Instruction: Generate impression based on findings.

Input: Female 73 years old; pancreatitis , mild chronic peptic duodenitis, cholecystectomy. ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. T2 hyperintense foci may represent cysts but incompletely characterized without contrast. No intra or extra hepatobiliary ductal dilatation. Status post cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: Pancreatic duct is dilated measuring up to 10 mm. There is abrupt termination of the duct near the head of the pancreas due to a slightly T2 hyperintense mass measuring 1.4 x 2.0 cm. There are multiple cystic foci throughout the pancreas that communicate with the pancreatic duct. A larger cystic lesion located in the tail measures 2.1 x 1.8cm and is rounded. The pancreatic parenchyma is atrophic.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is focal masslike thickening of the mesenteric wall of the duodenum with a mass measuring 4.6 x 2.1 cm with infiltration of the mesenteric border with soft tissue spiculations. There are small scattered mesenteric lymph nodes in the vicinity. No T2 hyperintense fluid is evident to indicate acute inflammation. The duodenal mass appears separate from the pancreatic process.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Pancreatic duct stricture likely due to a soft tissue mass (see above) in the pancreatic head causing ductal dilatation with cystic foci. The stricture may be malignant and would be best evaluated on a contrast-enhanced MRI/MRCP. Most of the cystic foci are suggestive of either IPMN's or dilated side branches in the setting of duct obstruction. The cystic focus in the tail is indeterminate and may represent an old pseudocyst or cystic neoplasm as it has a rounded configuration.2.Soft tissue mass in the distal duodenum with extension into the mesenteric border suspicious for an underlying malignancy such as a duodenal adenocarcinoma, lymphoma. Repeat biopsy of the area can be considered as the imaging findings are discordant with pathology results.


Instruction: Generate impression based on findings.

Input: Redemonstrated are multiple foci of susceptibility abnormality throughout both infratentorial and supratentorial brain, including at the cervicomedullary junction, with imaging features consistent with cavernous malformations. The largest of these is centered in the right thalamus measuring 16 mm AP x 15 mm transverse x 12 mm craniocaudal. There is no associated mass effect or perilesional edema. There is no evidence of abnormal 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: Redemonstration of multiple cerebral cavernous malformations throughout the supratentorial and infratentorial brain, including at the cervicomedullary junction, without significant interval change.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 48-year-old male. The provided clinical data on the consultation form is illegible. Patient's previous consultation form from CT dated 7 -- 16 -- 08 is reviewed which indicates history of sphenoid sinus cancer status post treatment chemo/RT. Images through the skull base demonstrates extensive surgery at the level of the sphenoid sinus, right ethmoid air cells and nasal cavity. Minimal residual soft tissue densities within this surgical cavity may represent mucosal thickening. There is no evidence of any abnormal enhancement. The cavernous sinuses on this exam appear normal however this should be further evaluated if clinical concern exists with an MRI examination. The bony periphery of the area of surgery remains intact. Extensive chronic sinus disease of the maxillary sinuses is noted.All of the above findings have remained stable since prior study from 7 -- 16 -- 2008.Images through the soft tissues of the neck demonstrates stable left posterior triangle lymph node without enhancement which measures approximately 10.7 mm x 6 .8 millimeter identical to the prior study.No evidence of a mass or pathologic adenopathy is detected. Few additional left cervical nonenhancing non-pathologic lymph nodes are again identified also with no interval change.Limited images of the apices of the lungs are negative for metastatic lesions. No definitive mediastinal lymphadenopathy is detected. Both of these areas would be better evaluated with dedicated CT of chest. Please review report of the CT performed the same date. Bony density of area of exam is negative for metastatic lesions.CT of brain with infusion.No evidence of intracranial metastatic lesion to the brain or the leptomeninges. Extensive postsurgical changes of the sphenoid sinus would residual mucoperiosteal thickening.

Output: 1.Stable post therapy changes of the head and neck with no interval change and no evidence of recurrence of disease.2.Unremarkable CT of brain.


Instruction: Generate impression based on findings.

Input: Leg twitching. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma, including the basal ganglia, appears unremarkable. The pituitary gland appears to be intact. 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.Cervical Spine: The spinal cord displays normal signal and morphology. There is no abnormal intraspinal enhancement. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal or neural foramen stenosis. The paravertebral soft tissues are unremarkable.

Output: 1. No evidence of acute intracranial hemorrhage, mass, or infarction. In particular, the basal ganglia appear to be unremarkable.2. No evidence of cervical spinal cord lesions.


Instruction: Generate impression based on findings.

Input: There are 5 lumbar type vertebral bodies. The alignment of the lumbar spine is anatomic. The vertebral body heights are preserved. There is no evidence of acute fracture or subluxation. The bone marrow signal is unremarkable, including a small probable hemangioma in the L3 vertebral body. There is multilevel lower lumbar degenerative spondylosis. In particular, there is interval worsening L5-S1 disc disease at L5-S1, now with a disc extrusion that is slightly eccentric to the right and impinges upon the caudal equina nerve roots, particularly in the right lateral recess. There is also an unchanged right L3-4 lateral recess disc protrusion that contacts the exiting nerve roots and results in mild right neural foraminal stenosis. The spinal canal is congenitally slender. The conus is normal in signal and morphology and terminates at T12-L1. The visualized intra-abdominal and paraspinal contents are unremarkable.

Output: 1.Worsening L5-S1 disc disease at L5-S1, now with a disc extrusion that impinges upon the caudal equina nerve roots. 2.Unchanged L3-4 right lateral recess disc extrusion, which encroaches upon the exiting L3 nerve root.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Following a discussion of the procedure with the patient and/or family, including its risks, benefits, alternatives and steps to prevent infection, informed written consent was obtained and documented in the patient's chart. The time-out form was completed to confirm patient identity and side/type of procedure. All operators present for the case performed standard preprocedural prep including hand washing, sterile gloves, mask and cap. The patient was prepped and draped in the usual aseptic fashion. Local anesthesia over the target area was obtained by 1% lidocaine. Targeted CT examination demonstrated a focal soft tissue mass within the lateral head of the gastrocnemius corresponding to the findings seen on recent MRI examination. Using CT guidance, an 18-gauge Achieve core biopsy needle was advanced into the lesion. Touch preparations were handed to cytopathology to confirm specimen adequacy. Two 18-gauge core needle biopsy specimens were obtained and placed in formalin.The core biopsy specimens were hand carried to the Surgical Pathology labThe patient tolerated the procedure well without immediate complication. Routine post procedure instructions were communicated to the patient.ESTIMATED BLOOD LOSS: Less than 5cc. An adhesive bandage was placed on the patient’s skin.

Output: CT guided biopsy of a lateral head of the right gastrocnemius muscle mass.


Instruction: Generate impression based on findings.

Input: History of prostate cancer. No pathology results available. PELVIS:PROSTATE:Prostate Size: 3.2 x 4.3 x 3.8 cmPeripheral Zone: Right mid-gland medial 7 x 6 mm angulated lesion with decreased T2-weighted signal intensity (series 801/image 18), restricted diffusion (series 604/344) and arterial enhancement (series 1901/2252) is suspicious for prostatic adenocarcinoma.Central Gland: Left anterior apex 1.2 x 0.9 cm lesion with decreased T2 weighted signal intensity (series 801/14), restricted diffusion ( series 604/264) and arterial enhancement (series 1901/1613) is suspicious for prostatic adenocarcinoma. Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: No evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No enlarged pelvic lymphadenopathy.BONES, SOFT TISSUES: Fat-containing right inguinal hernia.OTHER: No significant abnormality noted.

Output: 1.2 cm left anterior apex and 7 mm right mid gland lesions are suspicious for prostatic adenocarcinoma without evidence of extraprostatic extension or pelvic lymphadenopathy.


Instruction: Generate impression based on findings.

Input: 28 years Female (DOB:11/6/1987)Reason: spastic gait, numbness in hands and feet History: as abovePROVIDER/ATTENDING NAME: HELENE G. RUBEIZ HELENE G. RUBEIZ The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin.

Output: No abnormal lesions are appreciated intracranially to explain the patient's spastic gait and hand numbness.


Instruction: Generate impression based on findings.

Input: There are postoperative findings related to T2-L1 posterior spinal fusion with residual mild scoliosis with a leftward apex at T2-T3 and a rightward apex at T8-T9. There is a slightly heterogeneous T1 and T2 hyperintense posterior epidural fluid collection extending from C4 through T1 that measures up to 1 mm in thickness, previously 4 mm, with mild residual spinal canal stenosis mainly secondary to reversed lordosis and mild disc-osteophyte complexes superimposed on a congenitally narrow spinal canal. The associated abnormal T2 hyperintensity within the cervical spinal cord has progressed and now involves the entire circumference of the cord extending from the C4-C5 level to the C6-C7 level. Artifact from the patient's spinal hardware limits thoracic evaluation. There are grossly unchanged scattered thoracic epidural blood products without spinal cord compression. The vertebral body and disc space heights are preserved. There is mild paranasal sinus mucosal thickening and minimal fluid within the mastoid air cells. There is T2 hyperintensity within the left lung base and a small right pleural effusion.

Output: 1.Progression of cervical spinal cord t2 hyperintensity centered at C5-C6; the adjacent epidural hematoma has redistributed and no longer results in significant spinal canal or cord compression. 2.Scattered additional epidural blood products throughout the thoracic spinal canal without cord compression. 3.Worsened right pleural effusion and unchanged left lower lobe atelectasis or pneumonia.


Instruction: Generate impression based on findings.

