Instruction: Generate impression based on findings.

Input: 76 years Male (DOB:5/14/1940)Reason: follow up the cavernoma, right temporal region. History: epilepsyPROVIDER/ATTENDING NAME: SHASHA WU SHASHA WU The CSF spaces are appropriate for the patient's stated age with no midline shift. There is redemonstration of a 14x9 mm axial dimension (on T2) lesion which is hypointense peripherally and has a popcorn-like appearance on T2 imaging located in the right inferior parietal lobule which was also present on the prior exam. Since the previous exam from 7/7/2010 there is a little bit more low signal on the medial aspect of the lesion when compared to the prior exam. Otherwise the lesion has not changed substantially. There is associated blooming artifact. On susceptibility weighted imaging there is a punctate millimeter size lesion located adjacent and above the occipital horn of the left lateral ventricle which can also be subtly seen on FLAIR MRI images on the current exam but not readily appreciated on the prior examThere is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. These have accumulated more on the left hemisphere relative to the right and are more numerous on the current exam versus the prior examNo abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate a mucous retention cyst in the left maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Stable right inferior parietal lobule cavernoma.2.Since the prior exam patient has developed a millimeter size hemorrhagic focus in the left occipital lobe adjacent and above the occipital horn of the left lateral ventricle.3.Since prior exam the patient has accumulated more periventricular white matter lesions in the left hemisphere predominantly. At this age these are most likely vascular related.


Instruction: Generate impression based on findings.

Input: An enhancing mass within the right occipital lobe has increased over the interval, now measuring 30 x 32 mm transaxial dimension (previously 25 x 21-mm). Additionally, it now appears more centrally necrotic, with enhancement abutting the lateral aspect of the resection cavity, with new extensive edema extending anteriorly.Redemonstrated are post-surgical changes related to a right parieto-occipital craniotomy for prior tumor resection with new nodular enhancement along its medial aspect with worsening edema also along its lateral aspect. Normal flow-voids are demonstrated in the major intracranial vascular structures.

Output: 1.An enhancing mass within the right occipital lobe has increased over the interval, now measuring 30 x 32 mm transaxial dimension (previously 25 x 21-mm). Additionally, it now appears more centrally necrotic, with enhancement abutting the lateral aspect of the resection cavity, with new extensive edema extending anteriorly.2.Redemonstrated are post-surgical changes related to a right parieto-occipital craniotomy for prior tumor resection with new nodular enhancement along its medial aspect with worsening edema also along its lateral aspect.


Instruction: Generate impression based on findings.

Input: Redemonstrated is an intra-axial, predominately cystic lesion in the right frontal lobe measuring approximately 6.5 AP x 5.8 ML x 5.2 CC cm with surrounding confluent T2 signal abnormality. There is substantial mass effect on the right lateral ventricle with partial effacement, and 8mm midline shift to the left. There is mild left lateral ventricular dilatation compatible with entrapment. The lesion is dominated by two large cystic components. Anteromedial to them, there is an elongated ovoid region of near CSF signal intensity through which it appears that small vessels may pass and which may also be a part of the lesion. The walls of the cystic components enhance, as does the solid nodular portion which is located more laterally. The solid portions of the lesion demonstrate mildly increased diffusion signal and subtle susceptibility effect suggesting hemorrhage and/or mineralization. The solid nodular portions of this tumor are inseparable from the right frontal opercular gyri which are thickened and heterogeneous, further supporting that the mass is intra-axial, and possibly originating from the cortex. The internal cystic components show no restricted diffusion.

Output: Stable, large intra-axial cystic and solid mass with enhancing nodular components in the right frontal region with extensive mass effect, and midline shift as described above.


Instruction: Generate impression based on findings.

Input: 55-year-old male presented with mass in the right neck parapharyngeal. Please evaluate.Technique: Following the administration of 70 mL Omnipaque 3501.Contiguous axial images were obtained through the soft tissues of the neck. Sagittal and coronal reconstructions were performed.2.Contiguous axial images were obtained of the brain. There is a 3731 mm axial dimensions mass measuring 50 by a 34 mm and coronal dimensions which surrounds the styloid process on the right side. It is heterogeneous in appearance. It displaces the right submandibular gland inferiorly and a displaces the right tap mylohyoid muscle medially. It abuts the right mandible at the angle of the mandible and also is visually contiguous with the right carotid space and displaces the right carotid artery and right external carotid artery posterior lateral. The styloid process extends into this mass along its more superior aspect. This is centered in the right parapharyngeal space and visually contiguous with the right masticator space. Its density is a lower than that of muscle and higher than that of CSF. It appears to be well circumscribed and a is not associated with bony erosion. There is a vessel which appears to run through it and best seen on the recent MRI images along its inferior and posterior aspect which most likely represents the facial arteryAt the level of the right bone and just above now within the preepiglottic space and there is a 16 x 23 mm irregular shaped lesion which appears to be visually contiguous with the tongue base and contains a number of air bubbles at appearedWithin the right submandibular space anteriorly there is a 12-mm nodule present better seen on the recent MRI than on the CT scan which showed abuts and is visually contiguous with the mylohyoid muscle. Within the infrahyoid neck on the basis of size criteria for lymphadenopathy no lymphadenopathy is appreciated.Within the visceral space the thyroid gland appears intact.The airway appears patent.The visualized intracranial structures which include the posterior fossa are intact. The visualized portions of the orbits and paranasal sinuses are intact. The paranasal sinuses and mastoid air cells are clear.The parotid and the submandibular glands appear intact with displacement of the right submandibular gland as indicated above.The visualized lung apices appear clear with some emphysematous changes.The carotid and vertebral vasculature visualized on this exam appears intact with displacement of the right carotid vessels as indicated above.The cervical vertebral bodies in general are intact with no evidence for canal stenosis. There are degenerative changes in the cervical spine with endplate and uncovertebral osteophytes and narrowing the neural foramina on the left side at C3-4 and bilaterally at C5-6. There is semi-disk disease also present in the cervical spine as well.CT head:The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.No abnormal enhancing lesions are appreciated in the brain parenchyma.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.There is a new right to masticator space and parapharyngeal space mass as described above which appears well circumscribed. malignancy such as squamous cell carcinoma cannot be excluded. Schwanoma and nerve sheat tumors may have this appearance. Salivary gland neoplasm is also consideration. 2.There is a nodule present along the right submandibular space is indicated above better seen on the recent MRI exam . This is suspicious for lymphadenopathy3.there is an exophytic mass along the tongue base which projects into the preepiglottic space. The possibility this represents a neoplasm is raised. Please correlate with physical findings on clinical exam.4.Degenerative changes are present in the cervical spine as indicated above.


Instruction: Generate impression based on findings.

Input: Images of the internal auditory canals demonstrate the seventh and eighth nerves to be normal in size and symmetric bilaterally without masses or enhancing lesions along the course of these nerves or in the cerebellopontine angle cisterns bilaterally. The inner ear structures are normal in appearance and symmetric bilaterally without congenital inner ear anomalies identified on either side. There are no vascular anomalies.Limited views of the intracranial contents redemonstrate chronic small vessel ischemic disease.

Output: 1.Negative MRI of the brain and internal auditory canals including gadolinium enhancement. Specifically, there are no findings to explain the patient's asymmetrical sensorineural hearing loss.2.It should be noted that a vestibular schwannoma was not identified on the comparison MRI from 8/27/2014. For that study, an intradural and extramedullary incidental tiny nodule of apparent enhancement was noted within the cervical spinal canal at the level of C2 which was felt to potentially represent a small schwannoma, although artifact is a consideration.


Instruction: Generate impression based on findings.

Input: T4N0 nasopharynx adenoid cystic carcinoma status post chemoradiation. There is no significant interval change in the infiltrative mass within the left nasopharynx, left parapharyngeal, left carotid, left prevertebral spaces, with infiltration of the left central skull base and probable perineural extension into the left Vidian canal. There is minimal residual epidural enhancement along posterior aspect of the left petrous apex. There are mild persistent sinonasal inflammatory changes. There is no significant cervical lymphadenopathy. The thyroid and salivary glands appear unchanged. There is persistent fluid within the left mastoid air cells and middle ear. The orbits are unremarkable.

Output: 1. No significant interval change in the adenoid cystic carcinoma centered in the left nasopharynx with adjacent deep space and skull base extension.2. Persistent findings associated with left Eustachian tube dysfunction, as manifested by retained otomastoid secretions.


Instruction: Generate impression based on findings.

