Instruction: Generate impression based on findings.

Input: 35-year-old female with recently diagnosed breast cancer, concern for abscess post biopsy. There is heterogeneous amount of fibroglandular tissue in both breasts.Marked parenchymal enhancement is noted bilaterally, a limitation to the exam. The enhancing index right breast mass at 1:00 measures 3.9 x 3.7 x 3.8 cm. Medial to the mass there is a peripherally enhancing collection measuring 2.3 x 1.3 x 1.7 cm with adjacent skin thickening and central susceptibility artifact suggesting clip migration to within the collection.Two possible satellite lesions posterior to the index mass measure up to 1.5 and 0.9 cm respectively. There is an enlarged heterogeneously enhancing right axillary lymph node which measures 2.9 x 1.9 cm.In the left breast there is a 1.1 x 0.7 x 1.1 cm small enhancing mass at 12:00. At 11:00 in the left breast an additional small enhancing 1.0 x 0.9 x 1.1 cm mass is noted.Note is made of a likely hepatic cyst.

Output: 1. Superficial loculated enhancing fluid collection/abscess medial to the index cancer with adjacent inflammatory changes as described above. The biopsy clip appears to have migrated into the collection. 2. Index right breast cancer measures up to 3.9 cm and has two possible satellite lesions present posteriorly. As well, a suspicious right axillary lymph node is seen. MRI directed ultrasound is recommended. 3. Small enhancing masses in the upper left breast for which second look ultrasound is recommended. Findings were discussed with Dr. Jaskowiak.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: 25 years Female (DOB: 1/9/1991)Reason: Chiari malformation , new symptoms, lumbar peritoneal shunt, pseudotumor cerebri, new headaches, evaluate for changes. Please do with csf flow History: new headachePROVIDER NAME: DAVID M. FRIM DAVID M. FRIM MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. The patient status post posterior fossa decompression. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.An old ventriculostomy tract is identified coursing the right frontal lobe to the right lateral ventricle.On susceptibility imaging there are punctate foci of signal loss present in the cerebellar hemispheres as well as the brainstem.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.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal lesions are identified in the cervical spine. There is mild reversal of the normal cervical curvature present which could be positional or related to muscle spasm. No obstruction at the level of the foramen magnum is appreciated.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.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.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: Status post Chiari decompression without evidence for syrinx or ventriculomegaly


Instruction: Generate impression based on findings.

Input: There is a 6 mm solitary, focal, ovoid T2 hyperintensity within the mid right temporal lobe without associated mass effect, restricted diffusion, or susceptibility abnormality (best seen series 801, image 16/25). This was not present on the 2009 brain MRI.The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There is no mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. 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.

Output: There is a 6 mm solitary, focal, ovoid T2 hyperintensity within the mid right temporal lobe without associated mass effect, restricted diffusion, or susceptibility abnormality. This was not present on the 2009 brain MRI. This is nonspecific in appearance, and given its solitary nature is of uncertain etiology or significance and would be an unusual appearance of neuroblastoma metastasis. Recommendations are made to repeat MRI, with contrast, in 3 months to assess for stability.


Instruction: Generate impression based on findings.

Input: 47-year-old woman with personal history of left breast IDC status post lumpectomy in 2002 with radiation and chemotherapy. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. Postsurgical changes are seen in the left breast which include distortion and small volume. Postsurgical changes also noted in the left axilla. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: 68-year-old man with history of common bile duct dilatation and possible pancreatic lesion. ABDOMEN:LIVER, BILIARY TRACT: Scattered, subcentimeter T2 hyperintense foci in the liver are too small to actually characterize but appear unchanged. Mild common bile duct dilatation to the level of the ampulla is unchanged at 8 mm. No obstructing stone or mass is identified.SPLEEN: The spleen appears normal.PANCREAS: The pancreatic duct is diffusely dilated and unchanged. The pancreatic parenchyma appears normal without mass or abnormal enhancement.ADRENAL GLANDS: The adrenal glands are normal.KIDNEYS, URETERS: Bilateral subcentimeter renal cysts are unchanged.RETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: No significant abnormality noted of the partially visualized small bowel or colon.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Mild CBD and pancreatic duct dilatation to the level of the ampulla is stable from 10/2013. No obstructing mass or stone is identified and this dilatation is likely due to a benign stricture.


Instruction: Generate impression based on findings.

Input: Glioblastoma multiforme on Avastin. Again seen are postsurgical changes of right temporoparietal craniotomy for partial tumor resection in the right temporal lobe. There is persistent nodular enhancement surrounding the right temporal resection cavity, which is not significantly changed. At least 3 distinct separate nodular foci of enhancement more anteriorly and laterally involving the right temporal lobe cortex are more distinct than on the prior examination, and the largest of these lesions now measures 12 x 11 in greatest axial dimensions with peripheral nodular enhancement. Perfusion imaging in this region did not demonstrate any significantly increased cerebral blood volume.There is also no significant change in extent of T2/FLAIR hyperintensity surrounding the resection cavity, as well as to a lesser degree in the left cerebral white matter, as well as along the occipital horns. Restricted diffusion related to treated tumor is not significantly changed. There is no significant change in size of the ventricular system, which remains prominent. No evidence of acute infarct or acute hemorrhage. No new significant mass effect, midline shift, or herniation.

Output: More distinct foci of enhancement within a previously seen area of ill-defined enhancement anterolateral to the resection cavity does not demonstrate hyperperfusion, and may relate to treatment related changes. Continued follow-up is suggested to exclude progression of tumor.


Instruction: Generate impression based on findings.

Input: Male, 27 years old. Reason: shoulder pain History: pain, labral tear? ROTATOR CUFF: There is a full-thickness tear of the supraspinatus tendon within 2 cm of its attachment, with minimal retraction. The supraspinatus muscle appears within normal limits. The other tendons and muscles of the rotator cuff appear normal.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint and glenoid labrum appear normal.BICEPS TENDON: The biceps tendon is displaced anteromedially, not present within the bicipital groove. The tendon itself is otherwise intact, without evidence of tear. There is a small amount of fluid surrounding the biceps tendon. ADDITIONAL

Output: 1.Full-thickness, minimally retracted tear of the supraspinatus tendon within 2 cm of its attachment.2.Dislocation of the tendon of the long head of the biceps as described above.


Instruction: Generate impression based on findings.

Input: Reason: research History: new prostate cancer axial PELVIS:PROSTATE:Prostate Size: 4.6 x 2.3 x 3.3 cmPeripheral Zone: There is a lesion in the left apex measuring 11 x 8 mm which is dark on T2/ADC with early enhancement and washout, suspicious for prostatic adenocarcinoma. An additional lesion in the left paramedian mid gland measures 6 x 4 mm and is dark on T2/ADC. This lesion does not definitely exhibit early enhancement and washout and is considered indeterminate.Central Gland: No significant abnormalitySeminal Vesicles: No significant abnormalityExtracapsular Extension: NoneBLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Left apical lesion is suspicious for prostatic adenocarcinoma.2.Left paramedian mid gland lesion is considered indeterminate.3.No lymphadenopathy.


Instruction: Generate impression based on findings.

Input: Diagnosis: Multiple sclerosisClinical question: baseline in patient with MSSigns and Symptoms: BLE n/t tingling The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal overall morphology.At the C3 vertebral body level there is suspicion for a high signal focus along the left posterior lateral aspect of the spinal cord. Similarly at the C5 vertebral body level there is a small T2 hyperintense lesion along the right posterior lateral aspect of the spinal cord. These are not confirmed on sagittal imaging and mainly apparent on T2 axial imagingAt 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.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.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.Findings are suspicious for small lesions in the cervical spinal cord at the C3 (left posterolateral) and C5 (right posterolateral) levels which would be consistent with demyelination.


Instruction: Generate impression based on findings.

Input: Male 69 years old currently on active surveillance for low grade prostate carcinoma. Evaluate for tumor. A prostate biopsy on 11/28/2016 revealed a Gleason 3+3=6 in one of ten cores, 1% of submitted tissue. PELVIS:PROSTATE:Prostate Size: 5.0 x 3.5 x 4.2 cmPeripheral Zone: History there is diffuse T1 hyperintensity compatible with postbiopsy hemorrhage. There is a wedged shaped region of T2 hypointensity in the left lateral apex without associated contrast enhancement or ADC hypointensity. No additional areas of signal abnormality are noted.Central Gland: Benign prostatic hypertrophy.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: None.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Postsurgical changes are seen along the anterior pelvic wall.