Input: Knee pain, check for meniscal tear MENISCI: Lateral meniscus is well visualized and normal. The medial meniscus however demonstrates a discrete oblique complex tear through the body extending into the posterior horn and extending to the inferior articular surface. A small flipped fragment towards the midline cannot entirely be excluded (image 11 series 4).ARTICULAR CARTILAGE AND BONE: Heterogeneous signal is observed in the patellar cartilage without focal discrete defect, changes greater along the lateral facet. Medial and lateral compartments are intact. Bone marrow signal is uniform and unremarkableLIGAMENTS: Abnormal increased signal is observed in the distal ACL at the tibial spine attachment. Fibers appear intact, however appearance suggests moderate tendinosis. Additional moderate diffuse thickening of the MCL is identified with out tube appearing signal abnormality; presumably old scarring. The remaining ligaments are otherwise intact and well visualized. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Complex medial meniscal tear involving the body extending into the posterior horn as described. 2. Moderate ACL tendinosis and old suspected scarring of the MCL.


Instruction: Generate impression based on findings.

Input: Male, 65 years old, with cervical and lumbar degenerative disease, now with bilateral lower extremity weakness. Cervical:Image quality is reduced by motion artifact. Within this limitation, the following observations are made.Alignment is anatomic. Vertebral body heights are preserved. No pathologic marrow replacement or edema is demonstrated. The visualized spinal cord shows grossly normal signal throughout. No epidural abnormalities are suspected.C2-3: No significant spinal canal foraminal stenosis. C3-4: Facet arthropathy. Posterior disc-osteophyte complex formation asymmetric to the left. Moderate spinal canal stenosis with mild cord deformation. Moderate to severe bilateral foraminal narrowing. No interval changes.C4-5: Facet arthropathy on the left. Posterior disc-osteophyte complex formation asymmetric to the left. Moderate generalized spinal canal stenosis with mild cord deformation. Severe left and moderate to severe right foraminal narrowing. No interval changes. C5-6: Facet arthropathy. Posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Moderate to severe bilateral foraminal narrowing. No interval changes. C6-7: Mild central posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Mild bilateral foraminal narrowing. No interval changes.C7-T1: Mild posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Mild left foraminal narrowing. No interval changes.Lumbar:Apart from mild straightening of the lumbar lordosis, spinal alignment is anatomic and unremarkable. Vertebral body heights are observed. There is a transitional morphology of the L5 vertebral body. No areas of pathologic marrow replacement or edema are demonstrated. The distal spinal cord, conus, and nerve roots of the cauda equina are unremarkable. No epidural abnormalities are suspected.L1-2: Mild facet arthropathy. No significant spinal canal or foraminal stenosis. No interval changes. L2-3: Mild facet arthropathy. Bulging disc with a small superimposed right paracentral protrusion. Mild spinal canal stenosis, particularly of the right lateral recess. Moderate right and mild left foraminal narrowing. No interval changes. L3-4: Mild facet arthropathy. Ligamentum flavum thickening. Disc bulging. Mild generalized spinal canal stenosis. Mild bilateral foraminal narrowing. No interval changes. L4-5: Mild facet arthropathy. Mild bulging disc. Mild spinal canal narrowing. Moderate bilateral foraminal narrowing. No interval changes. L5-S1: Facet arthropathy, right side was the left. Bulging disc with a small right paracentral protrusion, increased in size from the prior exam. No significant spinal canal stenosis. Mild bilateral foraminal narrowing.

Output: 1.Multilevel degenerative disease in the cervical spine is grossly unchanged when compared to the prior study. This includes moderate spinal canal stenoses at C3-4 and C4-5 as well as scattered foraminal narrowing.2.Multilevel degenerative disease in the lumbar spine is also grossly stable with the exception of a small right paracentral protrusion at L5-S1 which has increased. Nevertheless, this does not cause a significant canal stenosis. Scattered foraminal narrowing is seen as above.


Instruction: Generate impression based on findings.

Input: 67 year-old female with abnormal lesion on prior MRI, follow-up Vertebral body heights are intact. Multilevel disk desiccation with disk space loss at L2-L3 and L3-L4, unchanged. Well-circumscribed 12-mm lesion in the left posterior lateral aspect of the L5 vertebral body is stable in size and hyperintense on T2, isointense on T1 and now has decreased STIR signal than the prior exam. Additional multilevel foci heterogeneous T1 signal, most prominent at L2 and L5, may represent small hemangiomas or focal fat. No destructive lesions are evident. Signal within the distal cord and conus is normal, terminating at L1. Minimal grade 1 anterolisthesis of L3 relative to L4.T12-L1: No spinal or neuroforaminal stenosis.L1-L2: No spinal or neuroforaminal stenosis.L2-L3: Mild diffuse disk bulge, unchanged. No spinal canal or neural foraminal stenosis.L3-L4: Mild diffuse disk bulge, unchanged. No spinal canal or neuroforaminal of stenosis.L4-L5: Mild diffuse disk bulge. No spinal or neural foramina canal stenosis. L5-S1: No spinal or neuroforamina stenosis.

Output: 1.Well-circumscribed lesion in the L5 vertebral body remains unchanged in size. Lesion may represent an atypical hemangioma but remains nonspecific. May consider additional longer term follow-up if clinically indicated. 2.Mild spondylosis as above.


Instruction: Generate impression based on findings.

Input: Clinical question: Response. Signs and symptoms: Right-sided weakness and aphasia. Unenhanced CT of brain:Examination demonstrates findings consistent with extensive small vessel disease and supratentorial brain parenchyma. Very subtle area of low attenuation of the cortex of the operculum of left temporal lobe and minimally within the insular cortex as was noted on prior MRI is identified. There is no definite interval change since prior exam. Calcification/possible clot of left MCA branch within the left sylvian fissure is again identified.There is no evidence of interval hemorrhage since prior exam. No definitive evidence of any new area of ischemic change.Ventricular system remains a stable cyst prior study.

Output: No definitive evidence of any new findings since prior study.


Instruction: Generate impression based on findings.

Input: Female, 28 years old, with headache. A 5 mm focus of T2 hyperintensity seen within the subcortical white matter of the right anterior temporal lobe (see image 20 series 6). There is no evidence of edema, mass effect or pathologic enhancement associated with this lesion.No other focal signal abnormally is seen. Brain morphology is within normal limits. No pathologic intracranial enhancement is observed. A small developmental venous anomaly is present in the left parietal lobe. No edema, mass effect or restricted diffusion is seen. There are no findings to suggest intracranial hemorrhage or any abnormal extra-axial fluid collections. Ventricular size and morphology are within normal limits.

Output: A 5 mm focus of signal abnormality is present in the subcortical white matter of the right anterior temporal lobe. There is no associated edema, mass effect or abnormal enhancement. This finding is nonspecific and probably incidental. The remainder of the brain is within normal limits.


Instruction: Generate impression based on findings.

Input: 24 years Female (DOB:12/14/1991)Reason: head trauma, r/o internal hemorrhage History: worsening headachePROVIDER/ATTENDING NAME: ADRIANNE V DADE ADRIANNE V DADE The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate minor mucosal thickening. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: MRI of the brain is within normal limits


Instruction: Generate impression based on findings.

Input: No diffusion-weighted abnormalities are identified to suggest acute ischemia. Encephalomalacia within the right temporal, occipital, and parietal lobes is compatible with a chronic infarct, present on prior CTs, but new from the prior MRI. An additional focus of encephalomalacia within the left occipital lobe is present on the most recent CT, but new from the prior MRI. Mild susceptibility artifact within these regions is compatible with chronic blood products. There is also minimal enhancement associated with the left occipital infarct. Moderate periventricular and subcortical T2 signal abnormality is compatible with chronic small vessel ischemic disease. Prominence of the ventricular system and cortical sulci is consistent with global parenchymal volume loss, similar to recent CTs. There is a partially empty sella. There are no extra-axial fluid collections. The paranasal sinuses and mastoid air cells are clear. There are bilateral lens implants.

Output: 1. Multifocal areas of encephalomalacia including the right temporal-occipital lobe as well as additional areas in the right parietal lobe and left occipital lobe consistent with chronic infarcts. No evidence of acute infarct or intracranial mass effect.2. Moderate chronic small vessel ischemic disease.3. Unchanged prominence of the ventricular system which is at least predominately related to parenchymal volume loss.


Instruction: Generate impression based on findings.

Input: Female, 72 years old, with left lower extremity swelling and distal lower extremity weakness. The L5 vertebral body demonstrates transitional morphology. Vertebral body heights are preserved and alignment is grossly anatomic. No pathologic marrow replacement, edema or enhancement is seen. An enhancing right paraspinal mass at T12 does not appear to have significantly changed in size. The visualized distal spinal cord and conus are within normal limits. A conjoined left L5-S1 nerve root is redemonstrated. No pathologic intrathecal enhancement is seen.L1-2: Facet arthropathy. Disc bulging. Mild generalized spinal canal stenosis. Mild bilateral foraminal narrowing. No interval changes. L2-3: Facet arthropathy. Disc bulging. Moderate generalized spinal canal stenosis. Mild bilateral foraminal narrowing. No interval changes. L3-4: Advanced facet arthropathy and ligamentum flavum thickening. Disc bulging. Moderate generalized spinal canal stenosis with some crowding of the cauda equina. Moderate bilateral foraminal narrowing. No interval changes. L4-5: Facet arthropathy. Bulging disc. No significant spinal canal stenosis. Moderate left and mild right foraminal narrowing. No interval changes. L5-S1: No significant spinal canal or foraminal stenosis. Conjoined left L5-S1 nerve root is seen. Mild ill-defined enhancement is seen within the paraspinal musculature of the lower back, right side more than left. No fluid collections are detected.