Input: MRI Brain:There is a small area of restricted diffusion involving the right corona radiata and extending inferiorly into the right lateral basal ganglia and insula. There is mild mass effect on the adjacent right lateral ventricular margin. Encephalomalacia within the left frontal lobe, left caudate, and left basal ganglia with associated adjacent ex vacuo dilatation of the frontal horn and anterior body of the left lateral ventricle consistent with chronic infarct. There is a small focus of susceptibility abnormality in the right frontal lobe which may represent chronic hemosiderin deposition.There is global volume loss and underlying periventricular and subcortical FLAIR hyperintense white matter lesions consistent with mild-moderate chronic small vessel ischemic changes. There are also chronic appearing patchy FLAIR signal abnormalities within the pons. There is no midline shift or herniation. There is prominent partially visualized upper cervical spondylotic changes with at least moderate central spinal canal stenosis at C3-C4. There is fluid in the right greater than left mastoid air cells.MRA Brain: The origin of the right M1 segment is occluded with collateral vasculature supplying a single more distal right temporal MCA branch. There is mild to moderate irregularity involving the left cavernous ICA segment with moderate focal stenosis involving the left supraclinoid ICA segment. The mid to distal left M1 segment is not visualized, with small caliber more distal left MCA branches with questioned tiny areas of curvilinear vasculature along the M1 segment again suggesting possible collateral supply. The left A1 segment is diminutive which may be developmental. The bilateral ACAs are otherwise patent. The left PComA is not visualized. The posterior circulation including the vertebral arteries, basilar arteries and PCA arteries are patent. No evidence of aneurysms or vascular malformations.

Output: 1.Small acute infarct involving the right corona radiata, lateral right basal ganglia and right medial insula. There is mild mass effect on the adjacent right lateral ventricular margin.2.Occlusion of the origin of the right M1 segment with collateral vasculature supplying a single right temporal MCA branch.3.Left frontal lobe, left caudate and left basal ganglia encephalomalacia indicating chronic infarcts.4.The mid to distal left M1 not visualized, with small caliber more distal left MCA branches with small areas of curvilinear vasculature again suggesting possible collateral supply.5.Moderate focal stenosis involving the left supraclinoid ICA.


Instruction: Generate impression based on findings.

Input: Female, 41 years old, with history of pituitary adenoma status post resection x 2 at an outside facility, assess for growth. A lobular, T1 hyperintense and T2 hypointense lesion is redemonstrated occupying the sella and extending into the suprasellar cistern. The lesion does not appear to enhance above and beyond its intrinsic T1 hyperintensity. The lesion has perhaps changed shape slightly when compared to the prior examination, however the overall size is approximately similar. Due to differences in head positioning, the most accurate measurements are obtained in the sagittal plane where the lesion measures 22 x 16 mm (see image eight series 3), previously 22 x 16 mm. There may be a septation in the left anterior inferior portion of the lesion, but this is better visualized previously.The lesion extends into the suprasellar cistern, probably contacting the optic apparatus. No definite evidence of cavernous sinus invasion is seen. The native pituitary gland is not clearly visualized but a portion of it may be present along the right sellar floor. The pituitary stalk is not distinctly visualized as separate from the lesion.

Output: A lobular lesion involving the sella and suprasellar cistern is redemonstrated showing no overall change in size though the shape of the lesion may have changed slightly. The nature of the lesion remains unclear. The particular signal characteristics of the lesion could reflect proteinaceous or mucoid secretions as well as blood product, each of which can be seen within a macroadenoma.


Instruction: Generate impression based on findings.

Input: 33 years Female (DOB:5/1/1983)Reason: 33y/o female with leg weakness, ?compression, ?inflammation History: R leg weakness and decreased sensationPROVIDER/ATTENDING NAME: JAMES AHN JAMES AHN 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. There appears to be a small disc protrusion at C5-6.

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. There appears to be a small disc protrusion at C5-6.2.Due to the screening nature of this protocol details are not as evident on imaging as dedicated protocols of the spine.


Instruction: Generate impression based on findings.

Input: Clinical question: SC abnormality? Signs and symptoms coronal previous neck surgery right upper extremity radicular pain. Pre-and post-enhanced cervical MRI:Examination demonstrates a stable post operative changes Chiari decompression with resultant expansion of subarachnoid space at the surgical site similar to prior exam.Examination redemonstrates a mildly expansile syrinx of cervical cord extending from C1 to the uppermost visualized thoracic cord.The syrinx at C2 level measures 4.4-mm in transverse axis which is smaller compare to prior study measurements of 6.1-mm at the same level. There is however suggestion of mild interval increased size of syrinx more inferiorly compared to prior exam at C4 and C5 levels. At C5 it measures 3.5 mm in transverse axis compared to prior study measurements of 2.5-mm.post-enhanced images demonstrate no abnormal enhancement of the cord, leptomeninges or the vertebral column.Degenerative changes of cervical spine results in mild central spinal stenosis at C3 -- C4 and C4 -- C5 levels.Mild bilateral neural foraminal compromise at C3 -- C4, moderate to severe bilateral neural foraminal compromise at C4 -- C5, severe right and mild left neural foraminal C5 -- C6, mild bilateral neural foramina compromise at C6 -- C7 and significant right neural foramina compromise at C7 -- T1 is also noted.

Output: 1.Stable postoperative changes of Chiari decompression since prior exam.2.Stable extent of mildly dilated syrinx of cervical cord extending from T1 through the entire cervical cord and into the upper thoracic.3.Minimal interval decrease transverse caliber of syrinx at C1 -- C2 level and sulcal interval increased at C4 and C5 levels.4.No abnormal enhancement of the cord, leptomeninges or the spinal column on post infused images.5.Degenerative changes of cervical spine results in a central spinal stenosis at C3 -- C4 and C4 -- C5 levels. Multi-level neural foraminal compromise is also present as detailed per level above.


Instruction: Generate impression based on findings.

Input: Strong family history of breast cancer in her mother, grandmother and two great grandmothers. There is heterogeneous amount of fibroglandular tissue in both breasts. Moderate parenchymal enhancement is noted bilaterally.No suspicious enhancement is seen in either breast. Numerous areas of focal parenchymal enhancement are unchanged. A few high T2 signal cysts are noted in the right upper breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: 59 year old with strong family history of breast cancer, BRCA 2 positive. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Headaches that are different from her migraines. Evaluate for vasculitis. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are scattered punctate foci of abnormal T2/FLAIR hyperintensity within the subcortical white matter. There is no pathological enhancement. These are not dedicated images of the pituitary gland; however, suspected is a tiny subcentimeter cystic lesion within the posterior aspect of the sella without evidence of mass effect. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable.

Output: 1. No evidence of acute infarct, mass, or mass effect.2. Scattered punctate T2 hyperintense foci within the subcortical white matter, which are non-specific, and may be related to mild chronic small vessel ischemic disease or migraines.3. Dedicated pituitary sequences were not obtained however there is a subcentimeter cystic lesion within the posterior sella which may represent a Rathke's cleft cyst. No associated mass effect.


Instruction: Generate impression based on findings.

Input: History of salivary cancer status post surgery and radiation now with draining fistula over the right clavicle. Evaluate for underlying cancer recurrence or abscess. Redemonstration of extensive soft tissue thickening in the right supraclavicular region. This appears long-standing based on prior imaging and favored to represent scarring. Within this area of soft tissue thickening there is a small fluid collection located superior to the clavicle, anterior to the scalene muscles, and lateral to the carotid sheath measuring approximately 10 x 10 mm in axial dimension and 16 mm craniocaudal. (Series 7 image 34). Postcontrast images show poorly defined enhancement surrounding this fluid collection (11 image 34 and 35). A sinus tract is identified tracking superiorly to the skin (series 8 image 26, 25, and 24). Based on the pattern of enhancement, this is most compatible with an infectious process with a central abscess. Infiltrative tumor with a necrotic core remains a diagnostic consideration, however this is considered less likely given absence of a discrete solid underlying mass.Remainder the neck demonstrates extensive post surgical changes with neck dissection. Soft tissue thickening and edema involving the supraglottic structures is compatible with posttreatment changes. No definite recurrent tumor or lymphadenopathy is identified.Post surgical changes involving the right mandible. Heterogeneous signal within the mandible and clavicular heads compatible with radiation change as seen on prior CTs. Multilevel degenerative changes in the cervical spine with partial fusion of the C4 and C5 vertebral bodies again seen. The orbits and paranasal sinuses are unremarkable. The visualized intracranial contents are unremarkable without mass, mass effect, midline shift, or abnormal enhancement. There is partial opacification of the bilateral mastoid air cells.

Output: 1. 10 x 10 x 16 mm diameter fluid collection in the right supraclavicular region with draining sinus tract extending to the skin anterosuperiorly. The pattern of enhancement surrounding the collection favors an abscess. Infiltrative recurrent tumor with a necrotic core remains a differential consideration, but seems less likely as the extensive surrounding infiltrative soft tissue thickening appears long-standing based on multiple prior CT studies.2. Extensive posttreatment changes throughout the neck as described without convincing evidence of recurrent tumor or lymphadenopathy.


Instruction: Generate impression based on findings.

Input: 58 years Female (DOB:1/9/1958)Reason: H/o lung cancer, r/o brain metastasis History: ConfusionPROVIDER/ATTENDING NAME: BLASE N. POLITE DANIEL V T CATENACCI The CSF spaces are appropriate for the patient's stated age with no midline shift. Exam is mildly degraded due to patient motion which will obscure more subtle abnormalities.There are several periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.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: There is no evidence for brain metastases.Several periventricular and subcortical white matter lesions present are nonspecific. They are most likely vascular related.


Instruction: Generate impression based on findings.