Output: 1.Low suspicion wedge shaped area of T2 hypointensity in the left lateral apex. PIRADS 2.2.No lesion suspicious for prostate adenocarcinoma.PI-RADS™ v2 Assessment Categories:PIRADS 1 – Very low (clinically significant cancer is highly unlikely to be present) PIRADS 2 – Low (clinically significant cancer is unlikely to be present)PIRADS 3 – Intermediate (the presence of clinically significant cancer is equivocal)PIRADS 4 – High (clinically significant cancer is likely to be present) PIRADS 5 – Very high (clinically significant cancer is highly likely to be present)https://www.acr.org/~/media/ACR/Documents/PDF/QualitySafety/Resources/PIRADS/PIRADS%20V2.pdf


Instruction: Generate impression based on findings.

Input: Clinical question: Assess for brain metastases. Signs and symptoms: Known stage IV lung cancer. Pre-and post-enhanced brain MRI:Negative diffusion weighted images.Examination demonstrates no detectable foci of signal abnormality or enhancement to suggest metastatic disease. Calvarium and soft tissues of the scalp as well as images through the orbits are also unremarkable and without evidence of metastatic lesions.Few tiny foci of flair hyperintensity in the subcortical white matter of bilateral frontal lobes are identified which are nonspecific however could representing chronic microvascular ischemic strokes.Otherwise there is normal anatomical morphology and signal intensity of brain parenchyma on all MRI sequences and without abnormal parenchymal or leptomeningeal enhancement.

Output: 1.No evidence of metastatic disease.2.Negative diffusion weighted series. 3.Minimal nonspecific periventricular and subcortical bilateral frontal foci of flair hyperintensity as detailed. 4.Unremarkable pre-and post enhanced brain MRI otherwise.


Instruction: Generate impression based on findings.

Input: Other amnesia [R41.3], Reason for Study: ^Reason: h/o MS, hospitalizations in last year with mental status changes, increased short term memory deficits. Evaluate for progression of MS History: memory problems Re-demonstration of bihemispheric multiple high signal intensity white matter lesions on FLAIR/T2 images, unchanged in terms of number and each lesions' size since prior scan.There is no evidence of new abnormal signal intensity lesion.There is no evidence of acute ischemic or hemorrhagic lesion. The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear.Right posterolateral ethmoid sinus shows retention cyst.Left eye lens is not seen possible prior lens surgery.Nasal septal deviation toward left.

Output: Multiple white matter high signal intensity lesions on FLAIR/T2 images, unchanged since prior scan.No evidence of new abnormal signal intensity.No evidence of acute ischemic or hemorrhagic lesion.


Instruction: Generate impression based on findings.

Input: Although more remote outside MRI brain exam are not available, comparison to the most recent outside exam demonstrates no current suspicious enhancing lesions. There is a faint rounded area of enhancement along the medial aspect of the upper left thalamus which could potentially be vascular in etiology or perhaps related to adjacent choroid. A small amount of susceptibility is noted in this location.The ventricles and sulci are prominent, consistent with mild to moderate age-related volume loss. The basal cisterns remain patent. There is no midline shift or mass effect. There are scattered punctate foci and minimally confluent areas of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, which are nonspecific but may represent mild chronic small vessel ischemic changes. There is a small developmental venous anomaly along the left occipital lobe. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits.

Output: 1. No definite MR evidence of abnormal intracranial enhancement.2. Small area of ill-defined enhancement projecting along the upper left medial thalamus is favored to possibly be vascular in etiology or represent minimal adjacent choroid. Treated metastasis is felt to be less likely, although there is associated susceptibility.Comparison to more remote outside exams where intracranial metastatic lesions are appreciated would be helpful to assess for follow-up appearance.


Instruction: Generate impression based on findings.

Input: Female, 30 years old, with headache, concern for viral meningitis. Brain parenchymal morphology is within normal limits. A punctate T2 hyperintense lesion is seen along the right lateral ventricle, and there may be one or two additional scattered punctate nonspecific white matter lesions. No evidence of parenchymal edema or mass effect is seen. No restricted diffusion is detected. There are no findings to suggest intracranial hemorrhage or any abnormal extra-axial fluid collection. The ventricular system is normal in size and morphology. Bone marrow signal characteristics are within normal limits. Mild mucosal inflammation is evident in the frontal sinuses and ethmoid air cells.

Output: 1. No definite acute intracranial abnormality or other specific findings to account for the patient's headaches, though please note that a normal imaging exam does not exclude the possibility of meningitis.2. Mild sinus mucosal inflammation.


Instruction: Generate impression based on findings.

Input: Male, 79 years old, with history of prostate cancer, under control with undetectable PSA on therapy, but with left increasing left leg sciatica, known L5 lesion on CT and bone scan. Trace retrolistheses are seen of L3 on L4, and L4 on L5. The normal lumbar lordosis is straightened.Vertebral body heights are preserved. The L5 vertebral body demonstrates heterogeneous low T1 and T2 signal which is compatible with the sclerotic lesion noted on prior CT and plain films, likely representing a metastasis. There is no edema or enhancement associated with this lesion, or elsewhere in the visualized lumbar vertebral bodies.The distal spinal cord and conus are unremarkable. The cauda equina nerve roots are also unremarkable except as discussed below. No pathologic intrathecal or epidural enhancement is seen.L1-2: Mild facet arthropathy. Minimal disc bulging. No significant spinal canal or foraminal stenosis. L2-3: Mild facet arthropathy. Mild bulging disc. No significant spinal canal stenosis. Mild right foraminal narrowing L3-4: Facet arthropathy and ligamentum flavum thickening. Disc bulging with a superimposed right paracentral and subarticular disc extrusion extending below the disc space for approximately 10 mm. This causes effacement of the right lateral recess in addition to a generalized moderate spinal canal stenosis both neural foramina are moderately narrowed. L4-5: Facet arthropathy and ligamentum flavum thickening. Disc bulging with a left paracentral and subarticular disc extrusion extending below the disc space for 10 mm. Severe encroachment of the left lateral recess and a moderate to severe generalized spinal canal stenosis with crowding of the cauda equina nerve roots. Moderate to severe left and mild right foraminal narrowing. L5-S1: Facet arthropathy. Bulging disc. No significant spinal canal stenosis. Moderate to severe left and moderate right foraminal narrowing.

Output: 1.Signal abnormality is evident within the L5 vertebral body compatible with a known sclerotic metastasis. Lack of edema and enhancement would suggest that this is a quiescent treated lesion.2.No additional areas of active metastatic disease are suspected in the lumbar spine. No vertebral body compression fractures are evident.3.At L3-4, there is a moderate generalized spinal canal stenosis with particular effacement of the right lateral recess due to a disc extrusion. At L4-5, moderate to severe generalized spinal canal stenosis is seen with crowding of the cauda equina nerve roots. The left lateral recess is significantly encroached at this level by a disc extrusion.4.Moderate to severe left foraminal narrowing is seen at L4-5 and L5-S1.


Instruction: Generate impression based on findings.

Input: 28 years, Female, intermittent disconjugate gaze and fatigue. Evaluate for multiple sclerosis. Evaluate for aneurysms, family history of aneurysms. BRAIN: Unchanged subcentimeter nodular focus of mild T2/FLAIR hyperintensity in the left inferior parietal subcortical white matter. Few punctate additional foci of T2/FLAIR hyperintensity are again seen including the left frontal and bilateral parieto-occipital junction subcortical white matter and are also unchanged. There is no clear evidence of demyelinating disease. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. Focus of susceptibility, subtle T2 hyperintensity, and faint enhancement in the right aspect of the pons likely represents an incidental capillary telangiectasia. There is otherwise no abnormal parenchymal or meningeal enhancement in the brain. No intracranial mass or mass-effect. No evidence of pituitary macroadenoma. Orbits are grossly unremarkable. The ventricles are within normal limits in size and configuration. Major flow-voids are preserved. Unchanged heterogeneous signal involving the right aspect of the clivus which may be related to combination of asymmetric pneumatization and a small right sphenoid sinus mucus retention cyst; this finding is unchanged since 7/9/2015.MRA HEAD: The intracranial internal carotid arteries demonstrate no significant stenosis. The middle and anterior cerebral arteries are also patent. The vertebral arteries, basilar artery, and posterior cerebral arteries also are patent with no significant stenosis. No evidence of aneurysms or vascular malformations.

Output: 1. Unchanged few nonspecific foci of T2/FLAIR hyperintensity including a relatively more conspicuous left inferior parietal white matter lesion. These are nonspecific with differential including prior inflammation, demyelination, ischemia or other injury. No highly suggestive findings of demyelinating disease in the brain.2. No evidence of intracranial aneurysms.3. No evidence of pituitary macroadenoma. Note dedicated pituitary study is scheduled for a separate day.


Instruction: Generate impression based on findings.