Output: 1.No change in the severity of multilevel disc and posterior element degeneration.2.A right paraspinal mass at T12 does not appear to have changed significantly.3.Mild inflammation is suspected in the paraspinal musculature of the lower back. This may be related to strain or prolonged recumbency.4.No new findings are seen which would account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis or mass. The spinal cord displays normal signal and morphology. There is no abnormal enhancement. The paravertebral soft tissues are unremarkable.

Output: No significant spinal canal stenosis, spinal cord compression, or demyelinating lesions.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Pilocytic astrocytoma post ablation follow up History: pilocytic astrocytoma post ablation follow up. There are postoperative findings related to laser ablation with interval decrease in size of a tectal plate mass that now measuring approximately 16 x 20 mm in cross-section, previously 21 x 21 mm. However, there is more diffuse enhancement centrally within the mass. There is no evidence of acute intracranial hemorrhage or acute infarct. The right cerebral convexity fluid collection has resolved. There is a right transfrontal ventricular catheter that terminates adjacent to the right caudate nucleus. There are also postoperative findings related to endoscopic third ventriculostomy, with an apparent jet of cerebrospinal fluid into the third ventricle. Nevertheless, the third and lateral ventricles remain enlarged. There is no midline shift or herniation. There is a left cerebellar hemisphere developmental venous anomaly. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues appear unchanged.

Output: 1. Postoperative findings related to laser ablation with interval decrease in size of a tectal pilocytic astrocytoma.2. Postoperative findings related to endoscopic third ventriculostomy, with an apparent jet of cerebrospinal fluid into the third ventricle. Nevertheless, the third and lateral ventricles remain enlarged. 3. The right transfrontal ventricular catheter terminates adjacent to the right caudate nucleus.


Instruction: Generate impression based on findings.

Input: Status post embolization and SRS intervention for dural AV fistula. 1 year follow-up. BRAIN MRI:Confluent and patchy periventricular frontoparietal white-matter T2-hyperintensity is not significant changed and probably reflects chronic microvascular ischemia. There is no abnormal brain diffusion restriction or susceptibility effect to indicate acute infarct or intracranial hemorrhage. There is no mass-effect, midline shift or brain herniation. The ventricles and the other CSF-containing spaces are normal in size.There is no gross orbital abnormality. There is minimal mucosal thickening in the ethmoid sinuses. The included paranasal sinuses are clear. Mastoid air cells are clear as well. Multiple heterogeneously T1-hyperintense, T2-hypointense scalp nodules are unchanged and may reflect inclusion cysts.CRANIAL MR ANGIOGRAPHY:The small arteries traveling along the left jugular bulb, which probably reflect jugular branches of the ascending pharyngeal artery, are unchanged. There are also small vessels along the left sigmoid sinus, which are not significantly changed. The occipital arteries are now more symmetric in size. Otherwise, the intracranial arteries remain unchanged without significant stenosis or aneurysm.

Output: 1.Findings suggest a small residual arteriovenous fistula involving the jugular branch of the ascending pharyngeal artery. This has not changed substantially since the July exam.2.Periventricular and subcortical white matter changes of a mild degree are nonspecific. They're stable compared to the prior exam.


Instruction: Generate impression based on findings.

Input: History of metastatic colon ca with brain metastases. Status post whole brain radiation treatment. Please evaluate response. There are changes related previous left posterior fossa craniotomy. There is new/increased nodular, mass-like contrast-enhancing tissue at the resection bed. This measures in the axial plane 3.2 cm x 1.3 cm. Also, the dominantly infratentorial ring-enhancing brain lesions have progressed since the previous examination. For example, the oval shaped, 12 mm lesion just anterior to the surgical bed in the inferolateral aspect of the left cerebellar hemisphere now measures 16 mm. The more posterior medially located lesion along the inferior aspect of the left cerebellar hemisphere now measures 12 mm compared to 7 mm previously. An additional one involving the right cerebellar tonsil now measures 8 mm compared to 5 mm previously. Also, a ring-enhancing lesion involving the left thalamus now measures 10 mm compared to 4 mm previously. A new 4 mm contrast-enhancing cortically-based nodule has developed along the right middle frontal gyrus. The lesions are relatively small and are associated with relatively mild surrounding T2 hyperintensity/edema. This results in no midline shift or mass effect.T2/T2 FLAIR lesions without contrast enhancement involving the frontoparietal white matter have not changed significantly since April 7, 2015. These may represent chronic microvascular ischemia. The ventricles and the other CSF-containing spaces are enlarged reflecting volume loss.There is a 1 cm soft tissue nodule along the tail of the right parotid gland just superficial to the right masseter muscle. This is incompletely imaged but is most likely a soft-tissue metastasis as it was not present previously. The mastoid air cells are clear. There is minimal ethmoidal mucosal thickening without associated fluid. The other paranasal sinuses are clear. Orbits are normal. Besides the left retrosigmoid craniotomy defect, there not is a small contrast enhancing nodule involving the right parietal calvarium (best seen on image #9 of series #10) which was not present previously and suspected to represent osseous metastasis. Additionally, there is a contrast enhancing lesion along the superior medial right orbital wall. However, this was present on the previous examination of April 2015. This may represent an additional focus of osseous metastasis.

Output: 1.Compared to 4/14/2015, there is evidence of progression of intracranial metastatic disease. Multiple ring-enhancing lesions in the cerebellum and left thalamus have increased in size and number since April 2015. There are also new nodular enhancing lesions involving the left cerebellar resection bed. There is also a new right frontal lobe lesion. There is mild associated edema. No significant mass effect or herniation.2.Small right parietal calvarial enhancing lesion is suspected to represent an osseous metastasis and not well seen previously. An unchanged enhancing lesion is also seen along the right superior medial orbital wall which is nonspecific but may also represent an osseous metastasis.3.New nodule involving the right parotid tail also suspected to represent metastasis.


Instruction: Generate impression based on findings.

Input: Reason: ro meniscal/ligament injury History: continued pain, swelling since fall in May MENISCI: The posterior horn of the medial meniscus is abnormally small, highly suspicious for a tear. However no fragment is identified within the joint.ARTICULAR CARTILAGE AND BONE: The trochlear groove is abnormally shallow, consistent with trochlear dysplasia.There is bone marrow edema involving the lateral femoral condyle. The articular cartilage is within normal limits.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1.Shallow trochlear groove consistent with trochlear dysplasia.2.Abnormally small posterior horn of the medial meniscus, likely secondary to meniscal tear.3.Bone marrow edema involving the lateral femoral condyle.4.Moderate joint effusion.


Instruction: Generate impression based on findings.

Input: This preoperative planning MRI redemonstrates mild volume loss within the right hippocampus. There is bilateral maxillary sinus mucosal thickening and bilateral choroid plexus cysts. There is no evidence of enhancing mass. There are no areas of abnormal parenchymal signal. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact.

Output: Preoperative planning MRI redemonstrates mild right hippocampal volume loss.


Instruction: Generate impression based on findings.

Input: Female, 67 years old, with ALL and altered mental status. Dense hemosiderin staining within the right occipital lobe is redemonstrated compatible with a prior parenchymal hemorrhage. Since the prior MRI, numerous additional foci of susceptibility have developed compatible with small hemorrhages in both cerebral hemispheres but particularly posteriorly and in the parietal and occipital regions. Sulcal hemosiderin staining is also seen in the left frontal and right parietal lobes. Several of these foci are T1 hyperintense indicating a subacute time course, and several correlate with the suspected petechial blood on recent prior CT.No evidence of restricted diffusion is seen. Extensive ill-defined white matter FLAIR hyperintensity is seen bilaterally in the cerebral hemispheres and in the thalami with scattered foci also noted in the brainstem and cerebellum. These findings have progressed compared to the prior examination. Nevertheless, no significant generalized mass effect is seen and the ventricles remain stable and normal in size. On postcontrast imaging, a curvilinear focus of enhancement along the prior right occipital hemorrhage is seen. Sulcal vascularity is prominent in the posterior cerebral hemispheres. However no clear evidence of any additional discretely enhancing lesions are seen. Mild mucosal inflammation is seen in the ethmoid air cells.

Output: Multiple small foci of parenchymal and sulcal hemorrhage are identified, most of which are new when compared to the prior MRI, and several of which are likely subacute based on signal characteristics. A chronic right occipital hematoma shows no significant change apart from the possible development of some adjacent granulation tissue. These progressive small hemorrhages could reflect underlying thrombocytopenia/coagulopathy, treatment related vascular injury, or amyloid angiopathy. Certain intracranial infections including fungal etiologies can also present with multiple intracranial hemorrhages. Finally, intravascular leukemic aggregates could potentially induce leukostasis and vascular rupture resulting in small parenchymal hemorrhages.Since the prior MRI, there has also been a substantial increase in parenchymal signal abnormality unrelated to the hemorrhages and involving the cerebral white matter, thalamus, brainstem and cerebellum. This may be treatment related as well though the possibility of an atypical infection should be considered.


Instruction: Generate impression based on findings.