Input: Male, 55 years old. Pain. MENISCI: There is linear and globular intrasubstance signal within the posterior horn and body of the medial meniscus indicating degeneration. Signal abnormality within the body and posterior horn of the meniscus extends to the tibial articular surface indicating undersurface tearing, seen in both the red and white zones of the meniscus. The anterior horn of the medial meniscus is intact. There is mild prominence of the body of the lateral meniscus suggesting borderline discoid morphology, but we see no discrete tear.ARTICULAR CARTILAGE AND BONE: There is partial thickness degeneration of the articular cartilage of the medial femoral condyle along its lateral aspect with additional focal degeneration more anteriorly and posteriorly along the condyle associated with small foci of degenerative subchondral signal abnormality. The articular cartilage of the lateral compartment appears relatively spared. There is a focal full-thickness defect of the cartilage of the medial facet of the femoral trochlea with underlying subchondral cyst formation. There is mild superficial degeneration of the articular cartilage of the medial facet of the patella. There is a 3 cm slightly heterogeneous lobulated lesion in the distal femoral metadiaphysis compatible with a benign enchondroma.LIGAMENTS: There is minimal edema along the tibial collateral ligament which otherwise appears intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1.Degeneration and undersurface tearing of the medial meniscus.2.Mild cartilage degeneration and other findings as described above.


Instruction: Generate impression based on findings.

Input: cT4N1M0 squamous cell carcinoma of the left maxillary sinus. There is a bulky heterogeneous and infiltrative mass centered in the left sinonasal region, completely obliterating the left maxillary sinus and much of the left nasal cavity and ethmoid sinuses, with extension into the inferior and medial extraconal orbit, abutting the left inferior rectus muscle and globe, and into the overlying left facial subcutaneous tissues with surrounding fat stranding and into the retromaxillary space. There is also compression of the left nasolacrimal duct, with dilatation of the lacrimal sac. Overall, the mass measures up to approximately 7 cm. There are secretions and mucosal thickening in the left frontal sinus and portions of the bilateral ethmoid sinuses. The left optic nerve is intact. The right orbit is unremarkable. There is a partly imaged prominent left level 1B lymph node. The salivary glands appear to be intact. There is no evidence of gross intracranial tumor. There is no evidence of acute cerebral infarction, hemorrhage, or ventriculomegaly. There is minimal nonspecific periventricular T2 hyperintensity.

Output: 1. A large, aggressive mass centered in the left sinonasal region with extension into the left extraconal orbit, the overlying left facial subcutaneous tissues, and the retromaxillary space is compatible with a squamous cell carcinoma. 2. Partly imaged prominent left level 1B lymph node. Please refer to the prior neck MRI for additional details.


Instruction: Generate impression based on findings.

Input: Clinical question: History of lung cancer with brain metastases status post RT. Evaluate recurrence/progression. Signs and symptoms: None Pre-and post-enhanced brain MRI: Negative diffusion weighted images.Examination demonstrates no evidence of residual enhancing metastatic lesions in the supra-or infratentorial brain parenchyma. There is also no detectable abnormal enhancement of the calvarial, soft tissues of the scalp or the orbits.Diffuse bilateral hemispheric white matter flair hyperintensity with suggestion of subtle interval progression since prior study and likely representing post treatment/radiation changes.The cortical sulci and ventricular system as well as the CSF spaces remain within normal and similar to prior exam.Signal void the major intracranial arterial branches are identified.The signal intensity of intracranial venous sinuses are beginning normal and a normal pattern of enhancement.Unremarkable calvarium, paranasal sinuses and mastoid air cells.

Output: 1.No evidence of residual detectable metastatic lesion.2.Slight progression of bilateral hemispheric white matter flair hyperintensity likely treatment related since prior exam.3.Unremarkable pre-and post enhanced brain MRI otherwise there


Instruction: Generate impression based on findings.

Input: Dysarthria and anarthria [R47.1], Reason for Study: ^Reason: stroke? History: ataxia, unsteady gait No evidence of acute ischemic or hemorrhagic lesion.There are multifocal lacunar infarcts involving bilateral thalami, bilateral basal ganglia and bilateral periventricular white matter.Underlying brain also shows patchy high signal intensity lesions on FLAIR imaging especially on deep white matter and periventricular white matter indicating nonspecific small vessel ischemic disease.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. The distal left ICA shows high signal intensity rim within the arterial lumen indicating arterial wall thickening. The paranasal sinuses and mastoid air cells are clear.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.Multifocal lacunar infarctions and non specific small vessel ischemic disease.2. Left distal ICA wall thickening was appreciated but the degree of stenosis cannot evaluated based on this scan.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: Cause of facial numbness and dizziness. Signs and symptoms: Facial numbness and dizziness. Nonenhanced brain MRI:No acute intracranial process and negative diffusion weighted series.Examination demonstrates multiple small foci of FLAIR hyperintensity in the subcortical and periventricular white matter of bilateral cerebral hemispheres and including the right external capsule. The largest lesion is in the right periventricular white matter at the level of trigone of right lateral ventricle. Measuring approximately 10 x 7 mm in transaxial dimensions and containing a tiny focus of chronic hemorrhage. Although the findings are nonspecific and this appearance is often result of microvascular ischemic changes. The signal intensity of the brain is otherwise within normal on all MRI sequences. The sacral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination is unremarkable.The signal void of major intracranial arterial branches are identified and unremarkable. The signal intensity of intracranial venous sinuses remains within normal.Calvarium, soft tissues of the scalp, orbits and mastoid air cells are unremarkable. Mild bilateral ethmoid chronic sinus disease and unremarkable paranasal sinuses otherwise.

Output: 1.No acute intracranial process and negative diffusion weighted images.2.Multiple small foci of FLAIR hyperintensity in the subcortical and periventricular white matter of cerebral hemispheres with one lesion demonstrating minimal chronic hemorrhagic changes as detailed. Findings are concerning for chronic small vessel ischemic strokes. Correlate with history and risk factors and consider follow-up with an enhanced imaging to exclude other white matter lesions if clinically deemed pertinent.3.Unremarkable nonenhanced brain MRI otherwise.


Instruction: Generate impression based on findings.

Input: History of prostate cancer on active surveillance. 3 +3 disease in the left base, and left mid lateral on biopsy dated 8/25/2015. PELVIS:PROSTATE:Prostate Size: 2.2 x 4.5 x 4.0 cmPeripheral Zone: Punctate approximately 3 mm focus of T2 weighted hyperintensity with associated restricted diffusion (series 601/14 and series 704/284) in the left lateral mid-gland/apex. No additional dominant lesion.Central Gland: Changes of BPH.Seminal Vesicles: No evidence of seminal vesicle invasion.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: No significant abnormality noted.

Output: 3 mm focus in the left lateral mid gland/apex is non-specific. No additional dominant lesion. No evidence of extraprostatic extension or pelvic lymphadenopathy


Instruction: Generate impression based on findings.

Input: 45-year-old with leiomyosarcoma presenting with liver failure and decreasing mental status. Assess for cerebral edema. There is no evidence of intracranial hemorrhage or midline shift. A hyperintense focus near the terminus of the right internal carotid artery is worrisome for an aneurysm or metastasis (image 11/34, series 2). Given the patient's history of metastatic malignancy, an MRI/MRA with contrast is recommended for further evaluation and characterization. An additional questionable hyperintense focus is noted more posteriorly (image 22/34, series 2).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: Hyperintense right cerebral lesion. An MRI/MRA with contrast is recommended for further evaluation.


Instruction: Generate impression based on findings.

Input: Male 29 years old with right knee pain. Evaluate for meniscal tear or ligamentous injury, history of dancing on knees. MENISCI: There is blunting of the posterior horn of the lateral meniscus. The medial meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is thinning and fraying of the articular cartilage along the medial patellar facet without full-thickness cartilage defect. The articular cartilage in the medial and lateral compartments is preserved. There are small lateral compartment osteophytes.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1.Blunting of the posterior horn of the lateral meniscus.2.Mild chondromalacia in the patellofemoral compartment.3.Edema within Hoffa's fat pad.4.Moderate joint effusion.


Instruction: Generate impression based on findings.

Input: Grade III astrocytoma status post RT/TMZ and 12 cycles of TMZ. Currently off all treatment. A curvilinear area of T2 hyperintensity within the left paramedian precentral gyrus has increased in size compared to the previous exam where it now measures 6 x 13 mm (series 11, image 6), compared to 2 x 6 mm previously.A new predominantly ring-enhancing lesion is visualized within the middle left temporal gyrus which measures 16 x 13 mm (series 11, image 20). This lesion was not distinctly visualized previously.The T2 hyperintense lesion within the left thalamus shows no significant interval change in size or morphology over multiple prior examinations. A biopsy marker remains evident in the center of the lesion. The lesion demonstrates intrinsic T1 hyperintensity with little if any true superimposed enhancement.A subcentimeter enhancing focus along the margin of the left occipital horn may be slightly larger in size compared to the previous exam.Ill-defined periventricular white matter T2 hyperintensity along the left lateral ventricle is stable when compared to the immediate prior examination, but shows slight expansion in geographic extent when compared to older exams. Some of this signal abnormality was evident on the patient's initial pretreatment studies.Numerous additional scattered small foci of T2 signal abnormality are seen throughout both cerebral hemispheres, without significant or convincing interval change. No new mass effect or parenchymal edema is detected. Ventricles are stable in size including mild ex vacuo dilatation of the left lateral ventricle.