Input: Trauma. The ventricles and basal cisterns are normal in size and configuration. The gray-white matter differentiation is preserved. There is subtle hypoattenuation seen in the subcortical and deep white matter of the superior frontal gyri subcortical white matter and possible expansion of the gyrus. This is unusual for a patient of this age and further assessment with an MRI is advised.There is no mass-effect or midline shift, intra-extra axial fluid collection, or acute hemorrhage.The calvaria and skull base appear normal, no evidence of a skull fracture or diastases of the calvarial sutures. No pneumocephalus.The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. No acute intracranial abnormality.2. Subtle low attenuation in the in the high convexity bifrontal deep white matter unlikely traumatic and may represent congenital leukomalacia, further assessment with MRI may be helpful.


Instruction: Generate impression based on findings.

Input: Reason: Left knee continued pain and swelling s/p microfracture of femoral trochlea, chondroplasty MFC, evaluate healing History: left knee pain MENISCI: The medial meniscus is intact. There is pulsation artifact which obscures the root of the lateral meniscus on multiple views and a root avulsion cannot be excluded. The remaining lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: Patellar and trochlear cartilage diffusely thinned but without focal defects. There is full-thickness cartilage loss along the posterior lateral femoral condyle measuring 5 mm in length which is new since the prior exam. Associated underlying marrow edema is also noted. Partial-thickness cartilage loss along the anterior femoral condyle as seen previously is improved status post microfracture, with resolution of associated subchondral cysts and marrow edema. Diffuse thinning of the articular cartilage is otherwise noted in both compartments.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: Patellar and quadriceps tendons are intact.ADDITIONAL

Output: 1.New focus of full-thickness cartilage loss along the posterior lateral femoral condyle with associated underlying marrow changes2.Increased cartilage along the anterior lateral femoral condyle status post microfracture.3.Moderate size joint effusion.


Instruction: Generate impression based on findings.

Input: Innumerable bilateral periventricular and subcortical white matter lesions are again demonstrated, without significant interval change. There are extensive lesions within the brainstem as well as the brachium pontis, best appreciated on axial PD images. Direct comparison is made to more remote study in 2010 where an axial T2 series is available, for better visualization of the brainstem lesions. Although some of the infratentorial lesions were present at that time, there is clear progression throughout the entire brainstem when compared to 08/14/10. Recent direct comparison is difficult given differences in technique. No definite new supratentorial lesions are identified when compared to the most recent prior.The ventricles and sulci are mildly prominent for age. The basal cisterns remain patent. There is no midline shift or mass effect. There are no areas of abnormal signal. There is no diffusion abnormality. No extra-axial fluid collection is identified.The midline structures and craniocervical junction are within normal limits. There is a small amount of fluid in the left sphenoid sinus.

Output: 1.Redemonstration of innumerable white matter lesions, compatible with multiple sclerosis, including extensive infratentorial disease which has progressed since the remote 2010 exam. No definite new supratentorial lesions are identified.2.Overall, there is moderate T1 disease burden, and moderate T2 disease burden. 3.Mild diffuse volume loss, more than expected for age, likely relating to demyelinating disease.


Instruction: Generate impression based on findings.

Input: Female 13 years old with Li Fraumeni syndrome, routine screening. Exam is mildly motion degraded. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is an area of susceptibility artifact within the right posterior occipital lobe suggestive of a dural venous anomaly. No associated brain edema noted. The brain parenchyma and pituitary gland otherwise appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. Trace bilateral maxillary mucosal thickening and mild opacification of the mastoid air cells is noted. The orbits, skull, and scalp soft tissues are grossly unremarkable.

Output: 1. No evidence of measurable intracranial mass lesion.2. Probable dural venous anomaly in the posterior right occipital lobe. Associated cavernous malformation or brain AVM cannot be completely excluded. Recommend follow-up.


Instruction: Generate impression based on findings.

Input: Lower back pain Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position.Multilevel degenerative changes are seen, as described below:T12-L1: Diminished disc height with minimal disc bulge. No significant spinal canal or neural foraminal stenosis.L1-L2: Diminished disc height with minimal disc bulge. No spinal canal or neural foraminal stenosis.L2-L3: Mild disc bulge which is increased in the interval and associated with minimal spinal canal and mild left neural foraminal narrowing. Otherwise no significant spinal canal or neural foraminal stenosis at this level. Mild to moderate facet arthropathy, worse on the left; mild surrounding edema.L3-L4: Again seen is a small left foraminal disc protrusion with mild left neural foraminal stenosis and contact of the exiting left L3 nerve root similar to prior. There is no significant central canal or right neural foraminal stenosis. Mild to moderate facet arthropathy, worse on the left; mild surrounding edema.L4-L5: Severely diminished intervertebral disc height similar to prior. Mild disc bulge. There is mild right and minimal left neural foraminal narrowing.L5-S1: Diminutive disc space. No spinal canal or neural foraminal stenosis.Paraspinous soft tissues are within normal limits.

Output: 1. Multilevel degenerative changes in the lumbar spine are again seen. Compared to 12/6/2011, there is increase in disc bulge at the L2-L3 level. There is mild left L2-L3, mild left L3-L4, and mild right L4-L5 neural foraminal narrowing. No high-grade spinal canal or high-grade neural foraminal stenosis at any level. 2. There is also mild to moderate facet arthropathy at the L2-L3 and L3-L4 levels with mild surrounding edema and may be contributing to patient's back pain.


Instruction: Generate impression based on findings.

Input: Diagnosis: Muscle weakness (generalized)Benign neoplasm of adrenal glandClinical question: compression fracture? Metastatic disease?Signs and Symptoms: AMS, weakness The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology.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.At C4-5 there is no significant compromise to the spinal canal or neural foramina. There is mild posterior ligamentous hypertrophy at this level.At C5-6 there is no significant compromise to the spinal canal or neural foramina.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.Mastoid air cells are opacified. A nasogastric tube is in place.

Output: 1.No compression fractures are appreciated in the cervical spine. 2.No focal lesions are appreciated in the cervical spine to suggest metastases


Instruction: Generate impression based on findings.

Input: A 57 year old male with personal history of coronary artery disease after multiple PCI's and coronary artery bypass graft surgery on 2/2016 (Lima to LAD, SVG to DG and SVG to OM). MEDICATIONS: amiodarone, amlodipine, aspirin, atorvastatin, lisinopril, metoprolol, mexiletine, prasugrel, ranexa First Pass PerfusionA perfusion defect was noted at the basal infero-septal and inferior walls. Viability/ Myocardial ScarThere is late gadolinium enhancement in more than 50% of the thickness of the wall at the basal inferior wall compatible with an old transmural myocardial infarction. This segment is not likely to be viable. The remainder of the left ventricle is free of myocardial infarction and likely to be viable. Left VentricleThe left ventricle is normal in size with mildly reduced systolic function. The overall LV ejection fraction is 48%, the LV end diastolic volume index is 75 ml/m2 (normal range: 74+/-15), the LVEDV is 191 ml (normal range 142+/-34), the LV end systolic volume index is 38 ml/m2 (normal range 25+/-9), the LVESV is 98 ml (normal range 47+/-19), the LV mass index is 61 g/m2, and the LV mass is 157 g. There is hypokinesis of the basal to mid inferior wall. Left AtriumThe left atrium is normal in size (82ml). Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 58%, the RV end diastolic volume index is 71 ml/m2 (normal range 82+/-16), the RVEDV is 181 ml (normal range 142+/-31), the RV end systolic volume index is 30 ml/m2 (normal range 31+/-9), and the RVESV is 76 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is mild pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. The ascending aorta is mildly dilated (40mm). 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 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. There is a transmural myocardial infarction involving the basal inferior wall with minimal peri-infarct ischemia. Most of the infarcted segment is not likely to be viable. The remainder of the myocardium is free of myocardial infarction or ischemia and is viable.2. Normal LV size with mildly reduced systolic function (LVEF 48%) with basal to mid inferior wall hypokinesis.3. Normal RV size and systolic function (RVEF 58%).4. Mild dilation of the ascending aorta. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Ms. Laurie Schuenemann is a 55 year old female with BRCA1 gene. She has no current breast related complaints. MAMMOGRAM: Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density(BiRads Density Category B), unchanged in pattern and distribution. Small masses are present in both breasts which correlate with the benign cysts demonstrated on the breast MRI from 11/18/2015. A few benign calcifications are present. There are no new masses, suspicious microcalcifications or areas of architectural distortion identified in either breast.

Output: No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram and MRI are recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram.


Instruction: Generate impression based on findings.

