tumor resection with what appears to be slight interval decrease in size of the treated residual tumor and perhaps slightly decreased surrounding edema.


Instruction: Generate impression based on findings.

Input: 51-year-old female with stage IIB cervical cancer status post EBRT PELVIS: Sagittal sequences severely limited by motion artifact.UTERUS, ADNEXA: Tandem and ovoid brachytherapy apparatus placed within the vagina, traversing cervix and into uterus. The right ovoid is at the level of the previously identified site of disease. Marked interval improvement of primary cervical lesion, unable to make reliable measurements. Subserosal fibroid in the posterior wall of the uterus is unchanged.There is a focus of enhancement in the right parametrial soft tissues measuring approximately 2 x 1.6 cm, previously 1.8 x 1.3 cm, favored to be stable accounting differences in technique and related to right ovary (not able to delineate whether enhancement is secondary to normal ovarian tissue or persistent lesion; comparison made to earlier 6/20/16 MRI and outside pretreatment MRI exam and previously there was invasion of this ovary by patient's primary cervical mass). Additional right-sided T2 dark rounded lesion unchanged, may be an endometrioma. Possible mild distortion of left ovary on pretreatment imaging seems improved. BLADDER: Foley catheter within a partially collapsed bladder. Air within the bladder is presumed to be secondary to manipulation.LYMPH NODES: Redemonstrated is a peripherally enhancing lesion measuring 17 x 10, not significantly changed since the prior exam. This lesion may represent a paraovarian or adnexal cyst. Additional right-sided T2 dark rounded lesion unchanged (also alluded to above), may be an endometrioma.BOWEL, MESENTERY: Small amount of free fluid in the dependent portion of the pelvis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Marked interval improvement of primary cervical lesion. 2.No significant change in right parametrial soft tissue lesion previously described, favored to be right ovary. Uncertain whether persistent corresponding enhancement seen currently is related to treated ovarian tissue now devoid of tumor or persistent tumor infiltration of the ovary. Discussed with radiation oncologist Dr. Hasan. 3.Unchanged peripherally enhancing lesion adjacent to the right pelvic wall may represent a paraovarian or adnexal cyst (rather than necrotic lymph node reported previously).


Instruction: Generate impression based on findings.

Input: Male, 43 years old, history of metastatic renal cancer to C1, with neck pain. The right occipital condyle is infiltrated and expanded by enhancing tumor, and this lesion may be slightly increased in size from prior. A subcentimeter tumor deposit is also seen within the left basiocciput. A very large tumor deposit is evident centered on the left lateral mass of C1 with involvement of the anterior and posterior arches. This lesion extends medially to encroach upon the left lateral thecal sac, as well as into the left C1-2 neural foramen. A substantial lateral paraspinal component is also seen which infiltrates the prevertebral and paraspinal muscles causing a leftward deviation of the carotid space. This lesion measures up to 48 x 31 mm in the axial plane, previously measuring up to 37 x 22 mm. Although there is effacement of the left lateral thecal sac, tumor does not contact or impinge upon the spinal cord and there is no significant spinal canal stenosis.Tumor infiltration of the C4 vertebral body is demonstrated without evidence of significant extraosseous spread or loss of vertebral body height. This lesion is probably new or larger from the prior exam.A small area of tumor infiltration is suspected within the right aspect of the C5 vertebral body, and again within the right aspect of the C7 vertebral body. Both are new or larger from the prior exam. Tumor infiltration is also evident along the proximal left T2 rib which appears similar to prior.A nonenhancing, potentially cystic nodule, within the left posterior subcutaneous neck is unchanged. Mild pharyngeal edema and tracking fluid is seen, perhaps reactive to bulky C1 tumor.Spinal alignment is anatomic. Vertebral body heights are preserved. Disc osteophyte complexes are seen at C5-6, with mild spinal canal stenosis and moderate right foraminal narrowing, and at C6-7 with minimal spinal canal stenosis. Uncovertebral hypertrophy on the right is demonstrated at C3-4.

Output: Progression of metastatic disease with large growing tumor deposits involving the right occipital condyle and the left lateral mass of C1. The C1 lesion causes mild encroachment upon the left lateral spinal canal but no significant canal stenosis or cord impingement.Scattered smaller tumor deposits throughout the cervical spine may also be new or increased in size, but these are confined to the marrow space.Tumor encasing the proximal left second rib appears unchanged. A nodule in the posterior subcutaneous tissues of the neck is unchanged and may be benign.


Instruction: Generate impression based on findings.

Input: Reason: r/o fracture History: hip pain Evaluation is significantly limited by patient body habitus and technical factors related to portable technique. Again seen is severe osteoarthritis of the left hip. We see no discrete fracture line on this limited study, however, if there is strong clinical concern for fracture CT or MRI is recommended.

Output: Limited study showing severe osteoarthritis of the left hip but we see no displaced fracture. If there is strong clinical concern for fracture, CT or MRI be considered.


Instruction: Generate impression based on findings.

