Instruction: Generate impression based on findings.

Input: Diagnosis: Swelling, mass, or lump in head and neckClinical question: L trapezius mm mass, suspect lipoma, bu growingSigns and Symptoms: L trapezius mm mass, suspect lipoma, bu growing There is a 53 x 26 mm axial dimension mass hyperintense on T1 which suppresses on fat-suppressed imaging compatible with a lipoma located along the left neck posteriorly adjacent to the left trapezius muscle.Within the suprahyoid neck on the basis of size criteria for lymphadenopathy no lymphadenopathy is appreciated. Within the infrahyoid neck on the basis of size criteria for lymphadenopathy no lymphadenopathy is appreciated. The jugulodigastric nodes measure up to 14 mm short axis dimension.There is a left axillary lymph node present measuring 14 mm short axis dimension.Within the visceral space the thyroid gland appears intact. There is a lesion along the right thyroid gland lobe posteriorly measuring 12 mm in diameter which is bright on T2-weighted imaging and intermediate signal on T1-weighted imaging..The airway appears patent.The visualized intracranial structures which include the posterior fossa are intact. The visualized portions of the orbits and paranasal sinuses are intact. The paranasal sinuses demonstrate partial opacification of the right maxillary sinus and scattered opacities in the ethmoid air cells and right frontal sinus. The mastoid air cells are clear.The parotid and the submandibular glands appear intact.The visualized lung apices appear clear.The carotid and vertebral vasculature visualized on this exam appears intact.The cervical vertebral bodies in general are intact. There is a left paramedian disc protrusion present at C5-6 associated with some encroachment of the left-sided exiting nerve roots is a disc bulge at C6-7 associated with encroachment of the neural foramina.

Output: 1.There is a lipoma present along the left posterior neck adjacent to the left trapezius muscle.2.There is a small right thyroid gland lobe lesion present which on MRI is nonspecific. Please correlate with the patient's clinical symptoms and signs.3.There are degenerative changes present in the cervical spine worse at C5-6 where there is encroachment of left-sided exiting nerve roots due to disc protrusion.


Instruction: Generate impression based on findings.

Input: Female, 58 years old, with history of cavernoma status post resection in March 2016, postoperative surveillance examination. Postoperative findings are seen compatible with cavernoma resection from the right precentral gyrus. A small resection cavity is demonstrated at the site of the prior lesion. The cavity is mildly hemosiderin stained. Chronic hemosiderin staining of the adjacent parenchyma remains similar to that seen on the preoperative evaluation. Minimal intrinsic T1 hyperintensity is seen within the resection cavity with a small degree of superimposed enhancement, reduced when compared to the preoperative examination.The dura underlying the right parietal bone craniotomy is mildly thickened and enhancing, an expected postoperative finding. No other pathologic intracranial enhancement is seen. Scattered foci of white matter T2 hyperintensity are redemonstrated without significant interval change. No new edema or mass effect is detected. The ventricles are stable and normal in size. Opacification of the right maxillary sinus is a stable finding.

Output: Expected postoperative findings are seen status post resection of a cavernous malformation from the right precentral gyrus.


Instruction: Generate impression based on findings.

Input: 13-year-old male with anterior hip pain overlying the proximal quadriceps. Evaluate for muscular injury. ACETABULAR LABRUM: Although this examination was not protocoled for evaluation of the acetabular labrum, the labrum appears intact.ARTICULAR CARTILAGE AND BONE: Note is made of linear increased signal abnormality traversing the right AIIS at the site of the insertion of the rectus femoris indicating a nondisplaced fracture/avulsion injury. There is increased bone marrow signal abnormality within the AIIS. The tendon of the rectus femoris appears intact.SOFT TISSUES: There is mild peritrochanteric inflammation bilaterally, right greater than left. The remainder of the imaged musculature is normal in appearance.ADDITIONAL

Output: Nondisplaced fracture/avulsion injury of the right AIIS at the insertion site of the rectus femoris.


Instruction: Generate impression based on findings.

Input: Diagnosis: Low back pain Paresthesia of skinClinical question: evaluate for disc herniationSigns and Symptoms: low back pain, not improved with conservative 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. There is a mild degree of diffuse marrow replacement present. On T1-weighted imaging there is a high signal focus present within the L1 vertebral body measuring 13 x 10 mm sagittal dimensions which is bright on T1 and suppresses partially on the STIR images. This most likely represents a vertebral body hemangioma.Within the cutaneous tissues superficially there is a cystic appearing lesion present measuring approximately 14 x 10 mm axial dimensions which extends to the surface of the skin. It should be visible on physical exam and is midline in location at approximately the L4 vertebral body level. Most likely represents a sebaceous cyst.At L5-S1 there is no significant compromise to spinal canal . There is loss of disc space heights disc desiccation and endplate reactive change present at this level. There is irregularity along the endplates. The endplate reactive changes are high signal on T1. There is associated diffuse disc bulge at this level and mild ligamentum flavum and facet hypertrophy. The fat surrounding the exiting nerve roots within the neural foramina is effaced bilaterally. There is bilateral encroachment of exiting nerve roots within the neural foramina at this level.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is a moderate degree of facet hypertrophy present at this level. There is a mild disc bulge present at this level.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.There are multiple cysts present along the kidneys the largest one in the right kidney measures 36 x 43 mm axial dimensions and is not completely included on this exam. There are a couple smaller cysts present along the inferior pole of the right kidney and to a lesser degree than smaller cysts in the left kidney. Some of these can be seen on a CT of the chest from 2012.

Output: 1.There are degenerative changes present in the lumbar spine which are worse at L5-S1 where there is encroachment of the exiting nerve roots within the neural foramina bilaterally due to degenerative changes.2.Multiple renal cysts.3.There is a mild degree of diffuse marrow replacement present which is a nonspecific finding. This can be seen with chronic disease, anemia, lymphoproliferative disorders. It is nonspecific. In isolation it is of little clinical significance


Instruction: Generate impression based on findings.

Input: There are findings related to revision Chiari decompression with interval resolution of a fluid collection superificial to the reconstructed dura in the posterior neck. There is biphasic flow of cerebrospinal fluid flow across the anterior foramen magnum, but persistent paucity of flow posteriorly. There is also unchanged encephalomalacia and deformity of the posterior cerebellum. In addition, there is persistent indentation of the left posterolateral aspect of the medulla by the inferior left cerebral hemisphere. There is a punctate focus of susceptibility effect in the left cerebellar hemisphere as well, which is nonspecific. There is no evidence of hydrocephalus, acute infarct, acute hemorrhage, or mass lesion. There is unchanged encephalomalacia involving the right medial orbitofrontal and straight gyri and left straight gyrus. There are prominent perivascular spaces in the left basal ganglia. The major intracranial vascular flow voids appear intact. There is a small right maxillary sinus retention cyst.

Output: 1.Postoperative findings related to revision Chiari decompression with interval resolution of the pseudomeningocele. 2.Persistent paucity of cerebrospinal fluid flow across the foramen magnum posteriorly, which may be in part attributable to adhesion formation. 3.Unchanged encephalomalacia involving the right medial orbitofrontal and straight gyri and left straight gyrus, which is likely related to remote trauma.


Instruction: Generate impression based on findings.

Input: T2 and FLAIR images demonstrate areas of abnormal signal in the right anterior temporal and right parietal regions relating to areas of gliosis, with associated volume loss in the right parietal region. These 2 areas of high signal correspond to the low attenuation that was seen in the previous CT dated 7/12/2015.Diffusion images demonstrate a focus of high signal in the left superior frontal gyrus, with isointensity in the ADC image. In addition, a focus of restricted diffusion is seen in the deep white matter of the left frontal lobe. The left temporoparietal region demonstrates multiple scattered foci of diffusion restriction. These foci are most likely related to recent infarct of varying age. No diffusion foci are seen in the right cerebral hemisphere.Susceptibility images demonstrates scattered foci of low signal in the left greater than right cerebellum and occipital lobes, most likely representing chronic hemosiderin deposition. There is a focus of more prominent susceptibility in the left central sulcus medially, corresponding to the calcification seen in the previous CT.Chronic lacune is seen in the left cerebellum. Patchy abnormal high signal seen in T2 and FLAIR images in the periventricular white matter including the left putamen which represents chronic ischemic small vessel disease.Ventricular size is normal. The cisterns are patent. No midline shifts. No extra-axial collection of fluid is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. There is mild mucosal thickening of the bilateral maxillary sinuses

Output: 1. Multiple small predominantly left sided supratentorial infarcts of varying ages, ranging from subacute to acute.2. More chronic appearing right parietal and right temporal infarcts. 3. Other scattered chronic ischemic small vessel disease. 4. Scattered foci of hemosiderin deposits in the posterior fossa and occipital lobes.


Instruction: Generate impression based on findings.

Input: 39 years, Male, new facial numbness.. Few foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, including a subcortical focus in the right superior frontal gyrus, right frontal periventricular white matter, and in the left parietal deep white matter. Brain parenchyma is otherwise unremarkable on the available sequences. No abnormal parenchymal or meningeal enhancement. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. Visualized extracranial soft tissue structures are unremarkable.

Output: Few scattered nonspecific foci of T2/FLAIR hyperintensity in the supratentorial white matter. These are in a nonspecific distribution and not particularly suggestive of demyelinating disease. No abnormal enhancement. Brain parenchyma appears otherwise unremarkable.