Input: 40 year-old male, distention, right lower quadrant pain, flank pain evaluate for appendicitis. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Stable bilateral adrenal mass lesions. Right adrenal mass measures 4.6 x 4 .1-cm on image number 34. Left adrenal mass measures 9.9 x 5.1 cm image number 36.KIDNEYS, URETERS: Right nephrectomy site is clear. Irregular left kidney is unchanged. Possible photocell carcinoma cannot be excluded. Left renal vein is again distended suspicious for tumor thrombus. If there is a clinical concern to evaluate the left renal vein and the left kidney MRI may be helpful.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No change in the right paracolic cutter metastases measuring 5.8 x 2.6 cm image number 71.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Inflammatory changes and small fluid Colette since adjacent to the sigmoid colon consistent with diverticulitis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Metastatic renal cell cancer. New diverticulitis with small fluid collections in the pelvis.


Instruction: Generate impression based on findings.

Input: 65-year-old female with lumbar degenerative disc disease, spinal stenosis and facet arthropathy. With low back pain radiating down the bilateral lower extremities. There are apparently four non-rib-bearing lumbar vertebral bodies; this is a different numbering convention compared to what was used on the prior MRI. There are degenerative changes in the lower lumbar spine, as well as 10 mm of L3 upon L4 anterolisthesis and convex right lumbar scoliosis. In particular, at L3-L4, there is disc desiccation, loss of intervertebral disc space, severe disc bulge, moderate to severe facet arthropathy with effusions, and ligamentum flavum hypertrophy causing severe spinal canal stenosis and severe left and mild to moderate right neural foraminal stenosis. This has progressed when compared to the prior exam and there appears to be a new disc extrusion or sequestration that measures up to 10 mm posterior to the left aspect of the L3 vertebra. At L2-L3, there is a mild disc bulge, ligamentum flavum hypertrophy and mild facet arthropathy without significant spinal canal or neural foramen narrowing, and at L4-S1, there is disc desiccation, mild disc bulge, and mild to moderate facet arthropathy, with mild spinal canal and bilateral neural foraminal stenosis. There is associated degenerative bone marrow signal alteration and endplate irregularities at L3-4 and L4-S1. There is no significant spinal canal or neural foramen narrowing at T12-L1 and L1-2. The vertebral body heights are within normal limits. The conus medullaris is normal in position, but there is extensive buckling of the nerve roots at the L3 level. The paraspinous soft tissues are within normal limits, aside from dependent edema in the posterior subcutaneous tissues. There is unchanged thickening of the left adrenal gland.

Output: 1. Apparently four non-rib-bearing lumbar vertebral bodies; this is a different numbering convention compared to what was used on the prior MRI. Degenerative spondylosis of the lower lumbar spine, which is most pronounced at the L3-L4 level with severe spinal canal stenosis with compression of the cauda equina nerve roots and severe left and mild to moderate right neural foraminal stenosis, as well as an apparent disc extrusion or sequestration that measures up to 10 mm posterior to the left aspect of the L3 vertebra. The degenerative spondylosis has progressed since 2013.2. Convex right lumbar scoliosis and 10 mm of L3 upon L4 anterolisthesis. 3. Unchanged thickening of the left adrenal gland, which is nonspecific.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Rotator cuff weakness. Evaluate for rotator cuff tear ROTATOR CUFF: There is thickening and increased signal intensity of the supraspinatus and infraspinatus tendons indicating moderate tendinosis. Additionally, there is tearing and probably delamination of the bursal surface fibers of the supraspinatus tendon posteriorly beginning approximately 2.5 cm proximal to the tendon insertion on the greater tuberosity. I estimate this tearing to be approximately 1.5 cm in AP dimension and up to 2 cm in long axis. Along the majority of its length the tearing appears to involve approximately 50% of the tendon thickness although more focally there appears to be a small but near full-thickness defect with sparing of a thin layer of articular surface fibers. A small focus of increased signal intensity within the anterior fibers of the supraspinatus tendon at its insertion is suggestive of a tiny, possibly concealed insertional tear. Aside from mild fatty infiltration along the myotendinous junctions, the supraspinatus and infraspinatus muscles appear intact. The teres minor muscle and tendon appear intact. Thickening and increased signal intensity of the distal subscapularis tendon suggests tendinosis and perhaps mild interstitial tearing but I am not convinced that there is a full-thickness rotator cuff tear. The subscapularis muscle appears normal.SUPRASPINATUS OUTLET: Mild to moderate osteoarthritis affects the acromioclavicular joint with a small ossicle noted in the anterior aspect of the joint. There is trace fluid within the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint alignment is within normal limits. There is a small glenohumeral joint effusion. Mild osteoarthritis affects the glenohumeral joint. There is intermediate signal intensity throughout the glenoid labrum compatible with degeneration and degenerative tearing. BICEPS TENDON: The extra-articular portion of the tendon of the long head of the biceps appears intact. There is a small amount of fluid in the biceps tendon sheath which may simply represent extension of fluid from the glenohumeral joint. The intra-articular component of the tendon of the long head of the biceps is difficult to visualize as the patient's arm is held in internal rotation; there appears to be mild increased signal intensity within intra-articular portion of the tendon indicating mild tendinosis.

Output: 1.Moderate rotator cuff tendinosis with a small, possibly concealed insertional tear of the anterior fibers of the supraspinatus tendon, with more extensive high-grade bursal surface tearing of the tendon more posteriorly and proximally, as described above.2.Osteoarthritis and degeneration/degenerative tearing of the labrum. Other findings as above.


Instruction: Generate impression based on findings.

Input: Female, 30 years old, with Chiari malformation. The right cerebellar tonsil descends approximately 8 to 9 mm below the level of the foramen magnum. The left cerebellar tonsil descends approximately 6 mm below the level of the foramen magnum. Both tonsils demonstrate a peglike morphology. Findings have not significantly changed from prior. The CSF space at the foramen magnum is partially effaced but some CSF signal does remain along the brainstem and tonsils. Robust biphasic CSF flow is seen through the anterior foramen magnum. Mild but detectable CSF flow is seen through the posterior foramen magnum including around the cerebellar tonsils. Findings have not significantly changed.The visualized spinal cord is morphologically normal. No evidence of syrinx formation is seen. The conus terminates at the T12 level. The nerve roots of the cauda equina are evenly distributed through the thecal sac. No intraspinal masses are seen.Spinal alignment is anatomic. There is a transitional morphology of the L5 vertebral body. No pathologic marrow replacement or marrow edema is suspected.A small central disk protrusion at C5-6 is unchanged. No significant degenerative disk disease is seen elsewhere in the spine. No spinal canal or neuroforaminal stenosis is detected.

Output: Redemonstration of Chiari I malformation without significant change from the prior exam. The CSF space at the foramen magnum is partially effaced. CSF flow is robust along the anterior foramen magnum, but a mild degree of flow is also seen posteriorly and around the cerebellar tonsils, similar to prior.No evidence of syrinx or any other significant abnormality is seen in the spinal cord. A small central disk protrusion at C5-6 is unchanged. Evaluation of the spine is otherwise unremarkable.


Instruction: Generate impression based on findings.

Input: Clinical question: New parietal brain lesion, history of metastases. Signs and symptoms: AMS. Pre- and post enhanced brain MRI: Examination demonstrates a focus of restricted diffusion consistent with a subacute ischemic stroke in the left posterior temporal-parietal region. It demonstrate subtle gyriform enhancement which is unexpected finding in a subacute stroke. The finding results in effacement of adjacent cortical sulci.This examination demonstrate no convincing evidence of any metastatic lesion.Chronic postoperative changes (large area of encephalomalacia) of a right frontal parietal craniotomy is noted without detectable abnormal enhancement.Diffuse uniform FLAIR hyperintensity of bilateral hemispheric white matter highly suggestive of posttreatment/radiation changes. There is ex vacuo dilatation of supratentorial ventricular system however maintained midline. Diffuse patchy foci of FLAIR hyperintensity in the pons could also represent posttreatment changes or chronic small vessel ischemic strokes.Unremarkable calvarium and soft tissues of the scalp as well as orbits and without abnormal enhancement.

Output: 1.Subacute left MCA ischemic stroke with expected gyriform cortical enhancement in the left posterior temporal and parietal with regional mass effect.2.No evidence of residual or recurrence of metastatic disease.3.Extensive chronic postoperative changes of the right sided craniotomy.4.Diffuse FLAIR hyperintensity of bilateral hemispheric white matter and pons representing post treatment/radiation change however overlapping chronic small vessel ischemic strokes cannot be excluded.5.Ex vacuo dilatation of supratentorial ventricular system secondary to underlying parenchymal volume loss.


Instruction: Generate impression based on findings.