Output: 1.Interval increase in size of the left paramedian precentral gyrus enhancing lesion and possible increase in size of the lesion adjacent to the left occipital horn compared to the previous exam, suspicious for growing tumor.2.Interval development of a new left middle temporal gyrus ring-enhancing lesion, suspicious for new tumor that was not discretely seen previously.3.Stable appearance of the treated lesion involving the left thalamus.4.Ill-defined left periventricular white matter T2 hyperintensity is stable relative to the previous two examinations.


Instruction: Generate impression based on findings.

Input: 25 year old with history of ewings sarcoma with pulmonary metastases status post radiation, requires earlier breast cancer screening with breast MRI in conjunction with mammogram. There is scattered fibroglandular tissue in both breasts.Minimal parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.High T2 signal lesion in segment 3 of left lobe of liver is unchanged from prior MRI liver dated 10/6/14 and compatible with a simple cyst.

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


Instruction: Generate impression based on findings.

Input: HCC screening. Budd-Chiari syndrome and cirrhosis. Follow-up nonspecific lesion. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology, without appreciable ascites. The previously seen enhancing focus within the caudate lobe is again identified, unchanged at 1.0 x 1.0 cm (series 10, image 45). No definite washout is seen. The previously seen punctate focus of arterial enhancement in the caudate lobe (series 10, image 48), is also seen and again without washout.The left and middle hepatic veins are diminutive though patent, similar to prior. The right hepatic vein is again not well seen.Cholelithiasis without cholecystitis.SPLEEN: Splenomegaly with Gamna-Gandy bodies.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1. Cirrhotic liver morphology compatible with Budd-Chiari syndrome. 2. Arterially enhancing lesions in the caudate lobe, without washout, likely representing regenerative nodules. These lesions do not meet criteria for hepatocellular carcinoma.


Instruction: Generate impression based on findings.

Input: Reason: status of ruptured achilles tendon History: swelling with pain. TENDONS: Approximately 4.1 cm from the insertion, there is a near complete rupture of the distal Achilles tendon with approximately 4.6 cm of retraction. A few posterior fibers are intact. Surrounding edema.The remainder of the tendons are intact.LIGAMENTS: No significant abnormality noted.ARTICULAR SURFACES AND BONE: Bone marrow edema and osteophyte formation along the articulation between the navicular and cuboid compatible with degenerative etiology. Slightly irregularly marginated small foci of T2 hyperintense, T1 hypointense signal intensity in the distal tibia likely represent small enchondromas. ADDITIONAL

Output: Near complete Achilles tendon rupture.


Instruction: Generate impression based on findings.

Input: Diagnosis: Malignant neoplasm of upper lobe, left bronchus or lungClinical question: R arm tremor and shaking; concern for recurrent lung cancer The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.T2 and FLAIR hyperintense foci are present in the thalami and internal capsules bilaterally as well as in the brainstem.Punctate foci of susceptibility are present in the right thalamus and to a lesser degree left thalamusNo 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: 1.Periventricular and subcortical white matter lesions of a moderate degree are nonspecific. At this age they are most likely vascular related. 2.Multiple lesions in the brainstem, internal capsule and thalami are most likely vascular related.3.Several microhemorrhages are present in the right thalamus and to lesser degree left thalamus4.There is no evidence for brain metastases appreciated.


Instruction: Generate impression based on findings.

Input: Reason: 59M with history of low volume Gl6 prostate cancer, starting active surveillance History: as above. Limited examination due to artifact from left hip arthroplasty device on the DWI/ADC.PELVIS:PROSTATE:Prostate Size: 4.8 x 6.1 x 6.1 cm.Peripheral Zone: In the right posterior mid gland, there is a 0.6 x 1.1 cm focus of T2 hypointense signal, restricted diffusion and early enhancement, suspicious for tumor (series 801 image 12, series 704 image 224).Central Gland: Heterogeneous.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Possible small tumor within the right posterior mid gland peripheral zone.


Instruction: Generate impression based on findings.

Input: 53-year-old female with history of multiple sclerosis, evaluate for progression. There are unchanged mild scattered foci of T2 hyperintensity in the bilateral subcortical and periventricular cerebral white matter. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Unchanged mild scattered cerebral white matter lesions, which are nonspecific.


Instruction: Generate impression based on findings.

Input: Reason: evaluate rotator cuff History: left shoulder ROTATOR CUFF: There is thickening of the supraspinatus tendon without increased fluid signal within the tendon, suggestive of tendinopathy.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: No significant abnormality noted.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: Thickening of the supraspinatus tendon is compatible with tendinopathy, but no frank tear is evident.


Instruction: Generate impression based on findings.

Input: A 55 year old male with history of hypertension and a past hospitalization in Ghana due to cardiac reasons (no other details known). Now hospitalized because of a clinical picture of non-ST elevation myocardial infarction, the cardiac catheterization showed extensive coronary artery disease. Now referred to cardiac MRI to evaluate function, viability and suspected apical thrombus. Left VentricleThe left ventricle is normal in size with severe systolic dysfunction. There is asymmetric hypertrophy of the interventricular septum which suggests the diagnosis of underlying hypertrophic cardiomyopathy (septum 17mm, posterior wall 11mm). No systolic anterior movement of the mitral leaflet or LVOT flow acceleration was noted. The overall LV ejection fraction is 30%, the LV end diastolic volume index is 103 ml/m2 (normal range: 74+/-15), the LVEDV is 226 ml (normal range 142+/-34), the LV end systolic volume index is 72 ml/m2 (normal range 25+/-9), the LVESV is 159 ml (normal range 47+/-19), the LV mass index is 90 g/m2 (normal range 85+/-15), and the LV mass is 198 g (normal range 164+/-36). There are 2 distinct wall motion abnormalities noted. The first is smaller and involves the basal inferior hypokinesis. This segment is associated with a slight increase in T2-signal, has preserved wall thickness, and a transmural myocardial infarction (i.e. late gadolinium enhancement) Suggesting this might be secondary to the patient's recent non-ST elevation myocardial infarction. This segment has indeterminate viability. The second wall motion abnormality is much larger (mid anterior wall and apical anterior, septum, and inferior walls) and is associated with thinned myocardium and a large transmural myocardial infarction (i.e. late gadolinium enhancement). These segments are not likely to be viable. There is no other late gadolinium enhancement present and the remainder of the myocardium is viable. A large apical thrombus is present. No iron overload was noted.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 50%, the RV end diastolic volume index is 64 ml/m2 (normal range 82+/-16), the RVEDV is 141 ml (normal range 142+/-31), the RV end systolic volume index is 32 ml/m2 (normal range 31+/-9), and the RVESV is 71 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is 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 normal brachiocephalic branching pattern. The aortic root is mildly dilated (ascending aorta 40mm).Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with severe systolic dysfunction, LVEF is 30%. There is asymmetric hypertrophy of the interventricular septum suggesting the diagnosis of hypertrophic cardiomyopathy. Additionally, there are 2 distinct myocardial infarctions as described below.2. There is extensive transmural late gadolinium enhancement involving most of the apex and the mid anterior wall. This late gadolinium enhancement is associated with myocardial thinning and is due to an older myocardial infarction. This territory is not viable. 3. There is a second small transmural myocardial infarction involving the basal inferior wall. The myocardial infarction is within myocardium of preserved wall thickness and has evidence of increased T2-signal suggesting that it occurred more recently. The viability in this territory is indeterminate at this stage.4. No other myocardial infarctions are noted and the remainder of the myocardium is viable. 5. A large LV apical thrombus is present. 6. The right ventricle is normal in size and systolic function, RVEF is 50%.


Instruction: Generate impression based on findings.

Input: Right knee pain, questioning iliotibial band syndrome or patellofemoral stress syndrome MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: There is abnormal marrow edema within the patella with areas of near full-thickness to full-thickness articular cartilage loss particularly affecting the medial facet. The articular cartilage of the medial and tibial compartments is relatively preserved.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Articular cartilage loss affecting the undersurface of the patella with areas of near full-thickness to full-thickness loss affecting the medial patellar facet associated with likely reactive marrow edema within the patella. The remaining knee otherwise appears normal.


Instruction: Generate impression based on findings.

Input: Low back pain. There is a 15 mm thick disc central extrusion at L4-5 that result in severe spinal canal stenosis with compression of the cauda equina nerve roots, but no significant neural foramen stenosis. There is also a 9 mm thick eccentric right disc extrusion at L3-4 with effacement of the right lateral recess with compression of the adjacent nerve roots, but no significant neural foramen stenosis. There is no significant spinal canal stenosis at the other levels of the lumbar spine. The vertebral column alignment is within normal limits. The vertebral body are preserved. The vertebral bone marrow signal is unremarkable. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: 1. A central extrusion at L4-5 results in severe spinal canal stenosis with compression of the cauda equina nerve roots.2. An eccentric right disc extrusion at L3-4 results in effacement of the right lateral recess with compression of the adjacent nerve roots.


Instruction: Generate impression based on findings.