Instruction: Generate impression based on findings.

Input: 43-year-old woman with a history of a left mastectomy in 2010 for DCIS followed by reconstruction. History of benign right breast biopsy. Breast MRI of 12/3/2014 was unremarkable. No current symptoms. Left: Patient is status post left mastectomy and reconstruction. Left breast skin thickening and enhancement are compatible with postoperative changes. No suspicious enhancement is seen in the reconstructed breast or chest wall. Right: There is moderate background parenchymal enhancement in the right breast. Several benign foci are seen in the right breast which demonstrate rapid uptake and plateau kinetics, typically benign. No suspicious enhancement is seen in the right breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Shoulder pain. Assess labrum. ROTATOR CUFF: There is minimal undersurface fraying of the supraspinatus tendon. No evidence of rotator cuff tear.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is post-surgical changes of the posterior superior and posterior labrum with degenerative tearing. There is also mild degeneration of the anterior inferior labrum. The superior labrum is intact. A small T2 hypointense focus adjacent to the labrum may represent a displaced anchor or piece of labrum. The articular cartilage is intact. BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: 1. Post-surgical changes of the posterior superior and posterior labrum with degenerative tearing. Mild degeneration of the anterior inferior labrum. 2. No rotator cuff tear.


Instruction: Generate impression based on findings.

Input: Reason: s/p lymphoma with treated lesion in left humerus, evaluate for progression History: s/p lymphoma with treated lesion in left humerus, evaluate for progression. Again seen within the mid diaphysis is a ill-defined lesion that is T1 hypointense, T2 hyperintense with heterogeneous enhancement. Probable mild endosteal scalloping, but no evidence of cortical breakthrough. It measures approximately 5.5 x 1 x 1.2 cm (AP x TR x CC), unchanged. No evidence of soft tissue involvement.

Output: Stable mid diaphyseal lesion.


Instruction: Generate impression based on findings.

Input: Ms. Keller is a 75 year old female presenting with newly diagnosed right breast cancer. There is heterogeneous amount of fibroglandular tissue in both breasts. Minimal background parenchymal enhancement is noted bilaterally.In the right lower inner breast, 5:00 location, there is an irregular enhancing mass identified measuring approximately 2.0 x 1.6 x 1.9 cm (AP x ML x SI). Susceptibility artifact from biopsy marker clip is seen within the central aspect of this lesion, compatible with biopsy-proven malignancy. There is no additional abnormal enhancement seen in the right breast.There is no abnormal enhancement seen in the left breast. No abnormal lymph nodes are identified in either axillary or internal mammary region.

Output: (1) Unifocal malignancy of the right breast. If breast conservation therapy is to side, the biopsy marker clip can be used as targeting for preoperative surgical guidance.(2) No MRI evidence for malignancy in the left breast. BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Acute cervical pain with right radiculopathy; paresthesia and weakness. There is reversal of the usual cervical lordosis. The vertebral body heights are preserved. There is multilevel degenerative spondylosis. At C2-C3, there is a small disc-osteophyte complex that slightly indents the ventral aspect of the thecal sac, but there is no significant neural foraminal stenosis. At C3-C4, there is a disc-osteophyte that indents the ventral aspect of thecal sac without spinal cord signal abnormality. Uncovertebral arthropathy results in moderate left and mild right foraminal stenoses. At C4-C5, a disc-osteophyte complex indents the spinal cord without associated signal abnormality. Uncovertebral arthropathy results in mild bilateral neural foraminal stenoses. At C5-C6, a disc-osteophyte complex indents the ventral aspect of thecal sac. Left more than right uncovertebral arthropathy results in moderate left and mild right neural foraminal stenoses. At C6-C7, a disc-osteophyte results in no significant spinal canal stenosis, but uncovertebral and facet arthropathy result in severe left and mild right neural foraminal stenoses. At C7-T1 a disc-osteophyte complex eccentric to the right result in no significant spinal canal stenosis, but there is severe right and moderate left neural foraminal stenoses. At T1-T2, facet arthropathy results in mild bilateral neural foraminal stenoses. The vertebral body heights are preserved. The paraspinal soft tissues are unremarkable. There is patchy T2 hyperintensity in the pons, which may represent chronic small vessel ischemic disease.

Output: Multilevel degenerative cervical spondylosis, including mild C3-C4, C4-C5, and C5-C6 spinal canal stenosis and neural foraminal stenoses that are most pronounced on the right at C7-T1, and on the left at C3-C4, C5-C6, C6-C7, and C7-T1.


Instruction: Generate impression based on findings.

Input: 52-year-old with history of IDC/DCIS status post lumpectomy. Tumor close to margin. Evaluate for residual disease. There is scattered fibroglandular tissue in both breasts.Minimal parenchymal enhancement is noted bilaterally.Postoperative changes in the right upper-outer breast from prior lumpectomy. There is a small residual seroma measuring 6 mm in diameter. Surrounding the cavity is a thin uniform rim of expected postoperative enhancement. In aggregate the enhancement and collection measures 10 mm in diameter. No suspicious nodular or masslike enhancement adjacent to the operative bed.Both breasts contain scattered foci of parenchymal enhancement in a symmetric distribution.Scattered borderline enlarged right axillary lymph nodes with preserved fatty hila and smooth cortices are likely reactive. No abnormality in the left axilla or internal mammary chain.

Output: 1. Postoperative changes from lumpectomy without suspicious enhancement adjacent to the seroma.2. Symmetric scattered foci of parenchymal enhancement bilaterally. Given the distribution and bilaterality this is likely benign, but short-term follow-up MRI in 6 months is recommended to this assess stability.BIRADS: 3 - Probably benign finding.RECOMMENDATION: 3B - Followup at Short Interval (1-11 Months).


Instruction: Generate impression based on findings.

Input: 72 years Male (DOB:11/13/1943) PROVIDER/ATTENDING NAME: JYOTI D PATEL JYOTI D PATEL The CSF spaces are appropriate for the patient's stated age with no midline shift. There are ring-enhancing lesions present within the brain. One in the left inferior frontal gyrus measures 15 x 16 mm axial dimensions. One in the left orbital gyrus measures 10 x 7 mm axial dimensions.

Output: There are 2 lesions in the left frontal lobe which are suspicious for metastatic disease. No other lesions are appreciated within the brain parenchyma.


Instruction: Generate impression based on findings.

Input: Preoperative planning for meningioma. There is a left cavernous sinus and petroclival dural-based mass that measures up to at least 3 cm. There is associated marked mass effect upon th left pons. There is patchy high T2 signal in the adjacent brainstem as well. There are postoperative findings related to prior left temporal craniotomy with encephalomalacia in the left anterior temporal lobe. There is a right transfrontal ventricular catheter. The ventricles are unchanged in size and configuration.

Output: Preoperative planning MRI shows a left cavernous sinus and petroclival meningioma with marked mass effect upon the left pons and associated vasogenic edema.


Instruction: Generate impression based on findings.

Input: 49-year-old male with acute medial knee pain following twisting injury of the right knee. Evaluate for meniscal injury. MENISCI: The lateral meniscus appears intact. There is intermediate signal intensity within the posterior horn of the medial meniscus along its superior fibers, suggesting fraying/degenerative tearing. The peripheral margin of the posterior horn of the medial meniscus is also irregular suggestive of tearing in the vascular zone. The anterior horn of the medial meniscus appears intact. There is a small amount of signal intensity within the body of the medial meniscus indicating degeneration, but we see no discrete tear.ARTICULAR CARTILAGE AND BONE: There is edema within the medial aspect of the tibial plateau. Best seen on images 12, 13 and 14 of series 6, is a linear subchondral focus of low signal intensity within the medial aspect of the medial tibial plateau, suspicious for a small subchondral fracture. There is near full-thickness to full-thickness articular cartilage degeneration along the medial femoral condyle above the posterior horn of the medial meniscus extending posteriorly. There is also a focal full-thickness defect of the articular cartilage of the lateral femoral condyle above the posterior horn of the lateral meniscus. There is a small intra-articular osteophyte along the lateral femoral condyle more anteriorly above the anterior horn of the lateral meniscus. Moderate articular cartilage degeneration affects the patella as well as foci of near full-thickness to full-thickness articular cartilage degeneration affecting the femoral trochlea. There are small tricompartmental osteophytes. LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: There is an ossicle within the proximal patellar tendon which may reflect old trauma. The quadriceps and patellar tendons are otherwise unremarkable.ADDITIONAL

Output: 1. Edema within the medial tibial plateau may represent a contusion. There is a small linear subchondral focus within the medial tibial plateau which is suspicious for a small subchondral fracture.2. Tricompartmental osteophyte formation with articular cartilage degeneration/defects as described above.3. Fraying/degenerative tearing of the superior fibers of the posterior horn of the medial meniscus and possible tearing of the peripheral fibers of the vascular zone.4. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Pancreatic neuroendocrine tumor since 2011 with hepatic metastatic resection July 2015. ABDOMEN:LIVER, BILIARY TRACT: Posttreatment changes of segment 8. There is very faint ill-defined reticular enhancement superior to the cavity (series 1403/71) which demonstrates no abnormal restricted diffusion or T2-weighted signal hyperintensity, likely treatment related. Nonenhancing hypointense focus in segment 3 of the liver is unchanged. The liver is otherwise normal in size, signal intensity and enhancement without biliary ductal dilatation or vascular abnormality.Cholelithiasis without cholecystitis.SPLEEN: Status post splenectomy.PANCREAS: Status post distal pancreatectomy without a suspicious lesion or pancreatic ductal dilatation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Stable post-treatment changes of segment 8 with marginal likely treatment-related faint enhancement. No suspicious liver lesion.