Input: 38-year-old male with shoulder dislocations ROTATOR CUFF: The tendons and muscle fibers of the supraspinatus, infraspinatus, teres minor and subscapularis are normal.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is a new tear of the superior labrum coursing from anterior to posterior compatible with a SLAP (superior labrum anterior posterior) tear. There is fragmentation of the anterior inferior labrum. BICEPS TENDON: The biceps tendon appears normal with the long head of the biceps tendon situated within the bicipital groove.ADDITIONAL

Output: P1. Large Hill-Sachs deformity of the humeral head with fragmentation of the anteroinferior labrum consistent with a Bankart lesion. 2. New SLAP (superior labrum anterior posterior) tear.3. There is a suggestion of a loose body or debris within the axillary pouch.


Instruction: Generate impression based on findings.

Input: Ataxia, tremors; demyelinating disease. Evaluate for progression. Brain: Again seen are scattered foci of T2/FLAIR hyperintensity in the periventricular and subcortical white matter. There is no significant change compared to 1/19/2015. No new lesions. No lesions with enhancement to suggest active demyelination. Brain parenchymal volume is preserved. No evidence of intracranial mass or mass effect. No hydrocephalus or extra-axial collections. Evidence of prior left parietal burr hole placement for biopsy with gliosis involving the adjacent cortex again seen. Visualized extracranial soft tissues are unremarkable.Cervical spine: There is minimal patchy T2 signal abnormality throughout the cervical cord without findings to suggest a new discrete lesion. No discrete/large lesion with enhancement is appreciated. There are questionable foci of enhancement such as sagittal post gadolinium series 2201 image 8 and 6 at the C2 level, and axial post gadolinium images 29/44 series 2301 involving the cervical cord at the right C2 level and image 11/44 at the right lateral C6 level.Spinal alignment is anatomic. Vertebral body height and morphology are normal. No concerning marrow signal abnormality or enhancement is seen. No significant spinal canal or neural foraminal stenosis. Paraspinous soft tissues are unremarkable.

Output: 1. Unchanged small scattered T2/FLAIR hyperintense lesions in the white matter. No new lesions or lesions with enhancement to suggest active demyelination.2. Minimal patchy T2 signal throughout the cervical cord is again seen. There are questionable punctate foci of enhancement in the cervical cord as described above which given their small size cannot be definitively corroborated on both the axial and sagittal sequences. These may however suggest active demyelination/inflammation give such appearance on prior studies. Please note and as mentioned previously appearance of these lesions including punctate enhancement are atypical for multiple sclerosis and other inflammatory processes should also be considered.


Instruction: Generate impression based on findings.

Input: Reason: 63yo M h/o spina bifida with tethered cord and chronic pain, s/p intrathecal pain pump presenting with acute LE pain and weakness. Also fever; please eval for fluid collection/signs of infection around pump History: BLE weakness, pain. Cervical:There is mild reversal of the normal cervical lordosis. The cranial-cervical junction is normal. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The cord signal is normal. The cerebellar tonsils are again seen to extend approximately 3 mm below the level of the foramen magnum. There is again prominence of the central canal throughout the cervical and thoracic spinal cord. There is again seen partial fusion of the C3-C4 intervertebral disc. There is a hyperintense lesion in the C6 vertebral body again identified, likely representing a benign hemangioma.Thoracic:There is a normal thoracic kyphosis. The spinal alignment is anatomic and the vertebral body heights are preserved. There are no spinal cord signal abnormalities.The previously noted marrow edema within the T4, T10, and T11 vertebral bodies has decreased. There is increased fatty marrow signal involving several levels of thoracic vertebral bodies. As noted before there is a large anterior bridging osteophyte complex across these vertebral bodies. The T1/T2 dark band traversing the anterior inferior corner of the T11 vertebral body is unchanged compared to prior examinations and corresponds to a sclerotic band on CT.As above, prominence of the central spinal canal begins in the cervical region and continues to the T1-2 level. Intermittent mild prominence of the central canal begins again at the T3-4 level and continues to approximately the T7-8 level, unchanged. As before, the spinal cord is somewhat diminutive, particularly at lower levels. Postoperative scarring is seen within the soft tissues of the lower thoracic region and there is evidence of surgical deformity of the posterior elements at T9-10.An intrathecal catheter is seen entering at the T9 level and extends cranially, terminating at the T4-T5 disc space, unchanged in position compared to prior exam.Lumbar:There is normal lumbar lordosis. The L5 vertebral body demonstrates a mild transitional morphology. There is no abnormal spinal cord signal. The bone marrow and endplates demonstrate a normal MR appearance. Absence of posterior elements is redemonstrated at L4 and from L5 through the sacrum region, possibly of congenital or surgical etiology. The spinal cord remains low-lying, descending at least to the L5 level ultimately thinning and fanning out and blending with a network of soft tissue strands which traverse the lower thecal sac. These findings are unchanged. Degenerative changes are specified by the intervertebral level as follows: C2-C3: No neuroforaminal narrowing or spinal stenosis. C3-C4: There is a disc osteophyte complex with posterior fusion, resulting in left greater than right paracentral and foraminal narrowing. There is unchanged mild to moderate left foraminal stenosis at this level. There is similar effacement of the left ventral cecal sac and mild flattening of the spinal cord.C4-C5: There is similar hypertrophy of the ligamentum flavum and posterior disc osteophyte complex at this level. There is moderate to severe central canal stenosis without spinal cord signal changes, worse on today's exam, however may be related to motion degradation. There is left greater than right facet hypertrophy.C5-C6: There is left greater than right facet hypertrophy and posterior disc osteophyte complex, with worsening left moderate to severe foraminal narrowing and unchanged mild right foraminal narrowing. There is mild central canal narrowing at this level.C6-C7: There is a small posterior disc osteophyte complex without significant neuroforaminal narrowing or spinal stenosis. C7-T1: no neuroforaminal narrowing or spinal stenosis. T11-T12: There is moderate left foraminal stenosis and possible disc osteophyte complex at this level, unchangedT12-L1: no neuroforaminal narrowing or spinal stenosis. L1-L2: There is bilateral facet hypertrophy and ligamentum flavum thickening. There is minimal disc bulge. There is unchanged mild central canal stenosis and bilateral mild to moderate neural foraminal stenosis.L2-L3: There is bilateral facet hypertrophy and ligamentum flavum thickening. There is diffuse disc bulge with unchanged severe central canal stenosis and moderate bilateral foraminal stenosis. L3-L4: There is bilateral facet hypertrophy and ligamentum flavum thickening. There is diffuse disc bulge with unchanged moderate spinal canal stenosis and mild bilateral foraminal stenosis. L4-L5: There is bilateral facet hypertrophy. There is diffuse disc bulge with central protrusion. No central canal stenosis. There is unchanged mild bilateral foraminal narrowing.L5-S1: There is bilateral facet hypertrophy without neuroforaminal narrowing or spinal stenosis.

Output: 1. Degenerative changes of the cervical and lumbar spine as detailed above, with possible interval worsening of C4-C5 central canal stenosis, now moderate to severe.2. Improved bone marrow edema compared to prior exam.3. Unchanged epidural catheter without evidence of adjacent fluid collection or abscess.4. Stable low lying cerebellar tonsils.5. Prominence of the central canal of the spinal cord beginning in the cervical region and continuing in discontinuous fashion through the thoracic region are unchanged.6. Low lying spinal cord which continues at least to the L5 level where it begins to thin and fan out, ultimately terminating in a network of soft tissue strands which traverse the lower thecal sac, unchanged.


Instruction: Generate impression based on findings.

Input: Right hip pain, on anticoagulation. Mild osteoarthritis affects the right hip joint. I see no large joint effusion. Poorly defined sclerosis within the anterior aspect of the right femoral head suggests avascular necrosis; I see no subchondral fracture or articular surface collapse. There is slight prominence of the anterolateral aspect of the femoral head/neck junction suggesting a CAM deformity. Similar findings of mild osteoarthritis, avascular necrosis and CAM deformity are noted affecting the left hip. Severe degenerative disk disease affects the visualized lower lumbar spine. Given the limitations of an unenhanced study, the soft tissues appear normal. I see no mass or hematoma.

Output: Mild osteoarthritis of the right hip with avascular necrosis of the femoral head. This can be further evaluated with MRI if clinically warranted. Other findings as above.


Instruction: Generate impression based on findings.