Input: 59 year old man with history atrial fibrillation and hemachromatosis, referred for cardiac MRI for further evaluation of possible underlying cardiomyopathy and myocardial iron overload. Left VentricleThe left ventricle is normal in size with hyperdynamic systolic function. The overall LV ejection fraction is 75%, the LV end diastolic volume index is 101 ml/m2 (normal range: 74+/-15), the LVEDV is 218 ml (normal range 142+/-34), the LV end systolic volume index is 24 ml/m2 (normal range 25+/-9), the LVESV is 52 ml (normal range 47+/-19). There is mild concentric LVH. There are no regional wall motion abnormalities present. There is a small amount of patchy late gadolinium enhancement in the basal infero- lateral wall which may suggest the presence of an underlying fibrosing or prior infiltrative/inflammatory process. Based on T2 Star imaging, there is no evidence of myocardial iron overload. Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 70%, the RV end diastolic volume index is 92 ml/m2 (normal range 82+/-16), the RVEDV is 199 ml (normal range 142+/-31), the RV end systolic volume index is 28 ml/m2 (normal range 31+/-9), and the RVESV is 61 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is 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 normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac Findings This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with hyperdynamic systolic function. The overall LV ejection fraction is 75%.2. There is no evidence of myocardial iron overload.3. There is a small amount of patchy late gadolinium enhancement in the basal infero- lateral wall which may suggest the presence of an underlying fibrosing or prior infiltrative/inflammatory process.4. The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 70%.


Instruction: Generate impression based on findings.

Input: 60-year-old female with hyperglycemia and noninsulin-dependent diabetes mellitus, pancreatic body neuroendocrine tumor less than 2 cm. Patient needs repeat imaging in 3 months to evaluate any change in the lesion. ABDOMEN:LIVER, BILIARY TRACT: Mild fissural prominence suggesting chronic liver disease. The no focal lesion or biliary ductal dilatation.SPLEEN: Status post splenectomy.PANCREAS: Subtle T2 hyperintense focus of the proximal pancreatic body (axial series 7 image 34). Focal enhancement is noted on the postcontrast subtraction series (axial series 102 image 66) Similar appearing prominent peripancreatic and periportal lymph nodes. No pancreatic ductal dilatation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Stable nonspecific right cardiophrenic lymph node. Prominent right periportal lymph node adjacent to the caudate lobe measuring 1.9 x 1 cm (axial series 5 image 25) is again noted. Other prominent periportal lymph nodes are also unchanged (axial series 7 images 24, 31, 34).BOWEL, MESENTERY: Small hiatal hernia.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Subtle T2 hyperintense focus of the proximal pancreatic body with corresponding focal enhancement on the postcontrast subtraction series. This hyperintense focus corresponds to the location of a subtle enhancing lesion seen in retrospect on the 5/2/2016 CT exam (CT series 804 image 51).


Instruction: Generate impression based on findings.

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

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


Instruction: Generate impression based on findings.

Input: Female, 61 years old, with sensory changes. No evidence of restricted diffusion is seen. No areas of significant parenchymal signal abnormality, edema or mass effect are detected. There are no findings to suggest intracranial hemorrhage or any abnormal extra-axial fluid collections. The ventricles are normal in size and morphology.

Output: Unremarkable evaluation with no specific findings to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Clinical question: 69-year-old female with back/trunk pain and intermittent incontinence. Signs and symptoms: As above. Pre and postcontrast enhanced thoracic MRI:Examination demonstrates normal signal intensity and the alignment of vertebral column.Examination demonstrates mild degenerative changes of disc and the posterior elements are present.There is no evidence of a spinal canal or neural foraminal compromise or stenosis at any level.There is normal signal intensity and caliber of the thoracic cord.There is no detectable abnormal enhancement of the vertebral column, cord or the meninges.No detectable. Spinal soft tissue abnormalities.Pre- and post enhanced lumbar MRI:There is normal anatomical alignment of vertebral column.T12-L1 is unremarkable.L1-L2 demonstrate mild degenerative changes and which shallow bulging disc however without spinal stenosis or neural foraminal compromise.L2-L3 demonstrate mild disc disease and loss of disc height, shallow broad-based bulging disc, moderate ligamentum flavum and mild facet hypertrophic changes. There is a tiny right perimedian disc protrusion with expected minimal enhancement.Constellation of changes results in moderate central spinal stenosis however without neural foraminal compromise.L3-L4 demonstrate moderate disc disease and loss of disc height, moderate ligamentum flavum and mild bilateral facet hypertrophic changes. Constellation of changes results in moderate central spinal stenosis without neural foraminal compromise.L4-L5 demonstrate moderate disc disease and loss of disc height, mild to moderate left ligamentum flavum hypertrophy and mild bilateral facet hypertrophic changes. There is evidence of a right-sided prior laminectomy with resultant expansion of thecal sac and no central spinal stenosis. There is a large right lateral disc osteophyte at this level which results in right lateral recess compromise however without neural foraminal compromise.L5-S1 demonstrates significant loss of disc height and suggestion of fusion of L5 and S1. There is evidence of prior laminectomy with resultant expansion of thecal sac and without spinal stenosis or neural foraminal compromise.Unremarkable post enhanced images.

Output: 1.Pre- and post enhanced thoracic MRI demonstrate mild degenerative changes without spinal stenosis or neural foraminal compromise. Normal signal intensity of the cord. No detectable abnormal enhancement.2.Pre- and post enhanced MRI of lumbar spine demonstrate degenerative changes at L2-L3 and L3-L4 levels with resultant moderate central spinal stenosis (worse at L2-L3) without neural foraminal compromise. Postoperative changes of laminectomy at L4-L5 and L5-S1 levels without evidence of central spinal stenosis. Right lateral disc-osteophyte complex at L4-L5 with resultant right lateral recess compromise.


Instruction: Generate impression based on findings.

Input: 62 year-old female with left cerebellar peduncle hemorrhage, follow-up.IMAGE ACQUISITION: Nonenhanced CT of the head Again identified is a hyperattenuating focus in the left posterior pons, which appears to not have significantly changed in size. However, there is subtle increased associated vasogenic edema, as evidenced per recent MRI.No hydrocephalus or midline shift.Postsurgical changes with left temporal occipital encephalomalacia, unchanged. Mild hypoattenuation in periventricular and subcortical white matter, most consistent with small vessel ischemic disease.Visualized paranasal sinuses and mastoid air cells are clear.

Output: Stable size of left posterior pontine hemorrhagic lesion.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 90 year-old male with CLL and splenomegaly. Abdominal aortic aneurysm measured 3.5 cm in January 2, 2008. Known pancreatic mass. Bilateral lower quadrant abdominal pain. This examination is limited by the absence of intravenous contrast. ABDOMEN: Lung Bases: Bibasilar dependent atelectatic changes and increased interstitial markings suggesting borderline congestive heart failure. Status post median sternotomy. Small bulla in the right lower lobe. Cardiomegaly. Liver, Biliary Tract: Hypodense lesions in the liver, two in the left lobe and one in the right lobe. Lack of IV contrast precludes further characterization. Ultrasound may be helpful for further evaluation. No evidence of biliary dilatation. Cholelithiasis is present without evidence of cholecystitis. Spleen: Spleen is enlarged measuring 14 cm. Kidneys, Ureters: Punctate stone in the upper pole of the right kidney. Multiple fluid attenuating lesions in both kidneys which cannot be further characterized without IV contrast. Mild caliectasis is present in the left kidney. Complex left renal cyst. Adrenal Glands: No significant abnormality noted Pancreas: 2.5 x 2.5 cm fluid attenuating lesion at the tail of the pancreas. Lack of IV contrast precludes further evaluation. This represents a cystic neoplasm or pseudocyst, unlikely a solid neoplasm. The MRI scan showed two irregular cystic lesions communicating with pancreatic duct, smaller one in the body and larger lobulated lesion in the tail of the pancreas. These most likely represents a branch type duct IPMT (intraductal papillary mucinous tumor). Chronic pancreatitis. Retroperitoneum, Lymph Nodes: Infrarenal abdominal aortic aneurysm measuring 3.2-cm in its largest AP dimension. Common iliac arteries are unremarkable other than atherosclerotic changes.Bowel, Mesentery: Multiple soft tissue masses are present in the small bowel mesentery largest measuring 2.1 x 2.2 cm on image number 77/142. The etiology of these masses is probably CLL. The masses are stable.Bones, Soft Tissues: No significant abnormality noted Other: No significant abnormality noted PELVIS: Prostate, Seminal Vesicles: No significant abnormality noted Bladder: No significant abnormality noted Lymph Nodes: No significant abnormality noted Bowel, Mesentery: Nonobstructive bowel containing right inguinal hernia at axial image 119/142.Bones, Soft Tissues: No significant abnormality noted Other: A trace of ascites are present.

Output: Multiple hypodense liver lesions. Hypodense mass involving the pancreatic duct and tail is stable. Multiple mesenteric soft tissue masses and splenomegaly. The appearance is consistent with known CLL. These findings are stable.


Instruction: Generate impression based on findings.