Instruction: Generate impression based on findings.

Input: Patient used prophylactic antibiotics before and after the procedure as prescribed. The patient received antibiotic prophylaxis with oral Ciprofloxacin 500mg and Keflex 500 mg. The patient took 1 tablet of Ciprofloxacin 500mg the night before and morning of the procedure. The patient also took 2 tablets of Keflex 500 mg the morning of the procedure. After the procedures, the patient will take 2 tablets of Ciprofloxacin 500mg and 2 tablets of Keflex 500 mg.Following the discussion of the risks, benefits, and alternatives of the procedure, informed consent was obtained.  Dynatrim was used to localize the left mid gland peripheral zone of the prostate at the site of the T2 hypointense lesion. Using the Dynatrim guidance system an 18-gauge MR- compatible needle was inserted into the left side of the prostate. Upon confirmation of the tip of the needles close to the suspected lesion, MR guided biopsy using an 18 gauge biopsy needle was performed and 3 cores were obtained.Dynatrim was used to localize the left apex peripheral zone of the prostate at the site of the T2 hypointense lesion. Using the Dynatrim guidance system an 18-gauge MR- compatible needle was inserted into the left side of the prostate. Upon confirmation of the tip of the needles close to the suspected lesion, MR guided biopsy using an 18 gauge biopsy needle was performed and 3 cores were obtained.Dynatrim was used to localize the left apex transition zone of the prostate at the site of the T2 hypointense lesion. Using the Dynatrim guidance system an 18-gauge MR- compatible needle was inserted into the left side of the prostate. Upon confirmation of the tip of the needles close to the suspected lesion, MR guided biopsy using an 18 gauge biopsy needle was performed and 2 cores were obtained.The cores were hand delivered to the pathology lab.The patient tolerated the procedure well and was discharged without any immediate complications.ESTIMATED BLOOD LOSS: Less than 5 cc.

Output: Successful core-biopsies of the left mid gland peripheral zone, left apex peripheral zone and left apex transition zone prostate gland lesions.


Instruction: Generate impression based on findings.

Input: Right thumb pain and swelling LIGAMENTS: The ulnar collateral ligament of the thumb is intact. There is thickening and increased signal the radial collateral ligament is appreciated on series 4 image 12/17. There is no definite full-thickness tear however.TENDONS: No significant abnormality noted. BONES: There is mild radial subluxation of the proximal phalanx in relation to the metacarpal which may be positional or related to ligamentous laxity.ADDITIONAL

Output: Increased signal and thickening of the radial collateral ligament of the thumb suggesting possible partial tear and/or scarring. The ulnar collateral ligament is intact.


Instruction: Generate impression based on findings.

Input: Evaluate for meniscus or cartilage damage. Patient experiencing locking symptoms while walking and unable to extend. MENISCI: The posterior and anterior horns of the medial and lateral menisci demonstrate normal morphology and are without evidence of full-thickness tear. There is intermediate signal within the posterior horn of the medial meniscus, which does not meet criteria for tear and most likely represents vascularity.ARTICULAR CARTILAGE AND BONE: The bone marrow signal is normal. The articular cartilage of the medial, lateral and patellofemoral compartments is intact.LIGAMENTS: The anterior and posterior cruciate ligaments are intact. The medial and lateral collateral ligament complexes are intact.EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Minimal joint effusion, decreased from prior, with no other abnormality identified.


Instruction: Generate impression based on findings.

Input: Female, 40 years old, with facial paralysis and leg numbness. Evaluate for demyelination. Brain:The cerebral and cerebellar hemispheres and brainstem show normal signal intensity and morphology. No restricted diffusion is seen.No evidence of parenchymal edema, mass, or mass effect is seen. There is no evidence of intracranial hemorrhage or abnormal extra-axial fluid. The ventricular system is normal in caliber and morphology. Signal intensity of the bone marrow is unremarkable. No significant abnormalities of the paranasal sinuses are detected.C-spine:Alignment is anatomic. Vertebral body morphology and signal characteristics are normal.Allowing for mild motion degradation, the visualized spinal cord demonstrates normal signal intensity and morphology. No focal lesions are detected.Minimal degenerative disc disease is present at C6-7 with a small right paracentral posterior disc osteophyte complex. No significant spinal canal or neuroforaminal stenosis is detected at any level.

Output: No lesions are evident in the brain or cervical spine which would be suggestive of demyelinating disease.


Instruction: Generate impression based on findings.

Input: The risks (including, but not limited to, those of bleeding, infection, allergic reaction, temporary nerve block, pain, and inability to access the joint) and of the procedure were explained to the patient, and informed written consent was obtained. A pre-procedural “time-out” form was completed.The patient was placed supine on the fluoroscopy table. The right hip was localized fluoroscopically, and a spot radiograph was obtained. The course of the femoral artery was noted on the patient's skin using an ink marker. The skin was cleansed and covered with a sterile drape. The skin and subcutaneous tissues were anesthetized with 1% lidocaine using 25-gauge and 22-gauge needles.Under fluoroscopic guidance, a 20-gauge spinal needle was advanced into the joint. Attempted aspiration yielded no fluid. Next, 15 ml of a mixture of Omnipaque 240 (to confirm the intra-articular position of the needle), normal saline and lidocaine were injected into the joint. Contrast opacified the joint in the expected manner. A spot radiograph was obtained for documentation. The needle was withdrawn. Blood loss was negligible (<1cc), and patient tolerated the procedure well without immediate complication. An adhesive bandage was placed on the patient’s skin. Routine post procedure instructions were communicated to the patient. The patient was escorted to the MRI suite for further imaging in stable condition. Please refer to the subsequent MRI report for further information.Exposure time: 1:01 minutes

Output: Successful injection of fluid into the right hip for subsequent MR arthrography. MRI to follow.


Instruction: Generate impression based on findings.

Input: 11-year-old male w/ pain x 1 month, evaluate for OCD versus fracture There is increased T2 signal and low T1 signal within the epiphysis of the lateral epicondyle of the humerus without discrete fracture line or osteochondral defect. Mildly increased T2 signal within the proximal olecranon is also noted. A small amount of fluid is present within the joint. The extensor and flexor tendons and musculature about the elbow appear normal.

Output: Edema within the epiphysis of the lateral humeral epicondyle and to a lesser extent in the olecranon may represent contusion or overuse injury. No discrete fracture line or osteochondral defect.


Instruction: Generate impression based on findings.

Input: Clinical question: Neck pain. Signs and symptoms: Neck pain. Nonenhanced cervical MRI:There is normal anatomical alignment the vertebral column.The signal intensity of vertebral column demonstrate changes secondary to degenerative disease and unremarkable otherwise.There is normal caliber and signal intensity of the cervical and upper most visualized thoracic cord.Foramen Magnum and is unremarkable.C2 -- C3 is unremarkable.C3 -- C4 demonstrate mild degenerative changes and unremarkable otherwise.C4 -- C5 demonstrate mild degenerative changes. There is mild asymmetric left uncovertebral hypertrophic change with resultant mild compromise of the left neural foramina. No spinal stenosis.C5 -- C6 demonstrate mild degenerative changes with resultant moderate right neural foraminal compromise and no central spinal stenosis.C6 -- C7 demonstrate moderate degenerative changes, there is a shallow broad-based disk protrusion and hypertrophic spur which results in partial effacement of the ventral subarachnoid space however without spinal stenosis. Mild to moderate bilateral ligamentum flavum hypertrophy is also detected.C7 -- T1 demonstrate minimal degenerative disease and unremarkable otherwise.The uppermost visualized thoracic spine and thoracic cord to T4 level is unremarkable.

Output: 1.Mild-to-moderate degenerative changes of cervical spine without a meniscal central spinal stenosis at any level as detailed.2.Degenerative changes however results in mild to moderate neuroforaminal compromise as detailed per level above.


Instruction: Generate impression based on findings.

Input: Headache.IMAGE ACQUISITIONS: 5-mm contiguous axial images of the brain without contrast infusion. Low-attenuation lesion in the peripheral aspect of right cerebellar hemisphere or in the extra-axial space adjacent to the right cerebellar hemisphere measures approximately 19 x 12 mm transverse by AP. This could represent an arachnoid cyst but is in an atypical location for arachnoid cyst. Consider follow-up MRI of the brain before and after gadolinium to definitively exclude cystic mass.There are moderate chronic ischemic/degenerative changes of cerebral white matter. There is no hydrocephalus. There are no subdural fluid collections. Left parieto-occipital scalp swelling is noted. There is no depressed calvarial fracture.

Output: 1.No acute intracranial hemorrhage.2.Moderate chronic ischemic/degenerative changes.3.Posterior fossa cystic appearing lesion. Consider MRI for further evaluation.


Instruction: Generate impression based on findings.