Input: Evaluation of cardiac function prior to chemotherapy Left VentricleThe left ventricle has mildly reduced function. The overall LV ejection fraction is 51%, the LV end diastolic volume index is 99 ml/m2 (normal range: 74+/-15), the LVEDV is 205 ml (normal range 142+/-34), the LV end systolic volume index is 43 ml/m2 (normal range 25+/-9), the LVESV is 89 ml (normal range 47+/-19). There is hypokinesis of the mid-distal inferior wall. There is [no ]LV thrombus. Extrinsic flattening of the diaphragmatic surface of the LV.Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is dilated and hypocontractile. The overall RV ejection fraction is 36%, the RV end diastolic volume index is 126 ml/m2 (normal range 82+/-16), the RVEDV is 198 ml (normal range 142+/-31), the RV end systolic volume index is 55 ml/m2 (normal range 31+/-9), and the RVESV is 86 ml (normal range 54+/-17).Right AtriumThe right atrium is moderately dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is 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. Mildly reduced LV EF with inferior hypokinesis2. Moderately RV systolic dysfunction with RV enlargement.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Male, 16 years old, with von Hippel-Lindau and spinal cord lesions on MRI. A 2 mm focus of enhancement is seen along the dorsal aspect of the spinal cord at the T7-8 level. This lesion does not appear to have changed significantly when compared to the examination of 11/24/15. There may also be a punctate focus of enhancement along the left dorsal cord at the T1 level, though this could be artifactual and was not evident on the prior examination.A prior examination is not available for the lumbar spine. However, no pathologic enhancement is seen along the conus or cauda equina. No epidural abnormalities are suspected anywhere along the thoracolumbar spine.Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits allowing for scattered Schmorl's node deformities. No evidence of pathologic marrow replacement, edema or enhancement is seen. No significant compromise of the spinal canal or neural foramina is demonstrated.

Output: 1.A small focus of enhancement along the dorsal cord at the T7-8 level is unchanged and likely represents a small hemangioblastoma.2.A questionable focus of enhancement along the left dorsal cord at the T1 level is seen which could be artifactual or which could represent an additional small hemangioblastoma. This lesion was not identified on the prior examination, though differences in technique may account for this.3.No lesions suspicious for hemangioblastoma are seen in the lumbar region.


Instruction: Generate impression based on findings.

Input: The last well formed disk space is referred to as L5-S1, consistent with prior exam. There is new minimal 2-mm anterolisthesis of L4 on L5, and stable 2-mm retrolisthesis of L5 on S1. The vertebral body heights are preserved. There are scattered foci of high T1 signal intensity in the vertebral bodies likely representing foci of fatty deposition versus hemangiomas. There is disk desiccation at multiple levels and lumbar spine resulting in moderate loss of disk height at L4-5, and severe loss of disk height at L5-S1 with type II degenerative endplate changes at L5-S1 again seen. The conus terminates at T12-L1.T12-L1: No disk herniation or spinal stenosis.L1-2: No disk herniation or spinal stenosis.L2-3: No disk herniation or spinal stenosis. Mild bilateral facet arthropathy and minimal left far lateral disk bulge.L3-4: Mild disk bulge and left far lateral annular tear, facet arthropathy and ligamenta flava thickening with prominent posterior epidural fat without significant spinal canal or neural foraminal stenosis.L4-5: New 2-mm anterolisthesis of L4 on L5 with uncovering of the disk, worsening loss of disk height with new vacuum disk. Severe worsened bilateral facet arthropathy with facet effusions. Ligamenta flava thickening. Mild spinal canal stenosis with moderate bilateral subarticular zone stenosis. Moderate left and mild right neural foraminal stenosis.L5-S1: Mild disk bulge and facet arthropathy without significant spinal stenosis.

Output: 1.New 2-mm degenerative anterolisthesis of L4 on L5 secondary to worsening facet arthropathy with facet joint effusions. Mildly worsened disk height loss with new vacuum disk at L4-5. No significant change in mild spinal canal stenosis with moderate bilateral subarticular zone stenosis, and moderate marked left and mild right neural foraminal stenosis at L4-5.2.Degenerative changes elsewhere are stable.


Instruction: Generate impression based on findings.

Input: Pain. Follow-up DJD left hip. Two views of the left hip are provided. There is narrowing of the left hip joint with near bone-on-bone apposition superomedially, as well as subchondral cyst formation and small femoral head osteophytes. These findings indicate moderate to severe osteoarthritis. Lack of joint fluid on the MRI examination from earlier today argues against an acute inflammatory process.Two views of the right hip are provided. There is coxa profunda, which is not necessarily of any clinical significance. The right hip is otherwise unremarkable.The AP view the pelvis shows the aforementioned arthritic changes on the left. The remainder of the pelvis is unremarkable.

Output: Osteoarthritis of the left hip as described above.


Instruction: Generate impression based on findings.

Input: History of nonfunctioning pituitary macroadenoma, please evaluate for interval change. There is a homogeneously enhancing mass within an expanded sella that measures 16 AP x 15 RL x 14 SI mm, which is not significantly changed. There is no significant encroachment upon the cavernous sinuses and there is no mass effect upon the optic apparatus; however, the tumor or expanded sella extends into the sphenoid sinuses. The pituitary stalk is intact and situated in the midline. However, the posterior pituitary bright spot is not evident. The imaged portions of the brain are unchanged. The imaged portions of the sinonasal cavities are grossly unremarkable.

Output: No significant interval change in the sella mass, which likely represents a macroadenoma.


Instruction: Generate impression based on findings.

Input: Female, 10 years old, with neurofibromatosis type I, headache and vision changes, assess for any change in the right facial plexiform neurofibroma and for any new tumors. Redemonstrated is a large infiltrative homogeneously enhancing plexiform neurofibroma involving the soft tissues of the right head and face. As before, the lesion involves or infiltrates the right temporalis muscle with extension along the muscle into the infratemporal fossa, as well as the subcutaneous tissues of the right frontotemporal and periorbital scalp. There has been no significant interval change in the size or geographic extent of this lesion.Although the plexiform neurofibroma abuts the lateral wall of the right orbit, no intraorbital extension is seen. Globes are round and symmetric. The extraocular muscles demonstrate normal signal characteristics and pattern of enhancement. The optic nerves, tracts and chiasm are within normal limits and show no evidence of any tumoral involvement. No intraconal abnormalities are detected.Scattered ill-defined areas of FLAIR hyperintensity are redemonstrated involving the thalami and to lesser extent the globus pallidi, brainstem and cerebellar peduncles. No new intracranial lesions are seen. No pathologic parenchymal enhancement is detected. There are no abnormal extra-axial fluid collections. The ventricles are normal in size and morphology.Ill-defined enhancement is seen within the paramedian and left suboccipital soft tissues of the upper neck. This is nonspecific and unchanged.

Output: 1.Stable plexiform neurofibroma involving the right face and scalp.2.Stable appearance of scattered foci of NF-related abnormal signal intensity within the brain.3.No evidence of optic pathway tumor.


Instruction: Generate impression based on findings.

Input: 62-year-old female with history of biliary stent tube is presenting with abdominal pain and questionable pancreatic mass on outside hospital imaging. Lack of intravenous contrast limits sensitivity for solid organ pathology.ABDOMEN:LIVER, BILIARY TRACT: No suspicious hepatic lesions are evident. Mild to moderate intrahepatic biliary ductal dilation with extensive hepatolithiasis and choledocholithiasis. The common bile duct is distended with calculi and measures up to 2.4 cm. SPLEEN: No significant abnormality noted.PANCREAS: No focal pancreatic lesions evident. No pancreatic ductal dilation.ADRENAL GLANDS: Stable adenomatous hyperplasia of the adrenal glands.KIDNEYS, URETERS: Subcentimeter T2 hyperintense renal lesions are too small to characterize but likely due to 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: Biliary tree dilation with extensive hepatolithiasis and choledocholithiasis. Findings are more suggestive of a stricture at the level of the distal common bile duct or impaction from the extensive biliary lithiasis, rather than an obstructing mass. However, evaluation for a mass is limited due to the lack of intravenous contrast.


Instruction: Generate impression based on findings.

Input: 69-year-old female with increasing leg pain with standing which is better when sitting. Evaluate for progression of lumbar spinal stenosis. There are five lumbar type vertebral bodies present. There is grade 1 retrolisthesis of L2 on L3 which is new from the prior MRI and unchanged grade 1 anterolisthesis of L4 on L5 and grade 1 retrolisthesis of L5 on S1. There are multiple Schmorl's nodes including the the T11 vertebral body which is new since May 2015. The vertebral body heights are well-maintained. Edema is noted within the intervertebral disks at multiple levels and is likely degenerative in etiology. No suspicious marrow signal abnormality is appreciated. The conus medullaris terminates at T12-L1.L1-L2: Loss of disc height and mild diffuse disc bulge as well as bilateral facet hypertrophy and ligamentum flavum thickening with mild left neural foraminal stenosis. No significant right neural foraminal or spinal canal stenosis.L2-L3: Degenerative disc disease with loss of disc height and mild diffuse disc bulge asymmetric to the right resulting in partial effacement of the right lateral recess and moderate right neural foraminal stenosis. There is bilateral facet hypertrophy, ligamentum flavum thickening and prominent epidural fat resulting in mild spinal canal stenosis. No significant left neural foraminal stenosis. L3-L4: Degenerative disc disease, bilateral facet hypertrophy and ligamentum flavum thickening. No significant neural foraminal or spinal canal stenosis.L4-5: Degenerative disc disease, bilateral facet hypertrophy and ligamentum flavum thickening with mild to moderate right neural foraminal narrowing and mild central spinal stenosis. No left neural foraminal narrowing.L5-S1: Degenerative disc disease with loss of disc height, advanced bilateral facet hypertrophy and ligamentum flavum thickening. There is mild bilateral neural foraminal stenosis, relatively worse right. No significant spinal stenosisThere is fatty atrophy of the paraspinal and psoas muscles.

Output: 1.Mild progression of multilevel degenerative disc disease with neural foraminal narrowing worst at L2-3 and mild central spinal stenosis at L2-3 and L4-5.2.There are multiple Schmorl's nodes including at the T11 vertebral body which is new since May 2015


Instruction: Generate impression based on findings.