Input: 40 years Female (DOB:5/10/1976)Reason: r/o CVA History: sudden severe headache, R eye ptosis and facial asymmetryPROVIDER/ATTENDING NAME: PATRICIA CHAPMAN-KELLY PATRICIA CHAPMAN-KELLY The CSF spaces are appropriate for the patient's stated age with no midline shift. No foci of diffusion restriction are appreciated. There is a punctate T2 and FLAIR hyperintense lesion in the left frontal periventricular white matter.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.There is diffuse marrow replacement present.

Output: 1.There is no evidence for acute ischemic cerebral infarction.2.There is a left periventricular white matter lesion present which in isolation is probably of little clinical significance.3.There is diffuse marrow replacement present which is probably related to patient's known sickle cell.


Instruction: Generate impression based on findings.

Input: Assess for SLAP tear. ROTATOR CUFF: There is interstitial insertional partial tear of the supraspinatus tendon. Increased signal the infraspinatus tendon may reflect mild to moderate tendinopathy. The subscapularis and teres minor tendons are intact.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is suggestion of a small SLAP tear seen only on series 2, image 22, extending from the 11:00 to 1:00 position.BICEPS TENDON: Biceps tendon is intact with normal signal characteristics. ADDITIONAL

Output: 1.Small SLAP tear, as above.2.Partial thickness supraspinatus tear, as above.


Instruction: Generate impression based on findings.

Input: Female 65 years old. Reason: evaluate for osteo. History: Charcot foot, diabetes There is an ulcer of the soft tissue along the plantar aspect of the midfoot, with a collection of heterogeneous (partially fluid) signal intensity extending dorsally from the ulcer between the anterior aspect of the remaining calcaneus and the base of the fourth and fifth metatarsals up to the ankle joint. Overall, the collection is approximately 9 cm in greatest diameter. It surrounds what is left of the talus and abuts the tibial plafond. It also abuts the navicular and extends posteriorly along the lateral margin of the remaining calcaneus as well as to the distal fibula laterally and the medial tendons medially. There is abnormal signal intensity (low on T1 weighted images and high on T2 weighted images) involving the anterior and lateral aspect of the calcaneus, remainder of the talus, distal tibia, distal fibula, the navicular and lateral cuneiform, highly suspicious for osteomyelitis. The medial malleolus is completely eroded. The head and neck of the talus are absent and the cuboid is not clearly visualized on this study presumably secondary to long-standing erosion. There is also relatively mild signal abnormality and erosion of the remaining cuneiforms and the metatarsal bases suggesting long-standing neuropathic arthropathy, although additional foci of osteomyelitis cannot entirely be excluded.The posterior tibial tendon is abnormally thickened and of abnormal signal intensity likely reflecting tendinosis and type I tearing. Fluid signal intensity along the posterior tibial tendon and the flexor digitorum longus likely reflects focal tenosynovitis. The peroneus longus tendon is enlarged with a split tear posterior to the fibula. The Achilles' tendon is slightly thickened indicating mild tendinosis. The anterior tendons are partially surrounded by the aforementioned fluid collection. The muscles of the ankle and foot are of increased signal intensity on T2 weighted images suggesting edema. There is also reticulation of the subcutaneous fat indicating subcutaneous edema.

Output: Findings compatible with severe Charcot arthropathy. There is also a plantar soft tissue ulcer with heterogeneous fluid tracking from the ulcer through the hindfoot/midfoot to the ankle joint, associated with bone destruction and signal abnormality as described above and consistent with extensive superimposed osteomyelitis. Other soft tissue findings as described above.


Instruction: Generate impression based on findings.

Input: Reason: 72M with history of Gleason 6 prostate cancer, with rising PSA History: rising PSA PELVIS:PROSTATE:Prostate Size: 4.4 x 2.5 x 3.2 cmPeripheral Zone: There is diffuse low T2/ADC signal surrounding the TURP defect which demonstrates early enhancement. This is most prominent along the left mid gland transitional and peripheral zones (704/284) and is suspected to represent fibrosis. There are more focal lesions which also surrounding the TURP defect which are also low signal on T2/ADC measuring 0.5 x 0.7 cm in the right lateral mid gland (601/18) and 0.4 x 0.4 cm in the right para median mid gland (601/17).Central Gland: A TURP defect comprises the majority of the central gland.Seminal Vesicles: No evidence of seminal vesicle in relation.Extracapsular Extension: No evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Bilateral fat-containing inguinal hernias.

Output: 1.TURP defect with diffuse surrounding low T2/ADC signal which is suspected to represent prostatitis/fibrosis, particularly in light of the low grade Gleason biopsy.2.There are two more focal regions of low T2/ADC signal in the right mid gland surrounding the TURP defect which are indeterminate and have been marked for biopsy.


Instruction: Generate impression based on findings.