Input: 57-year-old male with periorbital swelling. Please evaluate for signs of orbital cellulitis. Limited intracranial images show no evidence of intracranial hemorrhage or edema. Ill-defined focus of increased attenuation within the sella seen throughout the noted images may be related to volume averaging. With appropriate clinical history a dedicated pituitary MRI may be considered.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.ORBITS: Mild preseptal and periorbital soft tissue inflammatory changes are noted without evidence of discrete focal fluid collection to suggest abscess. The retro-orbital fat remains intact without evidence of infiltration. Optic nerve sheath complex appears unremarkable.

Output: Preseptal and periorbital mild soft tissue swelling without evidence of retro-orbital extension.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for lesion. Signs and symptoms: Neuropathy. Pre and post enhanced brain MRI:Negative diffusion weighted series.There is no evidence of congenital anatomical anomaly of the brain.There is also normal signal intensity of brain parenchyma on all MRI sequences.There is however prominence of bilateral hemispheric cortical sulci and cerebellar-vermian folia as well as mild to moderately enlarged ventricular system for patient's stated age of 28 concerning for underlying parenchymal volume loss.Anatomical variation of midline cisterna magna is detected.Post enhanced images demonstrate no detectable abnormal parenchymal or leptomeningeal enhancement.Calvarium demonstrate normal signal intensity and without abnormal enhancement.The signal void of major intracranial arterial branches are identified.The signal intensity of intracranial venous sinuses is within normal and with normal pattern of enhancement.Unremarkable images through the orbits and including axial fat sat post enhanced series.Paranasal sinuses and bilateral mastoid air cells and middle ear cavities demonstrate normal pneumatization signal pattern.

Output: 1.Examination demonstrates generalized prominence of cortical sulci, ventricular system and mildly of the cerebellar/vermis folia for patient's stated age of 28 and concerning for underlying parenchymal volume loss.2.There is however no detectable signal abnormality of the brain on any of the MRI sequences and no detectable abnormal enhancement.3.Unremarkable calvarium, orbits, paranasal sinuses and mastoid air cells.


Instruction: Generate impression based on findings.

Input: 46-year-old woman history of right breast excisional biopsy with pathology showing LCIS and atypical lobular hyperplasia presents with palpable abnormality in the right breast, subsequently biopsied with pathology showing invasive lobular carcinoma. Subsequent MRI identified additional lesion also biopsied revealing invasive lobular carcinoma. Patient is status post mastectomy 7/16/2015. Biopsy of the mastectomy specimen is requested to help identify a lock shaped clip placed in the right breast index mass. On review of the prior studies, there are three (3) biopsy clips identified in the right breast. A lock-shaped clip denotes the palpable right index right breast cancer which was biopsied under ultrasound guidance. An S shaped clip denotes the additional lesion identified on MRI. An X shaped clip denotes site of previous benign biopsy. Orthogonal digital specimen radiographs of the right breast specimen and fragments revealed the fibroglandular tissue and multiple surgical clips. No clip is seen within the specimen. Additional radiograph of 36 pathology slides demonstrates breast tissue with few calcifications. No clip is seen.

Output: No lock clip seen in the right breast specimen, tissue fragments and pathology slides.


Instruction: Generate impression based on findings.

Input: Hodgkin's lymphoma with worsening left shoulder pain ROTATOR CUFF: No significant abnormality noted.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: No significant abnormality noted.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: Normal MRI of the left shoulder.


Instruction: Generate impression based on findings.

Input: S/p ventriculoscopy. Possible HCP. Examination demonstrates post operative changes of ventriculoscopy, including right frontal burr hole and air in the right frontal region and left frontal horn. A right frontal linear low density is present along the previous catheter tract. A cyst with peripheral calcification is present in the region of the pineal gland, which is unchanged in size from prior brain MRI. There is no intracranial hemorrhage, mass, midline shift or abnormal extra-axial fluid collection. The ventricles are normal in size and are symmetric. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. Expected postoperative change of ventriculoscopy. No evidence of a hydrocephalus or hemorrhage.2. Pineal cyst.


Instruction: Generate impression based on findings.

Input: 52 year old male with a history of intermittent AV dissociation due to cardiac sarcoid status-post pacemaker, non-sustained ventricular tachycardia and premature ventricular contraction status-post ablation referred for cardiac MRI. Left VentricleThe left ventricle is normal in size and mildly reduced in systolic function. The overall LV ejection fraction is 45%, the LV end diastolic volume index is 82 ml/m2 (normal range: 74+/-15), the LVEDV is 206 ml (normal range 142+/-34), the LV end systolic volume index is 45 ml/m2 (normal range 25+/-9), the LVESV is 114 ml (normal range 47+/-19), the LV mass index is 30 g/m2 (normal range 85+/-15), and the LV mass is 76 g (normal range 164+/-36). There is hypokinesis of the basal septal wall.There is patchy, transmural late gadolinium enhancement in the mid to apical anterior/anterolateral wall that suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is normal sized. Right VentricleThe right ventricle is normal in size and mildly reduced in systolic function. The overall RV ejection fraction is 45%, the RV end diastolic volume index is 76 ml/m2 (normal range 82+/-16), the RVEDV is 191 ml (normal range 142+/-31), the RV end systolic volume index is 42 ml/m2 (normal range 31+/-9), and the RVESV is 105 ml (normal range 54+/-17). There is a focal area of late gadolinium enhancement in the right ventricle free wall and on the RV-portion of the anteroseptum. 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 mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size and mildly reduced in systolic function (LVEF 45%). There is hypokinesis of the basal septal wall.2. The right ventricle is normal in size and mildly reduced in systolic function (RVEF 45%).3. There is patchy, transmural late gadolinium enhancement in the mid to apical anterior/anterolateral wall. There is a focal area of late gadolinium enhancement in the right ventricle free wall and anteroseptum. These findings are consistent with myocardial damage (either fibrotic or inflammatory) associated with cardiac sarcoidosis.4. The right atrium is mildly dilated.5. There is mild tricuspid regurgitation.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Patient is 17 month old female with history of intractable seizure disorder. Status post right frontal lobectomy. Now with right subdural hematoma and 4 minute generalized seizure o/n Large area of low density in the right frontal lobe with minimal air is believed to represent postoperative changes of patient's given history of right frontal lobectomy. Large frontal craniotomy on the right which extends across the midline is also noted. The bony flap appears fragmented and may represent associated fracture. Please correlate with surgical history. This examination is compared with prior MRI examination which makes evaluation of bony structures difficult however no definitive evidence of similar findings of fragmented bony flap was detected. The comparison CT examination is a pre- surgical study.Extra-axial fluid collection under the craniotomy flap has mixed density and is consistent with epidural hematoma.There is evidence of mass-effect by the above findings however no definitive evidence of midline shift is detected.

Output: 1.Changes in the right frontal lobe with no hemorrhage are believed to represent postoperative change.2.Large epidural collection under the craniotomy flap consistent with hemorrhage.3.The bony flap is fragmented which may be postsurgical change however I cannot entirely rule out fracture.


Instruction: Generate impression based on findings.

Input: 70-year-old male with ultrasound showing pancreatic lesions ABDOMEN:LIVER, BILIARY TRACT: Status post liver transplant and portal vein stent with with associated susceptibility artifacts. Hypertrophy of the left lobe of the liver and fissural prominence may represent cirrhosis. Subcentimeter T2 hyperintense lesions in segment two and five compatible with liver cysts. Trace subhepatic fluid. SPLEEN: Trace amount of perisplenic fluid. Nonenhancing T1 isointense lesion in the spleen.PANCREAS: Lobulated cystic lesion in the mid body of the pancreas measures 11 x 8 mm with identifiable communication with the main pancreatic duct. An additional 6 x 7 mm cystic lesion in the head of the pancreas with identifiable communication with the main pancreatic duct.A 4 x 5 mm cystic outpouching from the proximal main pancreatic duct, just prior to the ampulla, is also identified. No associated abnormal enhancement is associated with these lesions. The main pancreatic duct is normal in caliber. ADRENAL GLANDS: Small left adrenal gland nodule measuring 8 x 9 mm with signal dropout on out of phase compatible with an adenoma.KIDNEYS, URETERS: There is a 1.4 x 1.4 cm renal cyst in the right superior pole.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Diastases of the rectus abdominal muscles.OTHER: No significant abnormality noted.

Output: 1.Multiple cystic pancreatic lesions communicating with the main pancreatic duct compatible with IPMN without concerning features as described above.2.Trace perisplenic and perihepatic ascites.


Instruction: Generate impression based on findings.