Input: History of a non-small cell lung carcinoma with brain metastasis and on coagulation. Altered mental status. Examination demonstrates multiple hypodensities in the right frontal lobe and basal ganglia, which are compatible with findings on the prior MRI. New since prior exam is a hypodense area in the right posterior temporal lobe, which involves the cortex. No evidence of intracranial hemorrhage, mass effect, midline shift or extraaxial fluid collection is identified. The ventricles are normal in volume. Deformity of the right lamina papyracea is present. Sinus disease is present. The calvarium is intact.

Output: 1. No evidence of intracranial hemorrhage. 2. Multiple right frontal and basal ganglia hypodensities likely represent metastases given clinical history and prior MRI provided. An infused MRI is suggested for further evaluation. 3. Right posterior temporal hypodensity likely represents ischemia, however, metastasis cannot be ruled out based on the current noninfused exam. 4. Right lamina papyracea dehiscence or blowout fracture. Please correlate clinically.


Instruction: Generate impression based on findings.

Input: 69 year old male with a history of coronary artery disease (STEMI in 3/2016) with incomplete revascularization of the right coronary artery (balloon angioplasty without stent placement), hyperlipidemia, HIV who is referred for stress cardiac MRI for shortness of breath. MEDICATIONS: Aspirin, Atorvastatin, Plavix, Metoprolol XL, anti-retroviral therapy First Pass PerfusionDuring hyperemia, there is a perfusion defect involving the basal to mid inferior and inferoseptal walls. The perfusion defect extends beyond the below described myocardial infarction and represents a moderate amount of peri-infarct ischemia. Viability/ Myocardial ScarThere is a moderate sized myocardial infarction involving the basal in mid inferior wall. Parts of the infarct are transmural and non-viable; where as, other portions are non-transmural and have an intermediate probability of viability. The remainder of the myocardium is free of myocardial infarction and is viable. Left VentricleThe left ventricle is normal in size with mildly reduced systolic function. The overall LV ejection fraction is 48%, the LV end diastolic volume index is 80 ml/m2 (normal range: 74+/-15), the LVEDV is 138 ml (normal range 142+/-34), the LV end systolic volume index is 42 ml/m2 (normal range 25+/-9), the LVESV is 72 ml (normal range 47+/-19), the LV mass index is 30 g/m2, and the LV mass is 52 g. There is hypokinesis of the basal to mid inferoseptal and inferior walls. The global pre-contrast native myocardial T1 relaxation time is normal (1020 ms). Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with mild reduced systolic function. The overall RV ejection fraction is 40%, the RV end diastolic volume index is 70 ml/m2 (normal range 82+/-16), the RVEDV is 121 ml (normal range 142+/-31), the RV end systolic volume index is 42 ml/m2 (normal range 31+/-9), and the RVESV is 73 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.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 FindingsMild, bilateral atelectasis. 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. There is a myocardial infarction involving the basal to mid inferior wall which has an intermediate probability of viability. There is additionally a moderate amount of peri-infarct ischemia which extends beyond the infarcted territory and is viable.2. The remainder of the myocardium is free of myocardial infarction and is viable. 3. The left ventricle is normal in size with mildly reduced systolic function (LVEF 48%) with evidence of a wall motion abnormality as described above.4. The right ventricle is normal in size with mild reduced systolic function (RVEF 40%). I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Headache. Tectal glioma and 3rd VC. Evaluate CSF flow through the fenestration and change to lesion. There has been apparent interval decrease in size and enhancement of the exophytic nodular portion of the tumor within the posterior third ventricle, which now measures 14 x 10 mm, previously 17 x 12 mm. Otherwise, there is no significant change in the ill-defined portion of the tumor within the left thalamus that contains associated susceptibility effect and intrinsic T1 hyperintensity likely related to prior hemorrhage, which measures approximately 20 x 15 mm. The third ventriculostomy appears to be patent, as evidenced by the presence of a robust traversing jet of CSF. There is no significant interval change in the degree of lateral ventricular dilatation with a right transfrontal shunt catheter in position. Likewise, effacement of the superior aspect of the cerebral aqueduct persists and the fourth ventricle appears unchanged in size. There is no evidence of acute infarction. The major cerebrovascular flow voids appears to be grossly intact. The skull, paranasal sinuses, mastoid air cells, scalp, and orbits appear unchanged.

Output: 1. Interval decrease in size and enhancement of the exophytic nodular component of the glioma within the third ventricle, but no significant change of the left thalamic portion of the tumor.2. Patent third ventriculostomy, but no significant interval change in size of the shunted lateral ventricles.


Instruction: Generate impression based on findings.

Input: Prostate cancer, biopsy proven. PELVIS:PROSTATE:Prostate Size: 5.3 x 2.7 x 3.5 cmPeripheral Zone: There is a 1.5 x 0.6 cm T2 hypointense lesion in the left lateral peripheral zone at mid gland, with diffusion restriction and enhancement, suspicious for carcinoma (series 1101, image 14).Central Gland: Heterogeneous. There is a 1.3 x 0.8 cm T2 hypointense lesion in the anterior fibromuscular stroma which demonstrates ADC low signal, suspicious for carcinoma (series 604, image 324).Seminal Vesicles: No evidence of seminal vesicle involvement.Extracapsular Extension: The left lateral peripheral zone lesion abuts the capsule, causing capsular irregularity, and abuts the left neurovascular bundle and levator ani muscle, without definite involvement.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted. No lymphadenopathy by size criteria BONES, SOFT TISSUES: No significant abnormality noted.

Output: Two lesions in the prostate gland suspicious for carcinoma, as described above.


Instruction: Generate impression based on findings.

Input: Posterior chest wall soft tissue mass Multiplanar, multisequence images demonstrate a soft tissue mass posteriorly in the subcutaneous tissue of the right shoulder measuring 6.4 cm x 9.1 cm (image 13 series 2200). This mass is composed of adipose tissue, is well-defined, and demonstrates no evidence of contrast enhancement.There is no evidence of a joint effusion within the right glenohumeral joint.The rotator cuff is well visualized and is intact.No abnormalities identified of the articular cartilage or glenoid labrum.

Output: Soft tissue mass within the subcutaneous tissues posterior to the right shoulder compatible with a lipoma. No findings to indicate malignant degeneration.


Instruction: Generate impression based on findings.

Input: Headache [R51], Reason for Study: ^Reason: daily headaches, chronic History: as above No evidence of acute ischemic or hemorrhagic lesion on the scan.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear.Minimal mucosal thickening on bilateral ethmoid sinuses.

Output: Normal brain MRI.


Instruction: Generate impression based on findings.

Input: Asymptomatic female presents for routine screening mammography. BRCA 2 mutation carrier. History of breast cancer in paternal aunt diagnosed at age 50. History of ovarian cancer in paternal great grandmother diagnosed at the age of 60 There is scattered fibroglandular tissue in both breasts. Minimal parenchymal enhancement is noted bilaterally.No suspicious enhancement is seen in either breast. There are a few scattered foci bilaterally that do not appear significantly changed. No abnormal axillary 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: Pain. Question of rotator cuff pathology. ROTATOR CUFF: There is partial thickness bursal surface tearing of the posterior fibers of the supraspinatus tendon. No full-thickness tear is identified. There is no atrophy of the supraspinatus muscle. The infraspinatus, teres minor, and subscapularis muscles/tendons are intact.SUPRASPINATUS OUTLET: There is a small amount of fluid within the subacromial/subdeltoid bursa. The acromioclavicular joint appears normal.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint alignment is within normal limits. The articular cartilage is preserved. There is no joint effusion.The labrum appears grossly intact.BICEPS TENDON: The biceps tendon is intact. ADDITIONAL

Output: Partial thickness tear of the supraspinatus tendon.


Instruction: Generate impression based on findings.

Input: Characterization of chest wall mass in right axilla Again seen is a mass in the right axilla abutting lateral aspects of several upper right ribs. The mass is approximately 11 x 3 cm in transverse dimension and approximately 10 to 11 cm in craniocaudal dimension. It is of predominantly fat signal intensity although contains a prominent lobulated nonadipose component laterally that is isointense to skeletal muscle on T1-weighted images, hyperintense on T2-weighted images, and enhances following gadolinium administration. A portion of this fatty mass posteriorly may be intramuscular within the serratus anterior. Intermediate signal intensity along the periphery of the mass may represent a capsule or perhaps splayed fibers of the serratus. The mass does not appear to invade the ribs.A second, smaller fatty mass is seen indenting the right teres minor/latissimus dorsi posteriorly. A third smaller fatty mass is noted with noted within the triceps musculature. A fourth fatty mass is noted within the upper paraspinal musculature to the left of midline.Osteoarthritis affects the right shoulder. Please note that this study is not protocoled for evaluation of the rotator cuff.

Output: Multiple fatty masses as described above. The three smaller intramuscular masses are compatible with benign lipomas. The larger right axillary mass is also predominantly fatty and may represent a lipoma, but contains enhancing nonadipose elements as well. Overall, the mass appears similar to that seen on the cardiac MRI from September 28, and I suspect that the nonadipose elements within the axillary mass are benign; nevertheless, referral to an orthopedic oncologist is strongly recommended, as the possibility of a differentiated liposarcoma is also considered. If the patient has any prior cross-sectional imaging of this region (including CT scans) from outside institutions, then further comparison can be made.


Instruction: Generate impression based on findings.