Input: known CCM left frontal lobe, headache and fatigue. There is no evidence of acute ischemic lesion.There is, however, at least two low signal intensity lesions on T2 weighted images.The most prominent and largest one is on the left frontal lobe lesion (about 9mm) with low signal intensity rim indicating hemosiderin deposition. Relatively enlarge vascular structure on the superior aspect of the lesion indicate associated small developmental venous anomaly.Another suspicious low signal intensity lesion is on the left posterior inferior thalami (series 601, image 14/28). Since there is no susceptibility imaging sequence, it cannot be confirmed as another CCM lesion.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. 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: Incomplete examination due to patient's intolerance.About 9mm sized CCM on the left frontal lobe associated with a small DVA.Suspicious lesion on the left thalami as described above.


Instruction: Generate impression based on findings.

Input: Reason: back pain, leg weakness History: back pain, leg weakness. The vertebral bodies are appropriate in the overall alignment and height. The spinal cord has normal signal characteristics and overall morphology. There is no compromise of the spinal cord. The paraspinal soft tissues appear normal. There are minimal disc osteophyte complexes involving C3-C4, C5-C6, C6-C7, without significant canal stenosis. There are minimal degenerative changes of the thoracic spine. There is a punctate T1 hyperintense focus in the T9 vertebral body, likely representing focal fat or hemangioma. The conus medullaris terminates at the mid L1 level. Mild degenerative changes are seen in the lumbar spine with disc desiccation at the L3-L4, L4-L5, and L5-S1 levels. There is a minimal disc bulge at L3-L4. There are disc herniations at L4-L5 and L5-S1 without evidence of significant spinal canal stenosis. There is mild bilateral neural foraminal narrowing at L5-S1.

Output: 1. This is a limited exam specific for the exclusion of cord compression only and does not exclude more subtle lesions such as intrinsic cord abnormalities. No cord compression is identified. Due to the screening nature of this protocol details are not as evident on imaging as dedicated protocols of the spine.2. Mild degenerative changes of the cervical and lumbar spine without evidence of significant central canal stenosis. There is mild L5-S1 neural foraminal stenosis


Instruction: Generate impression based on findings.

Input: Abnormal reflex [796.1] / Disturbance of skin sensation [782.0], Reason for Study: ^Reason: assess for demyelinating disease History: bladder symptoms, numbness in the legs, R.sided hyperreflexia T-SpineThere is flattening of upper to lower thoracic spinal cord from T4-5 to T T10 level without evidence of abnormal spinal cord signal.Well circumscribed slightly high signal intensity on both T1 and T2 weighted image lesion at T3 vertebral body represents vertebral body hemangioma.At the level of T8-9, there is a focal protrusion of disc which abuts thecal sac.There is minimal focal protrusion of disc at the level of T9-10.Broad-based disc protrusion central to left at the level of T 10-11 and T12-L1.There is normal thoracic kyphosis and lumbar lordosis. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. L-SpineThe conus finishes at the level of L34 intervertebral disc level, however, there is no abnormal spinal cord signal intensity. On axial scan, the spinal cord is located posterior aspect of the spinal canal.There is partial spina bifida of L5 vertebral body. However, there is no evidence syringomyelia, no evidence of fat-containing mass, no evidence of myelomeningocele, no evidence of thickening of filum.There is no abnormal enhancement.Multiple vertebral body lesions which are well circumscribed, high signal intensity on both T1 and T2-weighted images indicate vertebral body hemangioma at T11, L2 and S1 vertebral bodies.Minimal disc desiccation with the diffuse bulging of disc was seen at the level of L4-5.There is no evidence of spinal canal stenosis or neural foraminal stenosis.Constellation of above described findings including flattening of upper thoracic spinal cord, and low-lying conus at the level of L3-4 indicate possible tethered cord syndrome. Since there is no evidence of other associated findings for tethered cord, prone position MRI can be considered if clinically indicated.

Output: 1. Lower lying conus medullaris with posterior location in spinal canal suggests tethered cord.2. Multi-level degenerative disc diseases, as described above.


Instruction: Generate impression based on findings.

Input: Ms. Liu is a 37 year old female with a family history of breast cancer in mother diagnosed at 42 years of age. There is extreme amount of fibroglandular tissuein both breasts.Mild parenchymal enhancement is noted bilaterally.There is an area of non-mass enhancement in the right breast 8-9:00 position, middle depth which measures 16 x 17 x 16 mm (AP x TR x CC). Approximately 5 mm posterior to this area of non-mass enhancement in the right central breast, posterior depth, there is an oval-shaped heterogenously enhancing mass which measures 8 x 5 x 6 mm (AP x TR x CC). The oval-shaped enhancing mass may have nonenhancing septa, although this is incompletely characterized. In total, the area of non-mass enhancement and the oval-shaped enhancing mass measure 2.8 cm in the anterior posterior dimension.No abnormal enhancement is seen in the left breast. No abnormal axillary lymph nodes are identified in either axillary region.

Output: Area of non-mass enhancement in the right breast at the 8-9:00 position, middle depth measuring up to 17 mm. Additional 8 mm oval-shaped mass in the central right breast, posterior depth. Targeted right breast ultrasound is recommended for further evaluation. If no ultrasound correlate is identified, MRI guided biopsy of the non-mass enhancement is recommended.BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: E - Additional Mammo/Ultrasound Workup Required.