Input: 55 year old man with history of OHT on 10/26/12, referred for cardiac MRI as part of annual ischemic/allograft vasculopathy evaluation.MEDICATIONS: amlodipine, synthroid, Toprol XL, pravastatin, prograf. First Pass PerfusionDuring hyperemia, no perfusion defects were present. Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable.Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 65%, the LV end diastolic volume index is 53 ml/m2 (normal range: 74+/-15), the LVEDV is 86 ml (normal range 142+/-34), the LV end systolic volume index is 19 ml/m2 (normal range 25+/-9), the LVESV is 30 ml (normal range 47+/-19), the LV mass index is 25 g/m2, and the LV mass is 41 g. There are no regional wall motion abnormalities present. Left AtriumThe left atrium is consistent with post transplant. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 59%, the RV end diastolic volume index is 55 ml/m2 (normal range 82+/-16), the RVEDV is 89 ml (normal range 142+/-31), the RV end systolic volume index is 22 ml/m2 (normal range 31+/-9), and the RVESV is 36 ml (normal range 54+/-17).Right AtriumThe right atrium is consistent with post transplant.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 FindingsSternal wires are noted. 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. No perfusion defects/ "ischemia" present during hyperemia.2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and systolic function (LVEF 65%) without evidence of underlying myocardial fibrosis, inflammation, or infiltration.4. Normal RV size and systolic function (RVEF 59%).I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 53 years Female (DOB: 5/22/1962)Reason: cord lesions vs compression History: prior R Optic neuritis / now R side weaknessPROVIDER NAME: THOMAS J KELLY THOMAS J KELLY MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There are several periventricular white matter lesions present some which are perpendicularly oriented to the lateral ventricles. Some extend to the corpus callosum. These are not associated with any contrast enhancement.There is a vague signal hypointensity present in the central portion of the lower brainstem on susceptibility weighted imaging on postcontrast imaging demonstrates linear enhancement suggesting this represents a vascular structure. It is associated with some T2 signal hyperintensity. It's possible this represents capillary telangiectasiaNo abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate some minor mucosal thickening in the left maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI cervical spine:There is T2 signal hyperintensity within the cervical spinal cord extending from the C2-3 disc space level to the C4 vertebral body level measuring 5 x 26 mm in sagittal dimensions. It predominantly involves the right hemicord posteriorly. It appears to be associated with some vague enhancement that should be noted that the post contrast imaging is degraded by patient motion. There is a lesion nearly contiguous with the above described lesion present within the cervical spinal cord at the C2 vertebral body level which is also suspected to be associated with contrast enhancement.The cervical vertebral bodies are appropriate in overall alignment and height. There is multilevel disc desiccation present. There are foci of T1 signal hyperintensity within the C2, C3 and C5 vertebral bodies as well as the T2 and T3 vertebral bodies which most likely represent vertebral body hemangiomas.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina. There is a mild disc bulge present at this level.At C4-5 there is no significant compromise to the spinal canal or neural foramina. There is a mild disc bulge present at this level.At C5-6 there is no significant compromise to the spinal canal or neural foramina. There is a small left lateral recess disc protrusion at this level associated with some uncovertebral osteophytes and mild encroachment of the nerve roots at the left lateral recess.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.There are upper cervical spinal cord lesions present associated with some suspected enhancement following contrast administration which would be suggestive of a subacute or acute demyelinating plaques. Some the post contrast imaging of the cervical spine is degraded by patient motion which may confound interpretation of contrast enhancement.2.There are are several periventricular white matter lesions present some which are perpendicularly oriented to the lateral ventricles and extending to the corpus callosum. There are number is somewhat limited. Demyelination is certainly a consideration here3.Findings raise the question of capillary telangiectasia versus a venous anomaly within the lower brainstem.4.There are some mild degenerative changes present in the cervical spine without significant compromise to spinal canal or exiting nerve roots. This is worse at C5-6 where there is some mild encroachment of left-sided exiting nerve roots.


Instruction: Generate impression based on findings.

Input: 42-year-old male with new onset seizure. History of left frontal gliosarcoma status post resection. Again seen are extra-axial air and other changes of left frontal craniotomy. There is a low attenuation area in the left frontal lobe, likely representing encephalomalacia and edema. The presence of residual tumor cannot be evaluated on a non-contrast examination. There is mass effect on the left lateral ventricle, not significantly changed from prior MRI.There is no evidence of intracranial hemorrhageThe visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Post surgical changes with low attenuation area in left frontal lobe representing edema/encephalomalacia. The presence of residual tumor cannot be evaluated on a noncontrast examination.


Instruction: Generate impression based on findings.

Input: 35-year-old female with right upper quadrant pain. ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis with pericholecystic fluid. No choledocholithiasis. Trace dependent perihepatic fluid. No intrahepatic or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: The right kidney is surgically absent. Small cyst in the left kidney.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Findings suspicious for acute cholecystitis. No choledocholithiasis.


Instruction: Generate impression based on findings.

Input: 50-year-old female with NMO. Evaluate for PML. There are foci of FLAIR hyperintensity in the left posterior frontal deep white matter (series 701, image 59) as well as posterior to the left lateral ventricle (series 701, image 54) that are larger than on the previous exam. Please note that the imaging parameters are not the same which may account for a portion of the difference in size. There is no enhancement associated with these lesions. Subtle increased FLAIR hyperintensity along the lateral ventricular margin is more prominent on the right than on the left but has decreased bilaterally since the previous exam. The previously seen ependymal and subependymal enhancement has regressed. There is no abnormal intracranial enhancement. There are no new FLAIR lesions. The lesion in the left pons is not seen on today's exam.There is no evidence of intracranial hemorrhage or mass. 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: 1.Increased size of periventricular T2 hyperintense lesions as described above. A portion of the size difference may be due to differences in imaging parameters. 2.The previously noted lesion in the pons is not seen. No new lesions are identified.3.Epididymal and subependymal enhancement has regressed. 4.Findings are compatible with the known diagnosis of NMO.5.No evidence of PML.


Instruction: Generate impression based on findings.

Input: Odynophagia, weight loss. History of neutropenia; evaluate for sinus infection. Sinus CT :Polypoid mucosal thickening is seen in left maxillary sinus. No air fluid level is seen.Neck CT:There is poor contrast opacification which may limit the sensitivity of the study.There are large CSF density lesions in bilateral middle cranial fossa, which may represent arachnoid cysts. There is compression of the adjacent brain parenchyma in the temporal lobes. Further correlation with MRI brain should be considered.No obvious mass or adenopathy based on size criteria is seen in the neck. There is subtle asymmetric thickening of the right aryepiglottic fold of uncertain clinical significance. No obvious mass is seen.There is mild thickening of the esophagus, but this can be secondary to lack of distention.Atherosclerotic changes are seen in the carotid arteries.The right submandibular gland is atrophic.There is severe degenerative disease of the cervical spine. There is anterolisthesis of C2 on C3 and C3 on C4. Disk osteophyte complexes and degenerative disease of the uncovertebral joints and facet joints are seen in multiple levels, resulting in spinal canal and neuroforaminal stenosis, with mild impingement of the spinal cord, and nerve roots.

Output: 1. Polypoid mucosal thickening in the left maxillary sinus.2. Subtle asymmetric thickening of the right aryepiglottic fold of uncertain clinical significance. No obvious mass is seen. Please also correlate with clinical examination.3. Mild thickening of the esophagus may be related to lack of distention. If patient's symptoms persist, barium swallowing study or endoscopic examination of the esophagus should be considered. 4. Large arachnoid cysts in bilateral middle cranial fossa, causing compression of the brain parenchyma. Further evaluation with MRI brain should be considered.5. Severe degenerative disease of cervical spine, with listhesis at multiple levels. There is spinal canal and neuroforaminal stenosis at multiple levels.


Instruction: Generate impression based on findings.

Input: Clinical question: Status post tumor resection. Signs and symptoms: Headache. Pre-and post-enhanced brain MRI:Examination demonstrate expected postoperative changes of a right frontal craniotomy for adrenal tumor. An irregular thin linear band of restricted diffusion surrounding the surgical cavity wall is within expected postop change.Surgical cavity CSF signal intensity and a small amount of expected postoperative hemorrhage layering in the dependent portion of cavity in the right frontal lobe is noted. Surrounding vasogenic edema demonstrate no significant change since prior study.There is significant decreased mass-effect since prior study and draped near complete resolution of midline shift to the left.Small amount of post operative hemorrhage is noted in the dependent portion of bilateral occipital horns.Mildly dilated left lateral ventricle demonstrate no significant change in size since prior study.Post enhanced images demonstrate no convincing evidence of enhancement in the surgical cavity or immediate surrounding parenchyma to suggest residual tumor. Further follow up however tis needed for assessment.

Output: 1.Expected postoperative changes of a right frontal craniotomy for removal of tumor.2.No convincing evidence of residual tumor on this initial postop study. Further follow up is recommended.3.Decreased in overall mass effect secondary to removal of tumor with only trace residual midline shift to the left.4.Stable mildly dilated left lateral ventricle since prior exam.5.Small postoperative blood in the dependent portion of occipital horns.


Instruction: Generate impression based on findings.

Input: 55-year-old male with elevated PSA who presents for evaluation of the prostate. PELVIS:PROSTATE:Prostate Size: 5.3 x 3.6 cmPeripheral Zone: There are 2 foci with abnormal T2 hypointensity with corresponding low ADC signal in the left lateral mid gland and right apex laterally. The right apex lateral lesion demonstrates slight contrast enhancement.Central Gland: Central gland is heterogeneous consistent with benign prostatic hypertrophySeminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: No evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Two foci of abnormal signal may represent neoplasm as above. 2.No evidence of extracapsular extension.


Instruction: Generate impression based on findings.