Input: Female, 60 years old, with weakness and confusion, history of pancreatic cancer now with multiple brain lesions, hemorrhage, possible aneurysm. MRI brain:At least 15 supratentorial masses are identified scattered through both cerebral hemispheres, and at least 4 masses are seen in the posterior fossa. All of these lesions enhance with some showing partial cystic morphology. Most demonstrate internal susceptibility compatible with blood product. The lesion within the suprasellar cistern noted on prior CT also represents a tumor nodule.The largest supratentorial lesions in the right temporal lobe and measures 39 x 35 mm. The largest lesion in the posterior fossa is in the left cerebellar hemisphere and measures 30 x 24 mm. The lesions are associated with variable mild to moderate edema and mass-effect. The right temporal lesion generates the most significant edema with associated effacement of the right lateral ventricle. The remaining ventricles are normal in size. No evidence of frank brain herniation is seen at this time.MRA brain:An inferiorly directed outpouching is seen arising from the distal left ICA, just before the terminus. This lesion measures 3 mm in length and up to 2 mm in width.No other aneurysms are suspected. No evidence of high-grade vascular stenosis or frank vascular occlusion is seen.

Output: Numerous metastatic lesions are identified both supra- and infratentorially, some of which demonstrate internal cystic morphology. Most show evidence of tumoral blood product. These lesions elicit variable mild to moderate edema and mass effect.No suprasellar aneurysm is seen. The lesion in question on prior CT represents a tumor nodule. However, a 3 x 2 mm aneurysm is detected incidentally arising from the terminal left ICA.


Instruction: Generate impression based on findings.

Input: 61-year-old woman status post laminectomy and discectomy 12/1/2016, now with left lower extremity weakness. Five lumbar type vertebral bodies are presumed to be present with hypoplastic ribs at L1. Vertebral body heights are within normal limits. There is minimal retrolisthesis of L5 on S1, otherwise alignment is within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position at L1/L2.The patient is status post L5 laminectomy. There is increased T2 signal material in the midline paraspinal musculature with low T1 signal. No discrete fluid collections are identified. Multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: There is a disc bulge without spinal canal or neural foraminal stenosis.L3-L4: There is a disc bulge and left facet arthropathy. There is mild bilateral neural foraminal narrowing but no spinal canal stenosis.L4-L5: There is a disc bulge. The spinal canal is distorted by the dorsal increased T2 signal tissue (801/6) resulting in moderate to severe central stenosis. There is mild bilateral neural foraminal narrowing.L5-S1: There is a disc bulge and facet arthropathy, left greater than right. The dorsally increased T2 signal tissue extends to this level, more asymmetrically prominent to the right, with moderate spinal canal stenosis. There is moderate left and mild right bilateral neural foraminal narrowing.

Output: 1.Postoperative findings with T2 hyperintense signal in the laminectomy bed causing distortion of the spinal canal from L4 to S1. This signal may represent a combination of edema and granulation tissue, but there is no discrete fluid collection in this location. Overall, there is resultant moderate to severe central stenosis at L4-L5 and moderate central stenosis at L5-S1.2.Additional multilevel degenerative change with mild and moderate neural foraminal stenoses.


Instruction: Generate impression based on findings.

Input: Metastatic bladder cancer. Evaluate for liver metastases. ABDOMEN:LIVER, BILIARY TRACT: 3 right hepatic lobe segment VIII lesions are again seen, demonstrating central hypoenhancement and peripheral rim enhancement, compatible with hypovascular liver metastases. The most inferior reference lesion measures 1.1 x 1.0 cm (series 13, image 61), unchanged from previously 1.0 x 0.9 cm.Stable punctate subcentimeter T2 hyperintense segment 6 lesion most compatible with simple cyst.SPLEEN: No significant abnormality noted.PANCREAS: No focal pancreatic lesion.ADRENAL GLANDS: No adrenal nodularity or thickening.KIDNEYS, URETERS: Kidneys enhance symmetrically without focal lesion.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Right lower quadrant ostomy again noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Three segment VIII liver metastases are not significantly changed from 8/25/2015 exam.


Instruction: Generate impression based on findings.

Input: Neck pain, tingling, pain upper extremities Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. There is mild grade 1 retrolisthesis of C3 on C4 and minimally of C5 on C6; alignment is otherwise maintained. Bone marrow signal is within normal limits. The cervical spinal cord has normal signal characteristics and overall morphology.Degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: Disc osteophyte complex and ligamentum flavum thickening result in mild to moderate spinal canal stenosis. There is mild narrowing of the bilateral neural foramina, right relatively worse than left.C4-5: Small disc osteophyte complex and ligamentum flavum thickening result in mild spinal canal stenosis. There is mild bilateral neural foraminal stenosis related to uncovertebral hypertrophy, left relatively worse than right.C5-6: Small disc osteophyte complex with mild spinal canal stenosis. There is mild to moderate left neural foraminal stenosis. Minimal right neural foraminal narrowing.C6-7: Small disc osteophyte complex including a central disc extrusion. Dorsal thecal sac is patent with at most mild spinal canal stenosis at this level. Neural foramina are patent.C7-T1: No significant compromise to the spinal canal or neural foramina.There is also mild generalized facet arthropathy. There is opacification of the right mastoid air cells, which are partially imaged. The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: 1. Multilevel degenerative changes in the cervical spine. There is mild to moderate spinal canal stenosis at the C3-C4 level without cord signal abnormality. Mild spinal canal stenosis is present at additional levels as described above.2. Multilevel neural foraminal narrowing is relatively worst at the left C5-C6 level. Please see additional details above.


Instruction: Generate impression based on findings.

Input: Clinical question: History of epilepsy, planning for laser fiber placement. Signs and symptoms: As above. Pre-and post-enhanced fusion brain MRI:There is no detectable acute or new finding since prior MRI exam from 2 -- 17 -- 15.Subtle enlargement of the tip of the right temporal horn of lateral ventricle and its adjacent sulci remains identical to prior exam.There are tracks of deep electrodes extending from the medial aspect of right hippocampus directly laterally and exiting the calvarium as are the directly posterior to the exiting calvarium in the right posterior temporal -- occipital junction. Focus of T2 hyperintensity in the right anterior temporal tip with resultant sulcal effacement of adjacent cortical sulci is new since prior exam and likely representing posttreatment change. Note should be made that this exam is a limited surgical -- treatment planning the study and not a diagnostic test. Cavum septum pellucidum and normal-size ventricular system without deviation of midline as was noted on prior studies.There is expected subtle dural thickening and enhancement at the surgical site in the right anterior temporal region and unremarkable post-enhanced images otherwise.

Output: 1.Focus of T2 hyperintensity in the right anterior temporal lobe laterally is a new finding since prior exam and could represent post treatment course surgical change.2.Tracks of electrodes traversing the right anterior temporal lobe directly laterally as well as posteriorly as detailed.


Instruction: Generate impression based on findings.

Input: 65 year old male status post right craniotomy for tumor. Expected postsurgical changes are noted including right superior frontoparietal craniectomy, with residual pneumocephalus and edema. Few punctate areas of hyperdensity consistent with petechial hemorrhage detected within the surgical cavity. Hypodensity within the right caudate is unchanged when compared to the previous MRI and represents an old lacunar infarct.The ventricles and basal cisterns are normal in size and configuration.The calvaria demonstrate stable post surgical change and skull base is radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Expected postoperative changes as described above.


Instruction: Generate impression based on findings.

Input: Forearm mass Within the dorsal soft tissues of the distal wrist is a fairly well-circumscribed mass measuring 2.6 x 2.8 x 2.5 cm in the greatest transverse, AP, and craniocaudal dimensions. Mass appears increased in T1 signal although demonstrates central areas of low T1 signal. On T2, the mass is predominantly hyperintense. There is no significant surrounding soft tissue edema. The underlying bone marrow and surrounding muscular signal is normal. Gradient echo imaging demonstrates no obvious blooming artifact.

Output: Well-circumscribed mass within the dorsal soft tissues of the wrist demonstrate imaging characteristics suggestive of a peripheral nerve sheath tumor.


Instruction: Generate impression based on findings.

Input: Female, 54 years old, with bowel and bladder incontinence. Assess for cord compression. No evidence of acute cord compression is seen. Degenerative disc disease has progressed at C3-4 resulting in a mild to moderate degree of spinal canal narrowing and mild indentation of the ventral cord. There is equivocal mild T2 hyperintensity within the cord versus artifact at this level.Degenerative endplate changes are seen superiorly at L1, progressed from prior. Otherwise, marrow signal characteristics are unremarkable. Spinal alignment is anatomic. No other areas significant spinal canal narrowing are detected. Mild to moderate foraminal narrowing is seen in the lower lumbar spine.

Output: 1. No definite evidence of acute cord compression.2. Degenerative disc disease has progressed in the cervical spine when compared to the prior examination, particularly at C3-4 where there is a mild to moderate spinal canal stenosis and mild indentation of the ventral cord. These findings can be further assessed with dedicated cervical spine imaging if clinically warranted.


Instruction: Generate impression based on findings.

Input: Female, 25 years old, with multiple sclerosis and paresthesias. Evaluate for progression. Brain:Multiple T2 hyperintense lesions are redemonstrated within the periventricular and juxtacortical white matter. To a much lesser extent, lesions are also seen in the brainstem and posterior fossa. A periventricular lesion on the left (image 52 series 41) does appear to have increased in size from prior, and there may be two or three very small new periventricular lesions, but this is equivocal and could reflect differences in technique.No evidence of cortical edema or mass effect is seen. The corpus callosum is thinned, particularly posteriorly. The lateral and third ventricles remain enlarged, similar to that seen on the prior examination. No abnormal fluid collections are detected.C-spine:The previously demonstrated ill-defined lesions within the cervical spinal cord are no longer distinctly visualized and no new discrete lesions are demonstrated. The spinal cord demonstrates normal morphology throughout.Straightening of the cervical lordosis may be positional. Vertebral body height and morphology are within normal limits. No evidence of pathologic marrow replacement or edema is seen. The intervertebral discs are preserved. No significant spinal canal or foraminal stenosis is detected.