Input: Reason: Right knee pain evaluate for meniscus tear vs chondral injury History: Right knee pain MENISCI: There is linear increased signal abnormality within the posterior horn of the medial meniscus which extends to the tibial and femoral articular surfaces consistent with a small radial tear. There is increased signal abnormality within the anterior horn of the medial meniscus which extends to the tibial and femoral articular surfaces consistent with a longitudinal tear. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: The lateral tibiofemoral articular cartilage appears intact. There is near full-thickness to full-thickness articular cartilage degeneration along the weightbearing surface of the medial femoral condyle and medial tibial plateau about the body and anterior horn of the meniscus. There is underlying degenerative subchondral signal abnormality. There is near full-thickness to full-thickness articular cartilage degeneration along the medial facet of the patella which may represent a combination of chondroplasty, degeneration and microfracture. There is subchondral cyst formation and degenerative subchondral signal abnormality in the surrounding area. There is a small amount of low signal intensity within this defect which could conceivably represent a small amount of fibrocartilage formation related to the patient's history of microfracture. These findings appear similar to the prior study. There is a partial-thickness articular cartilage fissure along the median eminence and lateral facet of the patella.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Tearing of the medial meniscus as described.2. Osteoarthritis of the right knee with near full-thickness to full-thickness articular cartilage degeneration and articular cartilage clefts as described above.3. Focal near full-thickness to full-thickness articular cartilage defect along the medial facet of the patella may represent a combination of prior chondroplasty, degeneration, and microfracture, which appears similar to the prior study.4. Patella alta.


Instruction: Generate impression based on findings.

Input: Known left breast ADH underwent a recent MRI that showed areas of non-Mass enhancement in the left upper outer quadrant with sonographic correlate. Left ultrasound re-identified the target lesion for biopsy. The lesion to be targeted is a hypoechoic area measuring 28 x 10 mm at the 1 o’clock position with increased vascularity, 1 cm from the nipple. The lesion was readily visible.PROCEDURE: The procedure and its risks, including bleeding, infection, and failure to diagnose, and expected benefits of ultrasound-guided core biopsy with percutaneous placement of a marking clip and post-procedure unilateral mammogram were discussed with the patient. Questions were answered. Consent was obtained both verbally and in writing. The time-out form was completed to confirm patient identity and side/type of procedure.The left breast was cleansed with chlorhexidine over the target area. Transducer was sterilely sheathed. Local anesthesia was obtained using 2% lidocaine superficially, with 1% lidocaine with 1:100,000 epinephrine at depth. A 3 mm incision was made in the skin with a #11 scalpel blade. Using aseptic technique, continuous ultrasound guidance and a inferolateral to superomedial approach, eight 12-gauge core needle (Suros) specimens were obtained of the lesion. Targeting was judged very good. Specimens were radiographed with digital magnification technique. 5 cores showed calcifications, segregated into 10% formalin container #1, and labeled "left breast with calcifications." The remaining core specimens were placed into formalin container #2, "left breast without calcifications." They were sent to pathology for histologic evaluation with an accompanying history sheet.Specimens were sent to Pathology with an accompanying history sheet. Using continuous ultrasound-guidance a Hydromark clip was placed into the lesion in the usual manner. Pressure was held over the biopsy site until all bleeding subsided. The skin incision was closed with a Steri-Strip. Post-procedure digital left CC and ML views revealed the percutaneously placed clip to be in the expected location at 1 o'clock position, 17 mm medial from the previous biopsy clip. No evidence of hematoma or other complication.Right unilateral mammogram CC and ML views were performed to locate the percutaneously placed clip from MRI guided biopsy which had been performed earlier. The clip is placed at 12 o'clock position with no evidence of any complications due to the procedure.A pressure dressing was positioned over the biopsy site and an ice pack positioned over the pressure dressing. Post-procedure instructions were reviewed with the patient both verbally and in writing. She tolerated the procedure well with no evident complications and left the Breast Imaging Department in stable condition.The procedure was performed by Dr. Abe.

Output: Successful ultrasound-guided core biopsy of the left breast lesion and clip placement. Pathology is pending at this time.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: 61 years, Female, obsessive-compulsive disorder. Examination for intraoperative guidance. There are postoperative changes of bilateral frontal lead placement for laser ablation, with the fiber tips at the level of the anterior limbs of the internal capsule bilaterally. Prior sites of ablation are noted with intrinsic T1 hyperintensity involving the white matter adjacent to the frontal horns. There is enhancement at the levels of the anterior limbs of the internal capsule as well as slightly more cranially compatible with sites of ablation. Corresponding areas of restricted diffusion are also noted. Expected postsurgical changes also include small amount of pneumocephalus. No large intracranial hemorrhage or significant mass effect is appreciated. No hydrocephalus.

Output: Expected postsurgical changes of repeat bilateral laser ablation of the anterior limbs of the internal capsules with areas of enhancement and restricted diffusion.


Instruction: Generate impression based on findings.

Input: Atypical meningioma status post surgery: surveillance. There are postoperative findings related to right transfrontal resection of a planum sphenoidale meningioma. There is a plaque-like areas of heterogeneous enhancement along the posterior right planum sphenoidale, which measures approximately 25 mm in diameter and 5 mm in thickness. There is a persistent focus of enhancement along the right frontal lobe resection cavity posteromedial margin. A more linear focus of enhancement laterally along the resection cavity margin is likely vascular in nature. There is unchanged diffuse confluent T2 hyperintensity in the right frontal lobe surrounding the resection cavity, as well as to a smaller extent in the left anterior left frontal lobe periventricular white matter. There is no evidence of acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable.

Output: Postoperative findings related to right transfrontal resection of a planum sphenoidale meningioma without significant change in what may represent a small amounts of residual tumor along the right planum sphenoidale associated with hyperostosis and along the right frontal lobe resection cavity posteromedial margin.


Instruction: Generate impression based on findings.

Input: 43-year-old female with right proximal hamstring pain. ACETABULAR LABRUM: A small collection of fluid signal intensity along the posterosuperior acetabular margin appears to arise from an underlying posterosuperior labral tear extending from the 11 to 9 o'clock position. Furthermore, there is deformity and increased signal intensity involving the anterosuperior labrum extending from the one to two o'clock position that likely represents additional labral tearing.ARTICULAR CARTILAGE AND BONE: Mild heterogeneous signal of the articular cartilage along the superior aspect of the joint suggests mild degeneration. However, no discrete fluid filled defects are identified. No CAM deformity seen. Slight prominence of the anterosuperior aspect of the acetabulum is suggestive of mild cranial acetabular retroversion. No bone marrow abnormality in the acetabulum or proximal femur.SOFT TISSUES: Slight enlargement and increased signal intensity of the conjoined tendon of the proximal right hamstring at its ischial origin suggests mild tendinosis. Additionally, a small focus of abnormal signal intensity in the underlying bone with mild surrounding edema is likely reactive in etiology. No frank hamstring tear identified. The remaining visualized musculature appears normal.ADDITIONAL

Output: 1.Mild tendinosis at the right hamstring origin with mild associated signal abnormality of the underlying ischium. These findings are of questionable clinical significance and there is no frank hamstring tear.2.Anterior/posterior superior labral tearing and other findings as described above.


Instruction: Generate impression based on findings.

Input: 52 years Male (DOB:12/17/1963)Reason: lung cancer on oral chemotherapy, evaluate response, compare to previous History: n/aPROVIDER/ATTENDING NAME: JYOTI D PATEL JYOTI D PATEL There is an enhancing mass measuring 11 x 16 mm located in the medial right temporal lobe which previously measured 9 x 7 mm axial dimensions. There is a left occipital lobe mass measuring 8 mm in diameter which previously measured 4 mm in diameter. There is a punctate right basal ganglia which is also present on the prior exam and is unchanged. There is a 6 mm lesion in the left frontal lobe within the posterior aspect of the left middle frontal gyrus which previously measured 4 mm. There is a 4 mm enhancing lesion in the left cerebellar hemisphere previously measuring the same. There is a 2 mm enhancing focus along the splenium of the corpus callosum which previously was barely visible. There is a 6 mm left temporal lobe lesion previously measured the same.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: Since the prior exam, many of the patient's metastatic lesions have progressed in size as detailed above.


Instruction: Generate impression based on findings.

Input: Alignment is anatomic. Multilevel heterogeneous marrow signal may be related to chronic renal disease. Additionally, there are multiple large Schmorl nodes. No findings to suggest acute cord compression.Multilevel cervical spondylosis with multilevel mild to moderate central spinal canal stenosis. There is questionable signal changes in the cervical spinal cord at C5/6 level which may be degenerative in etiology versus artifact.Increased STIR signal within L3/L4 disk space may be reactive inflammatory changes and underlying discitis is a concern. There is additionally a compression deformity of the inferior endplate of L3. There is disc bulge with possible annular tear resulting in severe central spinal canal stenosis at L3/4. No pre-vertebral soft tissue or epidural collections. Additional multilevel lumbar spondylosis noted. There is no evidence of traumatic subluxation. The conus is normal in signal and morphology and terminates at an appropriate level. The visualized paraspinal contents are unremarkable.

Output: 1.No findings to suggest acute cord compression.2.Increased STIR signal within L3/L4 disk space may be reactive inflammatory in etiology and underlying diskitis is a concern. Severe central spinal canal stenosis at L3/4, likely from degenerative changes. Dedicated lumbar spine MRI examination is recommended.3.Multilevel cervical spondylosis as above with questionable signal changes within the cervical spine which may be secondary to degenerative changes. Dedicated cervical spine MRI examination is recommended.Findings relayed to Dr. Carter over phone in the Emergency Department at 0940 hours.