Input: Pilocytic astrocytoma s/p XRT, craniotomy, and shunting. There are stable post-treatment findings in the left frontal lobe with unchanged confluent T2 hyperintensity surrounding the resection cavity. There is no abnormal intraparenchymal enhancement. Left transfrontal and right transoccipital ventricular shunt catheters are in unchanged positions. There is also a residual shunt catheter fragment in the third ventricle. There is T2 hyperintensity associated with the catheter tracks. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are grossly intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Stable post-treatment findings without evidence of tumor recurrence.


Instruction: Generate impression based on findings.

Input: 54-year-old female with hindfoot valgus and posterior tibial tendinitis. Evaluate for posterior tibial tendon insufficiency. TENDONS: Again seen is deformity of the peroneus brevis tendon consistent with a longitudinal split tear at the level of the distal fibular tip. There is marked thickening and intermediate signal abnormality within the posterior tibialis tendon consistent with moderate to severe tendinosis. There is deformity and increased fluid signal abnormality within the distal inframalleolar tendon indicating a partial thickness/interstitial tear. The extensor tendons appear intact. There is a small amount of fluid within the tendon sheath of the tibialis anterior tendon which may be of no current clinical significance. The Achilles tendon is normal in appearance.LIGAMENTS: The lateral collateral ligament complex appears intact. The distal tibiofibular syndesmotic complex appears intact. The visualized components of the deltoid ligament appear intact. The cervical and interosseous talocalcaneal ligament are poorly visualized due to edema type signal abnormality within the sinus tarsi. ARTICULAR SURFACES AND BONE: There is increased signal abnormality within the body of the talus and calcaneus, most pronounced along the anterior margin of the posterior facet of the subtalar joint, with associated subchondral cyst formation likely degenerative in etiology.ADDITIONAL

Output: 1. Partial thickness tearing of the posterior tibialis tendon and the posterior tibialis tendinosis.2. Longitudinal split tear of the peroneus brevis.3. Signal abnormality within the sinus tarsi suggesting sinus tarsi syndrome.4. Degenerative osteoarthritic changes of the subtalar joint.


Instruction: Generate impression based on findings.

Input: patient with posterior epidural and paraspinous fluid collection. Please aspirate for sampling. 42 yo female Serial CT images obtained during the aspiration procedure demonstrate the needle placement within the fluid collection. Following needle removal images obtained demonstrate no complications . A small amount of air was present in the remaining cavity.

Output: Paraspinous fluid collection aspiration under CT guidance.


Instruction: Generate impression based on findings.

Input: Left hip pain. Assess for left hip labral tear. ACETABULAR LABRUM: Small tear of the anterosuperior labrum is present. Otherwise the labrum is intact.ARTICULAR CARTILAGE AND BONE: Bone marrow demonstrates normal signal characteristics. Alpha angle is within normal limits at approximately 50 degrees. There is no clear offset of the left femoral head neck junction to suggest cam deformity or evidence of over coverage of the acetabulum suggest pincer-type deformity.SOFT TISSUES: No significant abnormality noted. ADDITIONAL

Output: Small anterosuperior labral tear.


Instruction: Generate impression based on findings.

Input: Female, 61 years old, with altered mental status, fever, history of melanoma. Scattered foci of T2 hyperintensity are seen predominantly within the subcortical white matter. No restricted diffusion is seen. No evidence of parenchymal edema or mass effect is detected. There is no pathologic parenchymal or extra-axial enhancement. The ventricles are normal in size and morphology. No findings to suggest acute intracranial hemorrhage or any abnormal extra-axial fluid collection are detected. A mucous retention cyst is evident in the left maxillary sinus.

Output: 1.No definite acute intracranial abnormalities.2.No evidence of intracranial metastases.3.Scattered nonspecific foci of white matter signal abnormality are seen which may represent the sequelae of prior microvascular ischemic disease, demyelinating disease, vasculitis or migraine headache among other etiologies.


Instruction: Generate impression based on findings.

Input: 56 years Male (DOB:2/7/1960)Reason: stroke versus right parietal mass History: left hand numbnessPROVIDER/ATTENDING NAME: KOUROSH J REZANIA KOUROSH J REZANIA There are patchy T2 and FLAIR hyperintense lesions present in the parietal subcortical white matter involving the right parietal subcortical white matter more than the left. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. There is no associated contrast enhancement with these lesions.There is a subgaleal focus of soft tissue thickening present adjacent to the parietal bones bilaterally along the midline measuring approximately 23 x 10 mm axial dimensions. It is associated with susceptibility effect on the susceptibility weighted imaging.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: 1.Periventricular and subcortical white matter lesions of a mild to moderate degree are nonspecific. Most likely these are vascular related. 2.There is no evidence for acute ischemic cerebral infarction.3.Findings are suspicious for hematoma along the subgaleal scalp tissues at the level of the parietal bones at the midline.


Instruction: Generate impression based on findings.

Input: Male 71 years old Reason: evaluation of possible mesothelioma spreading to abdomen History: reevaluation ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. No suspicious intrahepatic lesions. Hepatic veins are patent. Gallbladder and biliary tree are without diagnostic abnormality.SPLEEN: No significant abnormality noted.PANCREAS: Age related fatty atrophy of the pancreasADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right upper pole renal cyst with enhancing internal septations and complexity measures 4.5 x 4.5 cm (image 249/series 10). No hydronephrosis in either kidney.The smaller left renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Extensive thickening of the omentum and peritoneum. The thickened omentum shows restricted diffusion and enhancement. At its widest point the left upper abdominal the omentum measures 3.6 cm in thickness (image 82/series 12).There are scattered upper abdominal ascites.BONES, SOFT TISSUES: Nonspecific mild body wall edema which may be postsurgical.Postsurgical changes in the left thorax.OTHER: No significant abnormality noted.

Output: 1.Findings of extensive upper abdominal omental disease with thickening of the small bowel mesentery with reference lesions provided above.2.Complex right upper pole renal cyst with enhancing septations suspicious for a complex cystic renal neoplasm (cystic renal cell carcinoma)


Instruction: Generate impression based on findings.

Input: Reason: Left proximal arm mass, evaluate for hematoma vs malignancy History: expanding Left upper arm mass Note is made of a 5.1 x 3.4 x 6.8 cm lobulated collection along the anterior aspect of the biceps muscle at the level of the mid diaphysis of the humerus. There is associated peripheral increased signal abnormality on T1-weighted images without definitive enhancement on postcontrast sequences. These findings appear most consistent with a hematoma, however, follow-up examination is recommended to evaluate for interval change/resolution. No additional enhancing lesions are identified. No bone marrow signal abnormality is seen. The imaged musculature of the left shoulder and humerus is normal in appearance.

Output: 6.8 cm lobulated collection along the anterior aspect of the mid diaphysis of the humerus appearing most consistent with a hematoma, particularly in a patient on anticoagulation. However, follow-up examination is recommended to evaluate for interval change and to establish resolution.


Instruction: Generate impression based on findings.

Input: Clinical question: please do Dr. Javed MS protocol. Signs and Symptoms: left sided weakness and tremor Pre and post enhanced brain MRI:There is a tiny focus of FLAIR hyperintensity in the subcortical white matter of right posterior frontal and a small ill-defined focus of FLAIR hyperintensity in the subcortical white matter of right posterior temporal/parietal white matter. A punctate focus of FLAIR hyperintensity is also noted in the subcortical white matter of left frontal lobe. These lesions demonstrate no enhancement. The signal intensity and overall morphology of the brain and without abnormal enhancement.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces, corpus callosum and brain myelination otherwise and without abnormal enhancement.

Output: 1.Tiny subcortical foci of FLAIR hyperintensity in bilateral cerebral hemispheres without abnormal enhancement as detailed. There are no prior exams for comparison.2.Unremarkable pre and post enhanced study otherwise.


Instruction: Generate impression based on findings.

Input: 57 years Female (DOB:2/2/1959)Reason: low back pain, eval for lumbar spine stenosis History: abovePROVIDER/ATTENDING NAME: JAMES M MOK JAMES M MOK 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. There is mild multilevel disk dessication present.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is mild facet and ligamentum flavum hypertrophy at this level.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is mild facet and ligamentum flavum hypertrophy at this level.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.There is a 2cm cyst along the inferior pole of the left kidney.

Output: 1.There are mild degenerative changes in the lumbar spine without compromise to lumbar spinal canal or neural foramina.2.There is a 2cm cyst along the inferior pole of the left kidney.


Instruction: Generate impression based on findings.

Input: Brain MRI:There are numerous T2 hyperintense foci within the supratentorial and infratentorial brain. Several of the periventricular lesions are oriented in parallel fashion to the callosomarginal junction. Infratentorial lesions include lesions within the pons, cerebellar peduncles, cerebellum, and medulla. The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. Cervical spine MRI:Alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign. The visualized paraspinal contents are unremarkable. There are no significant degenerative changes and there are no stenoses.Abnormal T2 hyperintense foci are found within the spinal cord in the following levels: C2, C3 (which is slightly expansile), C3/4, questionable C5 right posterolateral cord, C6, and questionable C7 right lateral cord.

Output: Numerous T2 hyperintense lesions within the supratentorial brain, infratentorial brain, and cervical spinal cord consistent with the provided history of multiple sclerosis.


Instruction: Generate impression based on findings.