Output: 1.Numerous lesions are redemonstrated in the brain compatible with demyelinating disease. In comparison with the prior examination, one left-sided periventricular lesion may be slightly larger and there are perhaps two or three equivocally new lesions.2.Chronic ventriculomegaly is again seen, similar to prior.3.The previously demonstrated lesions in the cervical spinal cord are no longer clearly seen, and no discrete new lesions are identified


Instruction: Generate impression based on findings.

Input: Altered mental status, unspecified [R41.82], Reason for Study: ^Reason: assess for evidence of stroke History: acute stroke code called for slurred speech and possible facial droop, await CT read, however neuro thinks negative CT, recommended MRI Brain MRIDiffuse low signal intensity on clivus and upper cervical spine on T1 images indicate diffuse infiltrative process which could be related to the history of AML involvement.Multiple scattered T2/FLAIR high signal intensity lesions on periventricular white matter indicate non specific small vessel ischemic disease.There is a susceptibility lesion on right external capsule indicate either parenchymal calcification or chronic petechial hemorrhage.Prominent bilateral basal ganglia, red nucleus and substantia nigra on gradient echo images are seen which is non specific.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear.Mucosal thickening of ethmoid and sphenoid sinuses are seen.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal. No aneurysm. No significant luminal stenosis.Neck MRA3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The vertebral artery origins are normal. There is normal flow enhancement through the bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries.

Output: 1. Diffuse infiltrative lesions involving clivus and upper cervical spine, likely related to the patient's history of AML.2. Non specific small vessel ischemic disease.No acute ischemic or hemorrhagic lesion.3. Normal brain MRA and neck MRA.


Instruction: Generate impression based on findings.

Input: 47-year-old male. Persistent pain in left hip and infragluteal area. Xray - ? mild deformity - ? cam deformity of femoral head/neck (mild), probably not enough to explain symptoms. Please note that due to insurance issues, only the pelvis was imaged despite the order for a pelvis and left hip MRI. As a result, evaluation of the left hip is limited.JOINTS: Mild osteoarthritis affects the left hip with small anterior acetabular osteophytes and mild edema in the adjacent bone that is presumably degenerative in etiology. Slightly more pronounced osteoarthritic changes affect the right hip including small subchondral cysts in the anterior aspect of the femoral head. Given the sequences used for this study, we cannot adequately comment on the articular cartilage of the hip or the acetabular labrum.SOFT TISSUES: There is a small focus of edema within the superolateral fibers of the left gluteus medius near their origin, which may represent a mild strain injury. The remaining musculature is unremarkable.ADDITIONAL

Output: 1. Mild hip osteoarthritis.2. Mild edema in the superolateral aspect of the left gluteus medius, which may represent a mild strain.3. Other findings, as described above.


Instruction: Generate impression based on findings.

Input: Reason: eval for osteomyelitis or any other underlying infectious etiology History: left, lateral lower extremity wound x 3 weeks with surrounding cellulitis Bandage material overlies the lateral aspect of the lower leg. There is thickening and enhancement of the underlying skin with small fluid collections along the skin surface, which may represent superficial blister formation. There is diffuse subcutaneous edema with minimal enhancement following gadolinium administration. Additionally, there is edema of the anterior compartment and deep posterior musculature with little if any enhancement, and no discrete fluid collection. No bone marrow signal abnormality is present to indicate osteomyelitis. Osteoarthritis affects the knee. There is a small joint effusion as well as a small Baker's cyst.On the large field-of-view coronal images, there is also diffuse subcutaneous edema and metallic susceptibility artifact related to a right total knee arthroplasty.

Output: Left leg cellulitis without evidence of osteomyelitis.


Instruction: Generate impression based on findings.

Input: Eye pain OD>OS, vision changes, and questionable extraocular muscle restriction: Evaluate for thyroid eye disease with nerve involvement versus orbital pseudotumor versus scleritis. Right: There is diffuse enhancement and high T2 signal of the right orbital fat. There also appears to be mild thickening and enhancement along the posterior right globe. There is no evidence of abscess. The optic nerve, lacrimal gland and extraocular muscles are unremarkable. The superior ophthalmic vein appears to be patent.Left: The left globe, optic nerve, and lacrimal gland, and extraocular muscles are unremarkable. There is no evidence of abnormal enhancement or mass lesions in the left orbit. The superior ophthalmic vein appears to be patent.

Output: 1. Findings suggestive of right orbital inflammatory or infectious cellulitis, perhaps associated with scleritis.2. No findings specific for thyroid eye disease.


Instruction: Generate impression based on findings.

Input: Female, 81 years old, with optic nerve pallor, right more than left. Assess for causes other than glaucoma. The optic nerves and the optic chiasm are small bilaterally. However, no evidence of pathologic signal abnormality or enhancement is seen along the course of the optic apparatus. The optic nerve sheaths are not dilated. The globes are round and symmetric. Lenses are normally positioned. The extraocular muscles demonstrate normal caliber and pattern of enhancement. The intraconal soft tissues are unremarkable. On limited visualization of the brain, prominence of the ventricles and sulci is seen compatible with underlying parenchymal volume loss. The septum pellucidum is present. There is likely a mild degree of periventricular T2 hyperintensity which is a nonspecific finding.

Output: The optic nerves and optic chiasm are of small caliber bilaterally with no other significant orbital abnormalities detected. The etiology for this finding is uncertain but it could reflect either atrophy or congenital hypoplasia.


Instruction: Generate impression based on findings.

Input: Diagnosis: Malignant neoplasm of thyroid gland Secondary malignant neoplasm of brain Secondary malignant neoplasm of unspecified lungClinical question: h/o met thyroid ca, compare to previous, measurements plsSigns and Symptoms: none The patient is status post right-sided craniotomy involving frontal and parietal bones and part of the squamous temporal bone. There is abnormal signal within the posterior aspect of the right inferior frontal gyrus and the subcentral lobule associated with volume loss and some susceptibility effect. Stable when compared to the prior exam. The appearance on postcontrast imaging is stable. There is T1 hyperintensity within this lesion. There are some contrast enhancement along the areas of susceptibility effect stable since the prior exam.A punctate enhancing focus along the left superior cerebellar hemisphere remains stable compared to the prior examNormal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate a mucous retention cyst in the right maxillary sinus and some mild mucosal thickening in the ethmoid air cells as well as some minor opacities in the right maxillary sinus.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.The patient is status post right-sided craniotomy for a lesion centered in the right frontal lobe. There are posttreatment effects present in the surgical bed which appear stable. Some contrast enhancement at the surgical bed is present which is stable and could be due to posttreatment effect.2.A punctate lesion in the left superior cerebellar hemisphere remains stable.


Instruction: Generate impression based on findings.

Input: Right knee pain, check for chondromalacia patella MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: No significant abnormality noted. Small bone island of no clinical significance observed in the patella. Cartilaginous surfaces are unremarkable, specifically the undersurface of the patella is intact and homogeneous in signal characteristics. No marrow signal abnormalitiesLIGAMENTS: Questionable minimal signal within the distal ACL ligament with intact fibers. This may represent a minimal sprain towards its tibial attachment, however the remaining ligaments are all otherwise unremarkable and intact. Please correlate patient's symptomatology. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: No acute or chondral abnormalities.


Instruction: Generate impression based on findings.

Input: Cerebral infarction, unspecified [I63.9], Reason for Study: ^Reason: L temporal fullness ? Tumor or just a strange appearance of a prior stroke History: seizures There is no evidence of acute ischemic lesion.Left temporal occipital encephalomalacia is again seen with especially linear high signal intensities along the gray matter indicating laminar necrosis right evidence of susceptibility artifacts indicating prior hemorrhage. On post gadolinium enhancement, there is a subtle parenchymal enhancement with the chest at the dura which is not unusual for post ischemic stroke finding. There is no evidence of discrete intra or extra-axial abnormal enhancing mass lesion.Constellation of above findings indicate chronic left temporal occipital ischemic infarction with hemorrhagic transformation.Minimal nonspecific small vessel ischemic disease was seen on periventricular white matter high signal intensities on FLAIR imaging.The ventricles, sulci and cisterns are symmetric and unremarkable except ex focal changes of left lateral ventricle occipital horn. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1.No acute ischemic or hemorrhagic lesion.2.Encephalomalacia with hemosiderin deposition of the left temporal occipital lobe likely due to chronic ischemic infarct, no change since prior scan.3. No abnormal enhancement.


Instruction: Generate impression based on findings.

Input: Right shoulder pain ROTATOR CUFF: There is a high-grade partial-thickness insertional tear of the supraspinatus tendon involving both the bursal and articular surface fibers. There is no tendon retraction. Infraspinatus, teres minor, and subscapularis tendons appear intact. There is mild fatty infiltration along the myotendinous junction of the supraspinatus tendon but otherwise the rotator cuff musculature is preserved.SUPRASPINATUS OUTLET: There is moderate acromioclavicular osteoarthritis. A trace amount of fluid is present within the subacromial subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Alignment of the glenohumeral joint is normal. Within the limits of a non-arthrogram study, there is no evidence of discrete labral detachment.BICEPS TENDON: The extra-articular portion of the biceps tendon within the intertubercular groove is not well visualized which may be secondary to partial or longitudinal tearing. ADDITIONAL

Output: 1. High-grade partial-thickness tearing of the supraspinatus tendon involving both articular and bursal surface fibers.2. Moderate osteoarthritis of the acromioclavicular joint.3. Probable longitudinal tearing of the biceps tendon.


Instruction: Generate impression based on findings.