Instruction: Generate impression based on findings.

Input: 11-year-old female with history of ankle pain. History of right ankle injury/brain 3 months ago with continued pain and swelling. TENDONS: The flexor and extensor tendons of the ankle are within normal limits.LIGAMENTS: No significant abnormality.ARTICULAR SURFACES AND BONE: The articular cartilage is within normal limits. Bone marrow signal intensity is normal for patient's age. Patchy areas of high signal intensity in T2 and low density in T1 are likely related to bone marrow transformation. Possibility of mild bone edema in certain areas cannot be excluded.ADDITIONAL

Output: No fracture or other significant abnormality to explain the patient's pain. Small amount of joint fluid.


Instruction: Generate impression based on findings.

Input: Female, 57 years old. Reason: ?hydrocephalus History: headache There is redemonstration of a right cerebellar mass with surrounding vasogenic edema and compression of the fourth ventricle. There is stable ventriculomegaly of the lateral ventricles. Slight herniation of the right cerebellar tonsil into the foramen magnum is again noted. No areas of hemorrhage are identified.The calvaria and skull base are radiographically normal. Skull lesion seen on recent bone scan is not visualized on this study. There is opacification of the mastoid air cells bilaterally, left greater than right.

Output: Right cerebellar mass with associated vasogenic edema and compression of the fourth ventricle and crowding of the foramen magnum is not significantly changed since the prior examination.


Instruction: Generate impression based on findings.

Input: Female, 57 years old, with grade 2 oligoastrocytoma, status post surgery and RT in 2009. The left paracentral lobule resection cavity is unchanged in size and morphology. Curvilinear vascular enhancement within the cavity is unchanged. No new or concerning enhancement is seen. The degree of surrounding T2 hyperintensity is also unchanged.No new intracranial lesions are seen. A right superior cerebellar developmental venous anomaly is redemonstrated. No edema or mass effect is detected. One or two scattered foci of nonspecific T2 hyperintensity are unchanged. Ventricular size and morphology are stable.

Output: Evidence of prior surgery and treatment is redemonstrated with no findings to suggest recurrent tumor.


Instruction: Generate impression based on findings.

Input: 57 years Male (DOB:5/2/1959)Reason: mets lung cancer, brain mets, s/p RT, on MET inhibitor and Erlotinb, pls c/w previous study to evaluate tx response. pls provide bi-dimensional measurement to all lesions per RECIST 1.1 History: mets lung cancerPROVIDER/ATTENDING NAME: JYOTI D PATEL JYOTI D PATEL There is evidence of left frontal craniotomy with hemosiderin deposition on the left frontal lobe with a focal tissue loss indicating postoperative status.There is no MR evidence of acute ischemic or hemorrhagic lesion. There is no abnormal enhancement.Patch bilateral periventricular white matter FLAIR/T2 high signal intensity lesions are seen, unchanged in terms of extent and configuration since prior scan.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 orbits are intact.Opacifications on bilateral mastoid air cells are seen, unchanged since prior scan.

Output: 1.Post left frontal craniotomy weight metastatic tumor removal status, unchanged.2.No evidence of abnormal enhancement.3.No evidence of acute ischemic or hemorrhagic lesion.


Instruction: Generate impression based on findings.

Input: Personality change. Rule out ICH. Significant atherosclerotic calcifications are noted in the internal carotid arteries and vertebral arteries. Extensive low-attenuation in the right MCA distribution with significant volume loss and ex vacuo dilatation of the right lateral ventricle is consistent with a chronic right MCA infarct. If there is clinical concern for acute ischemia, an MRI with diffusion-weighted images is recommended for further evaluation. No acute intracranial hemorrhage is identified. No evidence of midline shift. The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Chronic right MCA infarct. If there is clinical concern for acute ischemia, an MRI with diffusion-weighted images is recommended for further evaluation.


Instruction: Generate impression based on findings.

Input: Male, 1 day old, born at 31 weeks gestational age, with neck lesion concerning for venous/lymphatic malformation. A large multiloculated, multispatial, predominantly cystic lesion is redemonstrated within the right neck. The largest cystic components of this lesion are centered at the level of the parotid, parapharyngeal and masticator spaces with extension from the skin surface deep to the level of the pharyngeal mucosa. Components of the lesion infiltrate into the right-sided tonsillar and soft palate tissues, the floor of mouth and submental spaces, the submandibular space, and even into the larynx. The mandible and maxilla are both deformed by this lesion.The cystic components of the lesion are for the most part T2 hyperintense and T1/FLAIR hypointense which would indicate a fairly watery consistency. One smaller medial cystic component demonstrates incomplete suppression on FLAIR images which may imply proteinaceous fluid. The cystic components of the lesion do not enhance and show no accumulation of contrast material. The rim and internal septations show thin enhancement.A cleft palate is noted. Just posterior to the cleft, or perhaps within the cleft, is a lobular soft tissue lesion which demonstrates heterogeneous internal fatty tissue and relative T2 hypointensity. This lesion enhances fairly homogeneously. It is in contact with the adjacent cystic lesion and may therefore represent a solid component of the overall lesion or perhaps a separate lesion.The dominant cystic component of the lesion encroaches upon the right infratemporal fossa and actually indents the floor of the right middle cranial fossa. The lesion just barely contacts the undersurface of the right temporal lobe without significant mass effect and no findings to suggest brain parenchymal edema. The lesion also approaches and may infiltrate the right temporal bone.Otherwise, the brain parenchyma as visualized demonstrates normal morphology for gestational age. No areas of significant parenchymal signal abnormality are seen. There are no findings to suggest acute ischemic injury. No abnormal intracranial collections are seen. No findings to suggest intracranial hemorrhage are demonstrated. The ventricles are normal in size and morphology.The skin of the right neck, overlying the cystic lesion, and continuing into the right scalp, is mildly thickened. This is favored to represent edema rather than diffuse lesional involvement.

Output: Redemonstrated is a large, predominantly cystic lesion occupying multiple right neck spaces. The rim and internal septations of the lesion demonstrate thin enhancement.A relatively more solid lesion with heterogeneous internal fat and fairly homogeneous enhancement is seen at midline in the nasopharynx, just posterior to or within the cleft palate. This lesion abuts the cystic lesion and may be part of it, or may represent a second lesion.The predominantly cystic and widely infiltrative, transspatial characteristics of the lesion support the possibility of a lymphatic malformation. The solid enhancing nasopharyngeal lesion could represent a venous malformation rendering the overall lesion a combined veno-lymphatic malformation, or it could represent a separate, possibly vascular lesion such as a hemangioma. The possibility that the combined cystic and solid lesions represent a teratoma should also be considered but this is felt to be less likely.The lesion encroaches into the right middle cranial fossa, but there is no significant mass effect upon the brain and no evidence of brain parenchymal invasion. Otherwise, assessment of the brain is within normal limits for gestational age. No findings are seen to suggest acute ischemic injury, though if clinical concern exists, a repeat examination in one week's time will increase sensitivity.


Instruction: Generate impression based on findings.

Input: Complex partial seizures. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma, including the hippocampi, appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No potential seizure foci are identified.


Instruction: Generate impression based on findings.

Input: Female 61 years old Reason: 61 yo with fam history pancreatic Ca History: high risk Pancreatic CA ABDOMEN:LIVER, BILIARY TRACT: Segment 7 lesion (11mm) is hyperintense on T2-weighted imaging and shows some peripheral nodular discontinuous enhancement and mostly likely represents a hemangioma. The hepatic and portal veins are patent.SPLEEN: No significant abnormality noted.PANCREAS: Pancreatic parenchyma is normal in signal. No focal pancreatic lesions. Pancreatic duct is normal in caliber.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No focal pancreatic lesion as clinically questioned.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for disk disease. Signs and symptoms: Pain. Nonenhanced lumbar MRI:There is normal anatomic alignment the vertebral column.There is unremarkable 6 months in situ column.T2 -- L1 is unremarkable.L1 -- L2 is unremarkable.L2 -- L3 is unremarkable.L3 -- L4 demonstrate mild disk desiccation and mild bilateral ligamentum flavum hypertrophy. No spinal stenosis or neural foraminal compromise.L4 -- L5 demonstrate mild disk desiccation and moderate bilateral ligamentum flavum hypertrophy and mild facet disease. No spinal stenosis or neural foraminal compromise.L5 -- S1 demonstrate mild disk disease and loss of disk height, moderate bilateral ligamentum flavum hypertrophy and mild facet (left greater than right) degenerative disease and hypertrophy. There is a central and left lateral disk protrusion with resultant left lateral recess compromise and without spinal stenosis or neural foraminal compromise.

Output: 1.A central and leftward disk protrusion at L5 -- S1 results in left lateral recess compromise without spinal stenosis or neural foraminal compromise.2.Mild degenerative changes at other levels without spinal stenosis or neural foraminal compromise as detailed per level above.


Instruction: Generate impression based on findings.