Input: 48 year old male with a family history of arrhythmogenic right ventricular cardiomyopathy who is referrer for further evaluation. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 56%, the LV end diastolic volume index is 62 ml/m2 (normal range: 74+/-15), the LVEDV is 152 ml (normal range 142+/-34), the LV end systolic volume index is 27 ml/m2 (normal range 25+/-9), the LVESV is 66 ml (normal range 47+/-19), the LV mass index is 35 g/m2 (normal range 85+/-15), and the LV mass is 86 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. The pre-contrast native myocardial T1 relaxation time is normal (910 ms). Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 54%, the RV end diastolic volume index is 72 ml/m2 (normal range 82+/-16), the RVEDV is 175 ml (normal range 142+/-31), the RV end systolic volume index is 33 ml/m2 (normal range 31+/-9), and the RVESV is 81 ml (normal range 54+/-17). There are no focal aneurysms noted of the right ventricle. Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with normal systolic function (LVEF 56%).2. The right ventricle is normal in size with normal systolic function. (RVEF 54%). 3. Findings not suggestive of arrhythmogenic right ventricular cardiomyopathy.


Instruction: Generate impression based on findings.

Input: 66 years Female (DOB:1/12/1950)Reason: stroke work up History: perioral numbness and body weaknessPROVIDER/ATTENDING NAME: JAMES R. BRORSON JAMES R. BRORSON MRI of the brainThere are 2 subcentimeter foci of diffusion restriction present in the right precentral gyrus along its lateral aspect. These display some contrast enhancement suggests an air in the subacute phase.There are punctate foci of signal loss on susceptibility imaging one located in the right temporal lobe subcortical white matter and one in the right basal ganglia no 1's located in the right occipital lobe subcortical white matter while another couple are located along the left superior frontal gyrus left and right orbital gyri as well as the left temporal lobe.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.A couple small nodules adjacent to the parotid gland probably represent lymph nodes.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. The posterior communicating arteries are intact. The vertebral arteries are similar in size.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries.

Output: 1.Foci of diffusion restriction are present in the right precentral gyrus laterally compatible with subacute foci of infarction.2.There multiple subcortical punctate foci of susceptibility effect which correspond to calcifications on a CT of the head. They are nonspecific suggestive of cysticercosis in the appropriate clinical setting. Please note that punctate calcifications can also be seen with other entities as well3.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: Female, 56 years old, with history of breast cancer and metastases to the brain with left meningeal carcinomatosis, assess for spinal disease. Fine, diffuse leptomeningeal enhancement is seen along the entire spinal cord, the conus and the nerve roots of the cauda equina. Spinal cord morphology is otherwise unremarkable. There is no evidence of significant cord edema. Thick leptomeningeal enhancement is partially visualized along the cerebellum. The CSF along the inferior aspect of the cerebellum may be loculated.No definite evidence of any osseous metastases is seen. T1/T2 hyperintense signal within the T6 vertebral body likely represents a benign hemangioma. Spinal alignment is anatomic and the vertebral body morphology is within normal limits.No significant disc degeneration is seen in the cervical or thoracic spine. In the lumbar spine there is mild disc bulging at L4-5 without significant spinal canal or foraminal stenosis. At L5-S1, facet arthropathy is seen, right side more than left. In addition, there is a bulging disc which results in mild effacement of the ventral thecal sac, moderate left and mild right foraminal narrowing.

Output: 1.Findings compatible with diffuse leptomeningeal carcinomatosis along the spinal cord and conus.2.No definite osseous metastatic lesions are seen.3.Disc degeneration and facet arthropathy at L5-S1.


Instruction: Generate impression based on findings.

Input: 62-year-old man with history of alcoholic cirrhosis, please evaluate for HCC and TIPS patency ABDOMEN:LIVER, BILIARY TRACT: The liver is cirrhotic in morphology with hypertrophied caudate lobe and signal suggestive of fibrosis and siderosis. No foci of abnormal enhancement within the hepatic parenchyma.TIPS is noted enhancing on the postcontrast images, no evidence of occlusive thrombus.Cholelithiasis without evidence of cholecystitis. There is no significant intra or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Cirrhotic liver without suspicious focal hepatic lesion.2.Patent TIPS.3.Cholelithiasis without cholecystitis.


Instruction: Generate impression based on findings.

Input: There are multiple nonspecific foci of T2/FLAIR hyperintensities in the subcortical and periventricular white matter, in the pons, and in the medulla, most likely representing chronic small vessel ischemic changes. These findings are unchanged since the previous study.There are no diffusion or susceptibility abnormalities. The ventricular size is normal. There is no midline shift. Vascular flow voids are unremarkable. The previously demonstrated well demarcated subcortical hyperintensity in the left anterior frontal lobe is unchanged and could represent a small focus of nonspecific CSF filled cyst. The vascular flow voids are unremarkable. The calvarium is unremarkable.

Output: 1. No evidence of any finding that may account for cause of patient's seizure.2. Multiple nonspecific foci of subcortical and periventricular FLAIR and T2 hyperintensities, most likely representing small vessel ischemic changes.


Instruction: Generate impression based on findings.

Input: 60 year-old female with left leg weakness and burning in the anterior right thigh. History of lupus with CNS involvement Study slightly limited due to patient motion.There is mild grade 1 retrolisthesis of L5 relative to S1. Otherwise alignment is anatomic. Vertebral body heights are intact. Signal within the distal cord and conus is normal, ending at L2. There is multilevel disk desiccation with severe degenerative disk disease at T10-T11. There is also severe degenerative disk disease at T11-T12 which is slightly worse than the prior exam. There is increased disk space loss at L5-S1 with a right far lateral annular fissure with also appears increased. There is increased STIR signal along the superior endplate of T12 and increased degenerative marrow signal changes. A Schmorl's node is noted along the inferior endplate of T10. There is mildly heterogeneous marrow signal which likely reflects focal fat. There is mild multilevel facet arthropathy. There is mild epidural lipomatosis at L5 and within the sacrum.T10-T11: On sagittal images only, there is a left paracentral disk extrusion extending caudally 8 mm, increased from the prior exam. Mild ligamentum flavum thickening. Mild to moderate central canal stenosis. Moderate bilateral neural foraminal narrowing is unchanged.T11-T12: Diffuse disk bulge with a left paracentral disk extrusion extending 8 mm caudally. Mild central canal stenosis. Moderate right and mild left neural foraminal stenosis is unchanged.T12-L1 through L3-4: Mild ligamentum flavum thickening. No central or neuroforaminal stenosis.L4-L5: Mild diffuse disk bulge. No central or neuroforaminal stenosis.L5-S1: Moderate diffuse disk bulge with superimposed left foraminal protrusion. Severe right and moderate left neural foraminal narrowing is unchanged. There is encroachment on the right lateral recess and the disk also abuts the left descending S1 nerve root. No central spinal canal stenosis.

Output: 1.Increased severe degenerative disk disease at T10-T11 with increasing disk extrusion at this level. Moderate bilateral neural foraminal stenosis and mild to moderate central canal stenosis at this level is unchanged2.Severe degenerative disk disease, disk extrusion and neuroforaminal narrowing at T11-T12 is unchanged.3.Increased degenerative disk disease at L5-S1 with stable neuroforaminal narrowing, up to severe in degree on the right.4.Additional mild degenerative changes at other levels are stable.


Instruction: Generate impression based on findings.

Input: Status post liver/kidney transplant in February 2005. History of cirrhosis. Evaluate for lesions and hepatic vessel patency. ABDOMEN:LIVER, BILIARY TRACT: Status post liver transplant. The liver morphology is unremarkable. The liver intensity is mildly increased on in phase imaging suggesting iron deposition. The biliary anastomosis is patent without a flow-limiting stenosis appearing similar to the prior study. The hepatic artery is patent.The portal vein is patent. There is partially occlusive chronic thrombus in the superior mesenteric vein, unchanged from 8/12/2013. Hepatic veins are patent.No ascites or other specific stigmata of portal hypertension.No suspicious liver lesion.SPLEEN: Borderline splenomegaly measuring 13 cm.PANCREAS: Pancreas is normal in morphology and signal intensity without a focal lesion.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: End-stage left native kidney. The left iliac fossa transplant kidney appears atrophic with mild hydronephrosis. Right iliac fossa transplant kidney without hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small duodenal diverticulum.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Status post liver transplant without suspicious lesion. No biliary ductal dilatation. The hepatic arteries and portal vein are patent.Chronic partially occlusive SMV thrombus.


Instruction: Generate impression based on findings.

Input: 55 year old with strong family history of breast cancer, brother with breast cancer at age 56, mother with breast cancer at age 84, and paternal grandmother with breast cancer. There is heterogeneous amount of fibroglandular tissue in both breasts.Minimal parenchymal enhancement is noted bilaterally.There are a few cysts in left breast.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for growth of GBM. Patient on TMZ. Compared to prior exam. Signs and symptoms: GBM. Pre-and post enhanced brain MRI:Examination demonstrates further interval decreased size of a focus of enhancing tumor in the left frontal lobe measuring at 5.2 x 9.2-mm compared to prior study measurement of 13.1 x 7.4 mm. surrounding flair hyperintensity consistent with edema is again identified and without appreciably change.There is also interval decrease size of a smaller focus of enhancement in right anterior frontal measuring approximately 4 mm in transaxial dimensions compared to prior study measurement of 7.2 mm. There is no associated surrounding vasogenic edema with this finding. This is a similar observation is prior study.Diffuse patchy confluent foci of flair hyperintensity in the white matter of bilateral cerebral hemispheres (left greater than right) likely secondary to treatment/radiation change however overlapping small vessel ischemic strokes cannot be excluded. This finding remains nearly identical to prior study.No evidence of any additional foci of new edema or abnormal parenchymal/ leptomeningeal enhancement since prior exam. Ventricular system remain within normal size and stable since prior study.