Input: Brain MRIThere are interval development of confluent, patchy and fairly symmetric FLAIR high signal intensity lesions involving bilateral frontal, parietal, temporal and occipital lobes. Most of these lesions appear to be progressed and coalesced from previously seen somewhat scattered FLAIR high signal lesions. However, there is no evidence of mass effects nor evidence of contrast enhancement. There is no evidence of associated global atrophy. Constellation of these findings indicate progressive multifocal leukoencephalopathy. Differential diagnosis include other demyelinating disease, HIV encephalitis, Mitochondrial encephalopathies such as MELAS, Acute disseminated encephalomyelitis (ADEM) and vasculitis. Possibility of HIV related infection such as toxoplasmosis or lymphoma is less likely considering lack of mass effects and contrast enhancement.Previously seen other scattered FLAIR/T2 high signal intensity lesions on bilateral white matter including brain stem, right middle cerebellar peduncle and bilateral cerebellar parenchyme, unchanged. The ventricles and sulci are within normal limits. The cisterns remain patent. There is no midline shift or mass effect. There are no areas of abnormal signal or pathological enhancement. There is no diffusion abnormality. Unchanged about 2mm lower lying cerebellar tonsils.No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits.MRA HEAD

Output: 1. Interval progression of previously seen FLAIR high signal intensity lesions and results bilateral confluent fairly symmetric white matter lesions without evidence of mass effects nor evidence of contrast enhancement. PML is the likely diagnosis, however, differential diagnosis of other demyelinating disease, HIV encephalitis, MELAS, ADEM and vasculitis may need to be excluded.2. No evidence of acute ischemic or hemorrhagic lesion.3. Spinal cord signal intensity is normal.4. Disc protrusion, central to right with right mild to moderate lateral recess stenosis at C56.


Instruction: Generate impression based on findings.

Input: 31-year-old female with pain and burning ROTATOR CUFF: Intermediate signal in the supraspinous tendon with mild thickening of the supraspinous tendon. No evidence of tear. Infraspinatus, teres minor, and subscapularis are within normal limits.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: No significant abnormality noted.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: Findings compatible with supraspinatus tendinopathy as described above. No tear is evident.


Instruction: Generate impression based on findings.

Input: Male 46 years old; Reason: new diagnosis of cirrhosis, evaluate liver morphology, veins, biliary tree and rule out PSC History: new ascites Suboptimal study secondary to artifact related to presence of patient's large ascites.ABDOMEN:LUNGS BASES: Partially imaged gynecomastia. LIVER, BILIARY TRACT: Hepatomegaly, liver measures 21 cm in craniocaudal dimension. Widening of the fissures and surface nodularity seen consistent with underlying cirrhosis. Diffuse signal loss on opposed phase imaging compared to in phase, consistent with hepatic steatosis. No suspicious arterially enhancing hepatic focus seen. Tiny nonenhancing focus at level of liver dome anteriorly on image 202 series 16 favored to be a tiny cyst with corresponding increased T2 signal suggested. Minimal biliary ductal irregularity seen centrally at level of confluence, see key image. No intrahepatic or extrahepatic biliary duct dilatation. Gallbladder contracted containing cholelithiasis. Mild gallbladder wall edema, nonspecific in setting of ascites. Patent portal veins and splenic vein, contrast noted opacifying SMV. Patent hepatic arteries and veins.SPLEEN: Spleen measures up to 13.2 cm.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Prominent upper abdominal including periportal lymph nodes, favored to be reactive in etiology.BOWEL, MESENTERY: Large ascites with associated centralization of bowel.BONES, SOFT TISSUES: Anasarca.OTHER: No significant abnormality noted.

Output: Cirrhotic liver morphology, hepatomegaly, and diffuse hepatic steatosis. Large ascites.Minimal biliary ductal irregularity seen centrally at level of confluence, nonspecific but may be seen in PSC in appropriate clinical setting. No intrahepatic or extrahepatic biliary duct dilatation. Additional findings as above.


Instruction: Generate impression based on findings.

Input: 83 year old female with soft tissue infection with abscess formation in perineum and labia. Concern for osteomyelitis. As seen on the patient's recent CT scan, there is reticulation of the mons pubis, particularly to the right of midline, extending posteriorly through the fat of the perineum. Evaluation for abscess is limited due to lack of intravenous contrast enhancement. However, within the mons pubis, there is a small crescentic collection of fluid signal intensity measuring approximately 3.5 cm in the AP dimension, 0.6 cm in the medial lateral dimension, and 1.0 cm in the craniocaudal dimension. There is a focus of signal void within the anterior aspect of this collection suggestive of gas. These findings are suggestive of abscess formation in the absence of recent intervention. Additionally, there are a few smaller, subcentimeter collections seen more anteriorly and superiorly within the mons pubis. The inflammation abuts the medial aspect of the gracilis. There is edema within the gracilis and to a lesser degree within the adductor musculature of the right hip, but we see no definite drainable inter- or intramuscular fluid collection. There is mild edema within the subcutaneous fat posteriorly and laterally which is nonspecific and not necessarily of any current clinical significance. We see no bone marrow signal abnormality to indicate osteomyelitis. There is intermediate signal intensity within the bone marrow on T1-weighted imaging suggesting residual red marrow. There is trace fluid within both hip joints which is within normal limits. The sacroiliac joints appear normal. Mild degenerative disc disease affects the lower lumbar spine. Facet joint osteoarthritis affects the lower lumbar spine.

Output: 1. Inflammation of the mons pubis and perineum particularly to the right of midline with small fluid collections, one of which contains a focus of signal void suggestive of gas, compatible with small abscesses. Please note we cannot exclude the possibility of a necrotizing infection.2. We see no evidence of osteomyelitis. Other findings as described above.


Instruction: Generate impression based on findings.

Input: 47 years Male (DOB:2/1/1969)Reason: evaluate disc disease History: painPROVIDER/ATTENDING NAME: SUSAN HONG SUSAN HONG MRI thoracic spine:The thoracic vertebral bodies are appropriate in the overall alignment. There is mild superior endplate compression at T3 and T4 which is unchanged compared to the previous exam. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots. At T11-T12 there is a left lateral recess disc protrusion extending into the left T10-T11 neural foramen. There is associated mild displacement of the spinal cord towards the right side. This is new since the prior examLumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is redemonstration of some loss of disc space height, disc desiccation and a broad-based left lateral recess disc protrusion. There is T2 signal hyperintensity along the periphery of the disc at the site of the broad-based left lateral recess disc protrusion. There is mild encroachment of the nerve roots at the lateral recess on the right and moderate encroachment of the nerve roots at the left lateral recess. Since the prior exam there is slightly less encroachment of the nerve roots at the left lateral recess. Signal characteristics within the disc have changed and are now high signal on T2 along the periphery of the disc protrusion.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.Degenerative changes are present lumbar spine with a broad-based disc protrusion at L4-5 which was previously present. There is associated moderate encroachment of nerve roots at the left lateral recess at this level and mild encroachment of the nerve roots of the right lateral recess at this level. Although the degree of nerve root encroachment has not changed significantly signal characteristics of the disc have altered 2.There is a new left lateral recess disc protrusion at T11-T12 encroaching the left-sided exiting nerve root and mildly displaces the spinal cord.3.Mild superior endplate compressions in the upper thoracic spine are stable compared to the previous exam.


Instruction: Generate impression based on findings.

Input: Reason: history of metastatic colon cancer with new brain metastasis s/p resection; please evaluate for radiosurgery treatment planning History: brain mass The CSF spaces are appropriate for the patient's stated age with no midline shift. The patient is status-post left-sided posterior fossa craniotomy and left cerebellar surgery. There are multiple enhancing lesions present in the left cerebellar hemisphere and vermis. One ring enhancing lesion in the inferior aspect of the right side of the vermis measures 5 mm in diameter. One in the medial aspect of the left cerebellar hemisphere along the inferior semilunar lobule measures 7 x 6 mm. One along the lateral aspect of the inferior left semilunar lobule measures 11 x 12 mm. There is contrast enhancement present along the edge surgical planes in the left cerebral hemisphere with a nodular component measuring 5 x 7 mm axial dimensions.There is a 6-mm enhancing lesion located in the left thalamus which was also present on the prior exam, however, because it was previously evaluated using T2 imaging direct comparison is not possible.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.Status post left cerebellar surgery with the residual enhancement at the surgical site.2.There multiple small ring enhancing lesions present in the cerebellar vermis, the medial and lateral aspect of the left cerebellar hemisphere as well as in the left thalamus. Given the patient's clinical history, metastatic disease is a strong consideration. There are no prior contrast enhanced MRI of the brain studies available


Instruction: Generate impression based on findings.

Input: 19-year-old male with newly diagnosed germinoma presenting with headaches, nausea, and vomiting. Evaluate for hydrocephalus. Postoperative changes status post right frontal craniotomy are again evident, with interval decrease in pneumocephalus and extra-axial fluid. No acute intracranial hemorrhage is evident. Again seen is diffuse decreased attenuation in the subcortical and periventricular white matter in the frontal lobes bilaterally which appear grossly unchanged. Hyperdense masses are again seen in the suprasellar and pineal regions, correlating with lesions seen on recent MRI. The suprasellar mass appears more prominent compared to the prior exam, which may be in part due to slice thickness and partial volume averaging. Hypodensity in the right periependymal region adjacent to the frontal horn of the right lateral ventricle is again seen, causing mass effect upon the ventricle at this level. The ventricles remain midline, with interval increase in volume of the lateral ventricles. The third and fourth ventricles demonstrate normal morphology and volume.Postoperative changes status post right frontal craniotomy, with the remaining calvaria stable in appearance. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. Interval increased volume of the lateral ventricles.2. Increased prominence of suprasellar mass, which may in part be due to slice thickness and partial volume averaging. Stable appearance of pineal mass. 3. Postoperative changes status post right frontal craniotomy, with no acute intracranial hemorrhage.