Input: Knee pain and effusion Tendons and ligaments: The anterior cruciate ligament and the posterior cruciate ligaments are intact.The medial collateral ligament is intact. The lateral collateral ligament, the biceps femoris tendon, the popliteus tendon and the iliotibial band are intact. The quadriceps tendon and the patellar tendon are intact.Menisci: There is maceration of the medial meniscus body and posterior horn. There is mild anterior extrusion of the anterior horn of the medial meniscus. There is an obliquely oriented tear of the posterior horn of the lateral meniscus.Joints:There is extensive cartilage loss of the medial femoral condyle with a small amount of reactive marrow edema along the posterior aspect. Similar although less severe cartilage loss is also identified in the lateral compartment. Again noted are apparent erosions of the medial cortex of the femur.The patellofemoral articulation is intact and without evidence of subluxation and articular cartilage defect.Joint effusion and soft tissues: There is a trace amount of joint fluid with thickened enhancing synovium. Additionally, a small focus of signal void is seen in the anterior joint space which demonstrates some associated artifact. A mild amount of subcutaneous edema is present.Osseous structures: No focal marrow replacing lesions are identified. There is no fracture.

Output: 1. Diffuse synovitis with apparent erosions of the medial joint space. Additionally, there is extensive cartilage loss particularly of the medial compartment with a mild amount of reactive marrow change in the posterior aspect of the medial femoral condyle. These findings are again nonspecific and may be inflammatory in nature however the possibility of infection cannot be excluded.2. Maceration of the posterior horn of the medial meniscus with oblique tear of the posterior horn of the lateral meniscus.3. Small focus of signal abnormality within the joint may represent either a small focus of gas or small metallic artifact possibly from instrumentation of the knee such as scope or aspiration


Instruction: Generate impression based on findings.

Input: History of meningioma resection. Surgical changes of the calvarium related to meningioma resection including frontal craniectomy with presence surgical changes in the nasal cavity and anterior cranial fossa skull base. Redemonstrated pockets of pneumocephalus deep to the craniectomy site along with extra-axial density tracking along the skull base which likely represents reconstruction material. Packing material is noted within the nasal cavity along with bilateral nasal tubing. Slight interval increased/fluid within the sphenoid sinuses and maxillary sinuses. Redemonstrated into the clivus which is remodeled and absence of the osseous floor of the sella. Redemonstrated volume loss and encephalomalacia of the frontal lobes as seen on prior MRI. No evidence of acute territorial ischemia within the brain. There is no evidence of intra-axial hemorrhage or cerebral edema. The ventricles are stable in size and midline. The basal cisterns are patent. Mastoid air cells are clear. Mucosal thickening and fluid is also noted in the maxillary sinuses. The orbits are unremarkable. Diffuse scalp swelling.

Output: Stable postsurgical changes related to meningioma resection. Slight increased amount of fluid in the maxillary and sphenoid sinuses. Stable pneumocephalus without evidence of acute intraparenchymal process.


Instruction: Generate impression based on findings.

Input: Male; 75 years old. Reason: obstruction? History: s/p RFA with increasing bili and LFTs ABDOMEN:LIVER, BILIARY TRACT: Interval posttreatment changes from thermal ablation of segment 8 HCC with new wedge-shaped area of non-enhancement spanning segments 8/5 and measuring up to 8.5 x 7.6 cm in greatest axial dimension (series 1101/3495). Increased T2 signal within this area, most likely due to post treatment edema. New mild perihepatic ascites. New mild intrahepatic biliary ductal dilation in the right and left hepatic lobes with poor visualization of the confluence of the right and left main hepatic ducts near Klatskin's point, which may be due to the posttreatment edema which extends to this location (series 301/22). Normal extrahepatic common duct is seen.Portal and hepatic veins are patent. Hepatic artery is patent.Cirrhotic liver morphology. No evidence of residual or recurrent segment 8 HCC. Previously described segment 2 and 3 arterially hyperenhancing lesions on prior CT are not appreciated on postcontrast sequences on the current MRI. No focal lesions which meet the criteria for HCC. Cholelithiasis.SPLEEN: Stable splenomegaly and perigastric varices.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: T2 hyperintense right adrenal lesion, stable in size and again likely the sequela prior of hemorrhage.KIDNEYS, URETERS: Small left inferior pole renal cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Posttreatment changes from recent thermal ablation of segment 8 HCC, as detailed above. No evidence of residual or recurrent disease.2. New intrahepatic biliary ductal dilation, which may be due to posttreatment change/edema extending to Klatskin's point. Continued follow up is suggested.


Instruction: Generate impression based on findings.

Input: Male, 64 years old, with upper extremity weakness. Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. No evidence of marrow edema or pathologic marrow enhancement is seen. The visualized spinal cord shows normal signal intensity and is likewise free of pathologic enhancement.C2-3: Facet arthropathy . No significant spinal canal stenosis or neuroforaminal narrowing. C3-4: Facet arthropathy . Mild posterior disc-osteophyte complex formation. No spinal canal stenosis. Mild bilateral foraminal narrowing.C4-5: Facet arthropathy . Posterior disc-osteophyte complex formation. Mild spinal canal narrowing. Moderate left and mild right foraminal narrowing.C5-6: Facet arthropathy . Minimal posterior disc-osteophyte complex formation. No spinal canal stenosis. Moderate left and mild right foraminal narrowing.C6-7: Facet arthropathy . Posterior disc-osteophyte complex formation. No spinal canal stenosis. Moderate bilateral foraminal narrowing.C7-T1: Unremarkable.

Output: Degeneration of the disks and facet joints is seen, resulting in at most mild spinal canal stenosis at C4-5 and mild to moderate scattered foraminal narrowing. No evidence of an inflammatory process is seen.


Instruction: Generate impression based on findings.

Input: Metastatic thyroid Ca, on therapy, eval for dz, compare to previous with measurements. Thoracic: Stable appearance of the enhancing lesion in the T5 vertebral body, measuring 15 x 9 mm in the sagittal plane, unchanged. Enhancing and slightly expansile lesions in the left transverse process and pars interarticularis of T5 and T6 appear similar to prior. Again seen are postsurgical changes at T10-T12 related to left lateral fusion and partial corpectomy of T11. There is persistent diffuse abnormal marrow signal in the T11 vertebral body. Kyphotic angulation of the thoracic spine is seen centered at T11. Abnormal fatty marrow replacement in the lower thoracic spine appears similar to prior, likely secondary to post radiation changes. No definite new lesions are identified and there is no epidural disease.Lumbar: Stable appearance of the enhancing lesions at L2, L3, and L5. The reference L5 lesion measures 18 x 16 mm in the axial plane, unchanged. Similar to the thoracic spine, there is abnormal fatty replacement of the vertebral bodies, compatible with previous radiation. No new lesions are identified and there is no epidural disease. Stable mild degenerative changes are again seen without significant spinal canal or foraminal stenosis.

Output: 1.No significant change in the appearance of multiple osseous metastatic lesions involving the thoracolumbar spine.2.No new lesions are identified.3.No evidence of epidural disease or significant spinal canal or neural foraminal narrowing.


Instruction: Generate impression based on findings.

Input: 24 year old female with RUQ pain and elevated lipase. Assess for pancreatitis and liver inflammation. ABDOMEN:LUNG BASES: Mild bibasilar atelectasis. LIVER, BILIARY TRACT: Mild hepatomegaly. No intrahepatic biliary ductal dilatation. No focal lesions within the liver. Gallbladder is markedly distended with multiple gallstones. No gallbladder wall thickening. No stent identified within the common bile duct. The patient underwent ERCP with balloon angioplasty of a CHD biliary duct stenosis and removal of CBD stent on 12/21/2011. SPLEEN: Moderate splenomegaly. Solid, heterogeneous mixed signal intensity mass arising in the spleen, measures 6.6 x 5.4 cm appears stable since the most recent MRI exam.PANCREAS: Pancreatic duct is not dilated. No definite findings of acute pancreatitis. 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.PELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Hepatosplenomegaly. CBD stent is not seen. No definite evidence of pancreatitis. Stable solitary splenic lesion. Cholelithiasis without evidence of cholecystitis.


Instruction: Generate impression based on findings.

Input: Male, 53 years old, with metastatic thyroid cancer, follow-up exam. Thoracic: An enhancing lesion within the left aspect of the T5 vertebral body measures approximately 15 x 9 mm and not significantly changed. Lesions within the left transverse process and pars interarticularis of T5 and T6 are also unchanged.Left lateral fusion of T10-T12 is again seen with partial corpectomy at T11 and placement of a strut graft. The residual T11 vertebral body continues to show diffuse abnormal marrow signal without significant change. Kyphotic angulation of the thoracic spine is seen centered at T11.No new lesions are seen. No significant epidural disease is seen. No significant spinal canal stenosis is seen.Fatty marrow replacement in the lower thoracic spine likely represents postradiation change. Failure of fat suppression is also seen in the lower thoracic spine on postcontrast fat-suppressed images.Lumbar: Enhancing lesions on the right at L2, on the left at L3, and on the left at L5 show no significant interval change. For reference, the L5 lesion continues to measure 18 x 16 mm.The background marrow remains fatty replaced compatible with prior radiation. No new lesions are seen. No significant epidural disease extension is detected. The spinal canal remains patent.Mild degenerative changes are again seen without significant spinal canal or foraminal stenosis.

Output: 1. No significant change in multiple osseous metastatic lesions involving the thoracic and lumbar spine. No new lesions. 2. No evidence of epidural disease or spinal canal or neural foraminal narrowing.