Output: 1.Further interval decreased size of enhancing lesions in the left and right frontal lobes as detailed/measured above.2.Diffuse patchy/confluent foci of flair hyperintensity in bilateral hemispheres white matter (left greater than right) without significant change.


Instruction: Generate impression based on findings.

Input: Thoracic myelogram and post myelogram CT of thoracic spine. No clinical data is provided. Post myelogram CT of thoracic spine:Axial helical CT of thoracic spine from T1 through the T12 after a thoracic myelogram were obtained.Images in both supine and prone position were obtained. Sagittal and coronal reformatted images of both of the series were also obtained.Examination demonstrates slight ectasia of thecal sac at T6 and T7 levels and to a lesser degree slightly superior and inferior to these levels.There is a slight anterior displacement of thoracic cord at this level. Both axial images in supine and prone projection demonstrate a thin layer of contrast anterior to the cord in this region. Be caliber of the cord remains normal otherwise throughout the rest of thoracic region. The exact etiology of this lesion is not clear however possibility of an anatomical variation of mildly ectatic thecal sac with resultant pulsation of CSF on the cord with anterior displacement.Other possibilities of arachnoid cyst within a permeable membrane, thoracic cord herniation through a dural tear or adhesion are considered highly unlikely considering patient's past history to support this diagnosis and the appearance of this finding on myelogram, post myelogram CT and MRI.Comparison off supine and prone images demonstrated no definitive change in the position of the cord however this is not particularly abnormal considering the slightly exaggerated kyphotic deformity of thoracic spine in this patient.

Output: Please see above comments.


Instruction: Generate impression based on findings.

Input: Memory loss. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are mild scattered foci of cerebral white matter T2 hyperintensity. There is mild diffuse cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull and scalp soft tissues are grossly unremarkable. There are bilateral lens implants. There is mild scattered paranasal sinus mucosal thickening. There is a small amount of fluid in the left mastoid air cells.

Output: Mild scattered foci of cerebral white matter T2 hyperintensity, which may represent chronic small vessel ischemic disease and mild diffuse cerebral volume loss, but no evidence of acute intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: 56-year-old male patient with history of prostate cancer status post radical prostatectomy presents with rising PSA. PSA of 0.24 on 09/16/2015. PELVIS:PROSTATE:Prostate Size: Status post prostatectomy.Peripheral Zone: Status post prostatectomy.Central Gland: Status post prostatectomy.Seminal Vesicles: Status post radical prostatectomy.Extracapsular Extension: Not applicable.BLADDER: No significant abnormality noted.LYMPH NODES: No lymphadenopathy.BONES, SOFT TISSUES: No suspicious soft tissue in the surgical bed.OTHER: No significant abnormality noted.

Output: Postsurgical changes from radical prostatectomy without evidence of recurrent or metastatic disease.


Instruction: Generate impression based on findings.

Input: 64-year-old female with history of sinusitis, sleep apnea and left-sided weakness. There is no evidence of intracranial hemorrhage, mass or edema. Scared foci of low density in periventricular, subcortical and deep white matter are seen. These foci are compatible with the findings from the recent MRI.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.SINUS

Output: 1. No evidence of sinus disease.2. Scattered low density foci are compatible with the findings of the recent brain MRI and likely represent small vessel ischemia.


Instruction: Generate impression based on findings.

Input: Reason: r/o structural lesion or infarct History: left sided numbness Exam is limited by motion artifact.There is superficial siderosis of the right cerebral hemisphere predominantly at the convexity with some staining of the sylvian fissure. This likely represents the sequela of prior subarachnoid hemorrhage. No acute intracranial hemorrhage is suspected. No abnormal diffusion restriction. No evidence of intracranial mass, mass-effect, or midline shift. No extra-axial fluid collections. The ventricles, sulci, and cisterns are normal in size without evidence of hydrocephalus. There are nonspecific scattered periventricular and subcortical white matter T2 hyperintensities, which may represent chronic small vessel ischemic disease. There is opacification of the bilateral maxillary sinuses. The imaged orbits are intact. The osseous structures are unremarkable.

Output: 1.No acute ischemia.2.Moderate chronic small vessel ischemic disease.3.Superficial siderosis of the right cerebral hemisphere, predominantly at the convexity, likely sequela of prior subarachnoid hemorrhage.


Instruction: Generate impression based on findings.

Input: Clinical question : evaluate for interval change for punctate hemorrhage/calcification seen on outside head CT. Signs and symptoms: 21 month old with sickle cell trait, history of altered mental status, staring spells and questionable evaluate for interval change of punctate hemorrhage or calcification.COMPARISON none Nonenhanced head CT:There are relatively symmetrical punctate and linear calcifications bilateral basal ganglia calcification. There is no associated edema or encephalomalacia with these findings. The coronal and sagittal reformatted images suggest that the calcifications appear to be along a similar course as of the lenticulostriate arteries. The exact etiology of this findings are not clear. Follow-up with an enhanced MRI is recommended to better assess these findings and in particular the surrounding brain parenchyma. There may be slight prominence of cortical sulci for patient's stated age of one year. There is no evidence of intracranial hemorrhage, edema, mass effect, midline shift or hydrocephalus. There is no evidence of any additional calcification in the brain parenchymal or the subependymoma region.Calvarium is intact. Mastoid air cells, middle ear cavities and limited view of the orbits are unremarkable. The

Output: Symmetrical bilateral linear calcification of basal ganglia with no associated edema or encephalomalacia of unknown etiology. Recommend follow-up with an enhanced MRI. Please see above comments.


Instruction: Generate impression based on findings.

Input: Spinal stenosis Five lumbar type vertebral bodies are presumed to be present. Bone marrow signal is benign. The conus medullaris is normal in position. Vertebral body heights are within normal limits. There is minimal retrolisthesis of L2 on L3 and L3 on L4 and grade 1 anterolisthesis of L4 and L5. There is mild left lateral subluxation of L4 and L5. There is mild levoscoliosis of the lumbar spine with apex at the L4-L5 level. Disc desiccation with vacuum phenomena noted at the L2-L3, L3-L4, and L4-L5 levels. There is particular height loss involving the right aspect of the L4-L5 disc space. Small Schmorl's nodes are evident in the lower thoracic spine as well as at the inferior endplate of L2. Advanced degenerative changes at the T11-T12 level are also noted. These findings are also evident on prior CT. Mild enlargement of the spinous processes is noted which are contacting, with T2 hyperintensity noted at the L3-L4 interspinous level; findings suggestive of bursitis/Baastrup's disease. Individual levels as below:L1-L2: Minimal disc bulge, facet arthropathy, and ligamentum flavum thickening. No significant spinal canal or neural foraminal stenosis. L2-L3: Minimal disc bulge, facet arthropathy, and ligamentum flavum thickening. No significant spinal canal or neural foraminal stenosis. L3-L4: Disc bulge with a component of right paracentral extrusion. There is also facet arthropathy and prominent ligamentum flavum thickening. There is moderate to severe central spinal canal stenosis and effacement of the right lateral recess. There is moderate to severe right and mild to moderate left neural foraminal stenosis.L4-L5: There is disc uncovering and mild bulge as well as a small right paracentral protrusion. There is advanced bilateral facet arthropathy as well as ligamentum flavum thickening. There is moderate to severe spinal canal stenosis. There is mild to moderate right and minimal left neural foraminal stenosis.L5-S1: Mild disc bulge. There is advanced bilateral facet arthropathy. No significant central canal stenosis. There is mild to moderate left neural foraminal stenosis. Right neural foramen is patent. Paraspinous soft tissues demonstrate fatty atrophy involving the lower lumbar paraspinous musculature, but are otherwise unremarkable. Small right renal cyst.

Output: 1. Advanced multilevel degenerative changes with moderate to severe spinal canal stenosis at the L3-L4 and L4-L5 levels. Multilevel neural foraminal stenosis is worst at the right L3-L4 level, where there is also effacement of the right lateral recess related to right paracentral disc extrusion. Additional levels as above.2. Advanced facet arthropathy at the L4-L5 and L5-S1 levels. There is mild left lateral subluxation as well as grade 1 anterolisthesis of L4 on L5; there is also lumbar levoscoliosis with apex at this level.3. Contacting spinous processes at L3-L4 with interspinous T2 hyperintensity suggestive of Baastrup's disease..


Instruction: Generate impression based on findings.

Input: 53-year-old female with persistent diarrhea and weight loss. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology. Hepatomegaly. No focal, enhancing lesion. No biliary ductal dilation. Stable subcentimeter cyst in left hepatic lobe.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No abnormal bowel wall thickening or enhancement is seen. Please note that evaluation of a small portion of the ascending colon at the hepatic flexure is limited due to susceptibility artifact from probable surgical clip.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: As above.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No bowel abnormality to explain the patient's symptoms.