Input: Alcoholic cirrhosis and hepatocellular carcinoma. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology.Numerous arterial enhancing foci are again noted.The previously characterized lesion in the hepatic dome segment VIII demonstrates arterial enhancement measuring 10 x 9 mm (series 11/23) with subtle corresponding washout (series 11/221), not significantly changed in size.The exophytic lesion at the level of the gallbladder fossa (series 11 image 42) demonstrates arterial enhancement but no definite nausea, unchanged.Scattered liver cysts. The portal vein is patent.Distended gallbladder with multiple gallstones. No specific evidence of acute gallbladder inflammation.SPLEEN: Borderline splenomegaly measuring 13 cm craniocaudal dimension.PANCREAS: 9 mm cystic lesion in the distal pancreatic body (series 8/17). No suspicious enhancing components. The main pancreatic duct is normal in caliber.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: Bilateral gynecomastia.OTHER: No significant abnormality noted.

Output: Stable examination from recent prior including cirrhotic liver morphology with an arterial enhancing hepatic dome focus measuring 1.0 x 0.9 cm with subtle washout. Additional arterial enhancing foci are seen without definite corresponding washout, unchanged from recent prior examination but new from 2013. Continued close follow-up imaging is recommended.


Instruction: Generate impression based on findings.

Input: Other encephalitis and encephalomyelitis [G04.81], Reason for Study: ^Reason: evaluate for worsening vs improvement of autoimmune encephalitis; patient is on a tapering dose of steroids History: Headaches Redemonstration of right hippocampal head and amygdala volume loss, unchanged since prior scan.There is no evidence of abnormal enhancement on the scan.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: Unchanged right hippocampal head atrophy since prior scan. Otherwise unremarkable.


Instruction: Generate impression based on findings.

Input: 56 year old with ADH found in the recent right breast biopsy. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.There is a small metallic artifact at posterior 10:00 position in the right breast, from recent biopsy. No abnormal enhancement is seen around the biopsy clip, except for the transverse enhancement from the lateral aspect near the skin to the biopsy site, consistent with the post-biopsy changes.No abnormal enhancement is seen in left breast. No abnormal axillary lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. Post-biopsy changes in the right breast.BIRADS: 2 - Benign finding.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Diagnosis: Compression of brainClinical question: Please evaluate for syrinx or cord tetheringSigns and Symptoms: Known Chiari, dizziness MRI thoracic spine:The thoracic vertebral bodies are appropriate in the overall alignment and height. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots. The thoracic spinal cord ends at approximately L1.There is a 12 mm T1 and T2 hyperintense focus present within the T10 vertebral body along its left posterior and inferior aspect. T1 signal suppresses on the inversion recovery images. There are Schmorl's nodes present at the T11-T12 and T12-L1 disc spaces.There is a left lateral recess disc protrusion at the T10-T11 without significant compromise to spinal canal or exiting nerve roots. It mildly narrows the left neural foramen at this level and impresses on the thecal sac at the left lateral recess.

Output: 1.There are mild degenerative changes present in the lower thoracic spine. There is a small disc protrusion at T10-T11 without significant compromise to the spinal canal or exiting nerve roots2.There is no evidence for tethered cord.3.There is no evidence for syrinx in the thoracic spinal cord.


Instruction: Generate impression based on findings.

Input: Male, 7 years old. Reason: evaluate proximal fibula radiographic abnormality. May need altered field of view History: knee pain x 6 months. slow onset. no trauma. BONE AND MARROW: The previously identified lesion along the medial aspect of the proximal fibular metaphysis is largely uniformly low signal on T1 sequences, and low signal on T2 sequences. No evidence of enhancement. The lesion arises in the fibular cortex, with discrete cortical sclerotic margins. There is no extension beyond the minimally expanded cortical margin and no adjacent soft tissue component is identified. No periosteal reaction. The bone marrow signal adjacent to the lesion is normal and no additional findings to suggest an associated fracture. Marrow and cartilage signal elsewhere is normal.MENISCI AND LIGAMENTS: No significant abnormality noted.SYNOVIUM: No significant abnormality noted.MUSCULATURE: No significant abnormality noted.ADDITIONAL

Output: Proximal fibular lesion with signal characteristics as described above, which remains most compatible with an uncomplicated benign nonossifying fibroma given the absence of additional abnormality. No findings to account for the patient's pain in the absence of an associated fracture or other abnormalities within the knee.


Instruction: Generate impression based on findings.

Input: Male, 64 years old, with left parotid mass. Evaluate for extent. A mass is present in the left parotid gland occupying the entire deep lobe and part of the superficial lobe measuring 38 x 28 mm in the axial plane (image 34 series 401), and 43 mm craniocaudal (image 28 series 601). Lesion margins are well-defined. The lesion itself is predominantly T2 intermediate in signal with small areas of higher T2 signal potentially representing cystic or necrotic material. On postcontrast images, a majority of the lesion demonstrates solid enhancement.The lesion contacts the posterior cortex of the angle and ramus of the mandible. No definite marrow signal abnormality is seen, though the possibility of mild cortical erosion is raised. The lesion also contacts the mastoid tip without obvious invasion of the air cells. No pathologically enlarged lymph nodes are demonstrated. A jugulodigastric node on the left is, however, mildly prominent measuring 12 x 10 mm (image 25 series 401). No definite evidence of perineural spread is seen along the fifth or seventh cranial nerves.The remaining salivary glands are free of focal lesions. The palatine tonsils are slightly prominent but otherwise unremarkable. Degenerative disc disease is seen in the cervical spine with probable moderate spinal canal stenosis at C3-4. Spinal cord signal characteristics are within normal limits.

Output: A mass is present in the left parotid gland occupying all of the deep lobe and a portion of the superficial lobe. Lesion margins are well-defined and the lesion itself is predominantly solid with a few small scattered areas of cystic or necrotic material. The lesion abuts the posterior cortex of the mandible and the possibility of some cortical erosion is raised, though this would be better assessed on CT. The lesion also contacts the mastoid tip without obvious invasion of the air cells. No definite findings are seen to suggest perineural spread. No frankly pathologic lymph nodes are observed though there is a mildly prominent left jugulodigastric node as above.


Instruction: Generate impression based on findings.

Input: Smoldering myeloma patient screening for clinical trial. Evaluate for myeloma lesions. The patient initially presented for her MRI examination on January 13, 2015. The examination was incomplete, and therefore the patient returned for additional imaging on January 16, 2015 (accession # 14675404). The following dictation represents an interpretation of both examinations combined.There is diffuse intermediate signal intensity within the medullary space of the lumbar and visualized lower thoracic vertebrae, as well as more patchy intermediate signal intensity within the medullary space of the bones of the pelvis. This could simply reflect residual red marrow; however, I cannot exclude the possibility of a myeloproliferative process such as multiple myeloma. There is a subcentimeter focus of increased signal intensity relative to suspected red marrow on the fat-suppressed T2-weighted images within the body of the right pubic bone adjacent to the pubic symphysis. This lesion is of low signal intensity on T1-weighted images relative to suspected red marrow, and shows enhancement following contrast administration greater than that of suspected red marrow. While nonspecific, this is compatible with a small myelomatous lesion. A degenerative subchondral abnormality is considered less likely given the relatively normal appearance of the pubic symphysis itself. Poorly defined signal abnormality and enhancement within the posterior aspect of the left iliac wing is favored to represent postbiopsy change rather than myelomatous involvement. There is a lobulated focus of near-fluid signal intensity seen within the fifth sacral segment on the fat-suppressed T2-weighted images. It is of intermediate signal intensity on T1-weighted images and does not appear to enhance. It may represent a small cyst or benign cartilage rest, but I suspect does not represent a myelomatous deposit. Moderate osteoarthritis affects both hip joints with small foci of signal abnormality the subchondral bone that is likely degenerative in etiology. Degenerative arthritic changes of the lower lumbar spine are noted; please refer to the accompanying spine MRI report for further information. The musculature of the pelvis appears normal. While the study was not protocoled for detailed evaluation of the abdominal and pelvic viscera, I see no abnormalities.

Output: 1.Subcentimeter round focus of signal abnormality and enhancement within the body of the right pubic bone. While nonspecific, this compatible with a myelomatous lesion.2.Diffuse/patchy intermediate signal intensity within the medullary space of the visualized spine and pelvic bones may simply represent red marrow, although I cannot exclude the possibility of a myeloproliferative disorder such as myeloma.3.Other findings as above.


Instruction: Generate impression based on findings.

Input: New diagnosis of cholangioadenocarcinoma and gallbladder carcinoma, abdominal pain and elevated LFTs Suboptimal exam due to extensive patient motion artifact.ABDOMEN:LIVER, BILIARY TRACT: Improved biliary duct dilatation, likely related to placement of biliary stent. Thick walled gallbladder, likely combination of inflammation from adjacent ascites and reported gallbladder carcinoma, small sludge/hemorrhagic or proteinaceous material and cholelithiasis in gallbladder, nonspecific rounded restricted diffusion seen in the gallbladder lumen, may also reflect reported gallbladder malignancy. Nodular liver contour. New from prior study are multiple hepatic lesions (examples include located in hepatic dome and hepatic segment 8/5 and hepatic segment 6, see images 524, 396 and 300 series 607) demonstrating mildly increased T2 signal and restricted diffusion, with ill-defined borders and minimal to no internal enhancement seen, appearance suspicious for hypoenhancing metastatic disease. Lesion near gallbladder fossa may reflect metastatic disease or direct tumor invasion. Submitted for reference is a hepatic segment 5 lesion measuring 1.3 x 1.2 cm, image 372 series 1502. Left portal vein and splenic vein not well seen, suspicious for occlusion, heterogeneous left lateral hepatic parenchymal enhancement.SPLEEN: No significant abnormality noted.PANCREAS: Nonspecific peripancreatic soft tissue attenuation and stranding.ADRENAL GLANDS: Diffusely enlarged adrenal glands.KIDNEYS, URETERS: Bilateral renal cortical thinning.RETROPERITONEUM, LYMPH NODES: Again visualized retroperitoneal soft tissue thickening, with associated flattened configuration of the IVC, assessment including patency suboptimal secondary to extensive patient motion artifact. Small inguinal lymph nodes.BOWEL, MESENTERY: Wall thickening, likely reactive in setting of ascites.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Right greater than left small pleural effusions and moderate to large ascites visualized.

Output: 1. Suboptimal exam due to extensive patient motion artifact and presence of ascites, contrast-enhanced CT abdomen and pelvic imaging for improved assessment should be considered.2. Hepatic metastatic disease, new. Left portal vein and splenic vein not well seen, suspicious for occlusion, heterogeneous left lateral hepatic parenchymal enhancement.3. Improved biliary duct dilatation, likely related to placement of biliary stent. Thick walled gallbladder, likely combination of inflammation from adjacent ascites and reported gallbladder carcinoma, small sludge/hemorrhagic or proteinaceous material and cholelithiasis in gallbladder, nonspecific rounded restricted diffusion seen in the gallbladder lumen, may also reflect reported gallbladder malignancy. 4. Nonspecific peripancreatic soft tissue attenuation and stranding. Again visualized retroperitoneal soft tissue thickening,5. Right greater than left small pleural effusions and moderate to large ascites visualized.


Instruction: Generate impression based on findings.

Input: 86 years Male (DOB:6/18/1930)Reason: new occipital left headache History: as abovePROVIDER/ATTENDING NAME: SCOTT STERN SCOTT STERN The CSF spaces are appropriate for the patient's stated age with no midline shift. On susceptibility imaging there is a focus of signal loss present within a sulcus in the right temporal lobe. On T2 imaging the lesion measures approximately 4 x 5 mm axial dimensions.Periventricular punctateNo abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate some 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. The eyeball lenses are thin.

Output: 1.There is a small hemorrhagic lesion present within a right temporal lobe sulcus. One possibility is that this represents a cerebral cavernous malformation. Hemorrhagic lesions from other sources can also produce such a lesion. If the patient has known primary tumor this could represent a hemorrhagic metastasis.2.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: 48 year old with cardiomyopathy, hypertension, diabetes and daily illicit drug use presenting for evaluation of cardiomyopathy. MEDICATIONS: carvedilol, furosemide, lisinopril, simvastatin First Pass PerfusionDuring hyperemia, no perfusion defects were present. A prominent dark rim artifact was noted at rest and stress.Viability/ Myocardial ScarThere is an area of transmural late gadolinium enhancement noted in the basal inferior and inferolateral walls. The pattern is most consistent with prior myocardial infarction; however, because the late gadolinium enhancement is associated with preserved myocardial wall thickness, the possibility of an infiltrative process can not be excluded, especially given the presence of mediastinal lymph nodes as described below. These segments of myocardium with late gadolinium enhancement are not likely to be viable. The remaining myocardium is without late gadolinium enhancement and likely to be viable. Left VentricleThe left ventricle is severely dilated with mildly reduced systolic function. The overall LV ejection fraction is 45%, the LV end diastolic volume index is 166 ml/m2 (normal range: 74+/-15), the LVEDV is ml (normal range 142+/-34), the LV end systolic volume index is 327 ml/m2 (normal range 25+/-9), the LVESV is 166 ml (normal range 47+/-19), the LV mass index is 85 g/m2, and the LV mass is 168 g. The systolic dysfunction is global. . Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is mildly dilated with moderately reduced systolic function. The overall RV ejection fraction is 37%, the RV end diastolic volume index is 115 ml/m2 (normal range 82+/-16), the RVEDV is ml (normal range 142+/-31), the RV end systolic volume index is 73 ml/m2 (normal range 31+/-9), and the RVESV is 144 ml (normal range 54+/-17).Right AtriumThe right atrium is mild to moderately dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is severe mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is trace pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild 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 (28mm).Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsA large mediastinal lymph node is noted. Emphysematous changes noted in lung apices. 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. There is an area of transmural late gadolinium enhancement noted in the basal inferior and inferolateral walls, most likely consistent with prior myocardial infarction; however, because the late gadolinium enhancement is associated with preserved myocardial wall thickness, the possibility of an infiltrative process can not be excluded, especially given the presence of a mediastinal lymph node. The segments of myocardium with late gadolinium enhancement are not likely to be viable. The remaining myocardium is without late gadolinium enhancement and likely to be viable.3. Severely dilated LV with mildly reduced systolic function (LVEF 45%).4. Mildly dilated RV with moderately reduced systolic function (RVEF 37%).5. Severe left atrial dilation.6. Severe mitral regurgitation.7. See extra-cardiac findings.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Rule out acute infarct or lesion. History of numbness on right side. Brain: No significant brain parenchymal signal abnormality. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. There is cerebellar tonsillar ectopia measuring up to 4 mm below the foramen magnum similar to prior without clear evidence of Chiari I. No significant crowding in the posterior fossa. Brain parenchyma is otherwise unremarkable for age. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits. Cervical: Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained aside from mild loss of cervical lordosis which may positional. Bone marrow signal is within normal limits. The cervical spinal cord has normal signal characteristics and overall morphology.Minimal degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: Minimal disc bulge with small central protrusion. No significant compromise to the spinal canal or neural foramina.C4-5: Minimal disc bulge. No significant compromise to the spinal canal or neural foramina.C5-6: No significant compromise to the spinal canal or neural foramina.C6-7: No significant compromise to the spinal canal or neural foramina.C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: 1. Brain MRI is essentially unremarkable. There is cerebellar tonsillar ectopia without significant crowding in the posterior fossa or evidence of Chiari I malformation.2. Cervical spine MRI is also essentially unremarkable. There are minimal degenerative changes without significant spinal canal or neural foraminal stenosis or cord signal abnormality at any level. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Male, 47 years old. Reason: pt with primary hyperparathyroidism, would like to identify any abnormal parathyroid glands and any thyroid nodules >1cm to that would require biopsy RIGHT LOBE MEASUREMENTS: 1.3 x 1.5 x 4.4 cmLEFT LOBE MEASUREMENTS: 1.5 x 1.2 x 4.6 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: Homogeneous echotexture, without focal lesion.LEFT LOBE: Homogeneous echotexture, without focal lesion.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: A mildly heterogeneous, hypoechoic nodule posterior to the inferior thyroid lobe measures 1.4 x 1.0 x 1.9 centimeters.LYMPH NODES: A right level 3 lymph node measures 0.8 x 0.2 x 1.1 cm. A left level 4 lymph node measures 0.4 x 0.2 x 0.7 cm.OTHER: No significant abnormality noted.

Output: A hypoechoic nodule posterior to the right inferior thyroid lobe corresponds with the abnormality seen on recent nuclear medicine parathyroid study and presumably represents a parathyroid adenoma. No thyroid nodules identified.


Instruction: Generate impression based on findings.

Input: 19-year-old female patient with history of PCL reconstruction as well as medial and lateral meniscectomies. Evaluate for possible lateral meniscus tear. Metallic susceptibility artifact resulting from multiple screws in the proximal tibia limits evaluation of the proximal tibia and adjacent structures, most notably the medial tibiofemoral compartment.MENISCI: Again seen is intrasubstance abnormal signal intensity within the lateral meniscus that is suggestive of degeneration as well as blunting of the free edge of the posterior horn of the lateral meniscus, which may represent a tear or postsurgical changes from meniscectomy. There is abnormal signal along the undersurface of the anterior horn of the medial meniscus, similar to prior. There is no fluid-filled meniscal tear seen.ARTICULAR CARTILAGE AND BONE: Evaluation of the articular cartilage is limited due to metallic susceptibility artifact. Again seen is a small full-thickness cartilage defect along the anterior margin of the medial femoral condyle with mild underlying bone deformity, suggestive of prior impaction fracture. This appears similar to prior examination. No new fluid-filled cartilage defects.LIGAMENTS: The anterior cruciate ligament is intact. The posterior cruciate ligament graft is intact and is associated with a tunnel and interference screws in the distal femur, compatible with history of prior reconstruction. The medial collateral ligament and lateral collateral ligament complex are intact.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: Limited study with stable appearing postoperative changes when compared to prior examination. No new findings to account for patient's pain.


Instruction: Generate impression based on findings.

Input: 61-year-old female patient with leg length discrepancy. Right lower extremity: Moderate osteoarthritis affects the right hip and mild to moderate osteoarthritis affects the right knee.Leg length measurements as below.Right tibia: 35.1 cmRight femur: 46.0 cmRight lower extremity: 81.6 cmLeft lower extremity: Again seen is deformity of the left femoral head with shortening of the femoral neck appearing similar to prior examination and compatible with diagnosis of long-standing Perthes disease. Minimal osteoarthritis affects the left knee.Leg length measurements as below.Left tibia: 34.8 cmLeft femur: 43.5 cmLeft lower extremity: 78.6 cm

Output: Leg length discrepancy with measurements as above.


Instruction: Generate impression based on findings.

Input: 66 years Female (DOB:6/2/1949)Reason: evidence of mets? History: Has had AMS and was lethargic, MS has somewhat improved, however concern for mets. Has leukemia.PROVIDER/ATTENDING NAME: LUCY A GODLEY LUCY A GODLEY There is evolution of a right posterior temporal lobe hematoma. It is smaller on the current exam and is surrounded by vasogenic pattern of T2 signal hyperintensity.There is a moderate degree of periventricular and subcortical confluent 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.

Output: 1.Continued evolution of right temporal lobe hemorrhage. There is no convincing evidence for metastatic disease at this time.2.Periventricular and subcortical white matter signal changes are nonspecific. At this age they are most likely vascular related though they could be related to a neurodegenerative process such as nonspecific leukoencephalopathy of aging. This could also be treatment related.


Instruction: Generate impression based on findings.

Input: 58-year-old male with history of Gleason 8 prostate cancer. PELVIS:PROSTATE:Prostate Size: 3.2 x 4.6 x 5.3 cm.Peripheral Zone: High T1 signal in the peripheral zone bilaterally, most compatible with hemorrhage. This finding limits sensitivity for prostate cancer detection. Within this limitation, there is a small, ill-defined focus of restricted diffusion in the left apex measuring up to 7 x 7 mm (series 803/264) with corresponding low T2 signal, suspicious for prostate cancer.Central Gland: Heterogeneous.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: Mild extracapsular extension of the left apical prostate cancer cannot be excluded; evaluation for such is difficult due to ill-defined appearance of the lesion.BLADDER: No significant abnormality noted.LYMPH NODES: Nonspecific prominent right external iliac lymph node measures up to 9 mm (series 2201/79). No pathologically enlarged lymph nodes by size criteria.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Small focus of prostate cancer in the left apex. Mild extracapsular extension cannot be excluded.


Instruction: Generate impression based on findings.

Input: Reason: assess for lateral meniscus tear History: right knee pain. MENISCI: Complex multidirectional tearing of the body and anterior and posterior horns of the lateral meniscus, new compared to prior. There is near complete loss of the posterior horn in its expected location with ill defined signal anterior to the anterior horn likely representing flipped posterior horn.Complex multidirectional tearing of the posterior horn of the medial meniscus is slightly improved compared to prior.ARTICULAR CARTILAGE AND BONE: Previously seen cleft-like defect of the articular cartilage of the femoral trochlea centrally is not significantly changed. Increased signal intensity along the lateral patellar facet articular cartilage likely reflecting degeneration is also not significantly changed.Diffuse thinning of the articular cartilage of the medial tibiofemoral compartment with full-thickness defect of the femoral cartilage overlying the torn posterior horn of the medial meniscus with underlying femoral condyle edema, unchanged.Near full thickness defect of the articular cartilage overlying the lateral tibial plateau underlying the expected location of the posterior horn of the lateral meniscus. Tricompartmental osteophyte formation again noted.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1.New complex multidirectional tearing of the body, anterior and posterior horns of the lateral meniscus, with the posterior horn flipped anterior to the anterior horn of the lateral meniscus.2.Previously seen multidirectional tearing of the posterior horn of the medial meniscus is stable to slightly improved compared to prior.3.Tricompartmental osteoarthritis.


Instruction: Generate impression based on findings.

Input: Cervical, thoracic, and lumbar radiculopathy on EMG as well as fasciculations, possible ALS. There is a small area of nonexpansile T2 hyperintensity in the dorsal columns and left grey matter of the spinal cord at the C2 level. There is no associated abnormal enhancement. The rest of the spinal cord appears to be unremarkable. The vertebral column alignment is within normal limits. The vertebral body heights are preserved. The vertebral bone marrow signal is unremarkable, aside from a small hemangioma in a mid thoracic vertebral body. There is a disc extrusion at L3-4 that results in moderate to severe spinal canal stenosis. There is also facet hypertrophy and ligamentum flavum thickening at this level, which results in mild to moderate bilateral neural foraminal narrowing. There is a disc protrusion at L4-5 that results in mild spinal canal narrowing. There is also facet hypertrophy and ligamentum flavum thickening at this level, which results in mild bilateral neural foraminal narrowing. There is no significant spinal canal or neural foraminal narrowing at the other lumbar levels or in the cervical and thoracic spine. The paravertebral soft tissues are unremarkable, aside from dependent edema in the posterior lumbar subcutaneous tissues. There is a small left renal cyst. There may be cholelithiasis.

Output: 1. Nonspecific lesion involving the dorsal columns and left grey matter of the spinal cord at the C2 level may represent manifestations of ALS. Differential considerations include prior ischemia, trauma, and infection, for example.2. A disc extrusion at L3-4 that results in moderate to severe spinal canal stenosis.3. A disc protrusion at L4-5 that results in mild spinal canal narrowing. 4. Possible cholelithiasis.


Instruction: Generate impression based on findings.

Input: Right lower extremity pain/numbness/coarse tremor. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is minimal retrolisthesis of L4 on L5. Alignment is otherwise within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position.Mild degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: No significant disc disease. No spinal canal or neural foraminal stenosis.L4-L5: There is disc desiccation with disc bulge and a small central disc protrusion. There is no significant spinal canal stenosis. There is minimal asymmetric narrowing of the right neural foramen. There is otherwise no significant spinal canal or neural foraminal stenosis.L5-S1: No significant disc disease. No spinal canal or neural foraminal stenosis.Paraspinous soft tissues are within normal limits.

Output: At L4-L5, there is a disc bulge and small central disc protrusion, minimally asymmetrically greater on the right. There is no significant spinal canal or neural foraminal stenosis at any level in the lumbar spine.


Instruction: Generate impression based on findings.

Input: 58-year-old male with hemarthrosis. Evaluate for structural abnormality versus PVNS. MENISCI: The medial and lateral meniscus appear normal.ARTICULAR CARTILAGE AND BONE: There is generalized thinning of the articular cartilage along the medial femoral condyle. There are focal areas of intermediate signal intensity partial defects along the articular cartilage of the medial femoral condyle anteriorly with adjacent subchondral bone marrow edema. Similarly there are foci of intermediate signal intensity partial defects along the articular cartilage of the medial facet of the patella. There are focal areas of subchondral bone marrow edema within the medial and lateral facet of the patella.LIGAMENTS: The collateral and cruciate ligaments appear normal.EXTENSOR MECHANISM: The extensor mechanism appears normal.ADDITIONAL

Output: 1. Findings most compatible with pigmented villonodular synovitis.2. Articular cartilage degeneration and other findings as described above.


Instruction: Generate impression based on findings.

Input: 73-year-old male patient with inability to walk on left leg with worsening exam and in the ED. Question of an epidural bleed. Interval postsurgical changes of a right laminectomy/facetectomy of L3, and laminectomy of L4. There are 2.2 x 1.3 cm and 1.7 x 1.6 cm T2 hyperintense and T1 hypointense collections at these levels, respectively, within the surgical bed, which extend into the epidural space and partially efface the thecal sac. However, the extent of effacement is similar to overall slightly improved from the presurgical study. These collections are compatible with postoperative fluid. No epidural hematoma is identified.The lumbar spine is in normal alignment, with continued straightening of the normal lumbar lordosis. There is mild disc narrowing at L4-L5 with disc desiccation at this level as well as at L1-L2 to L3-L4. The vertebral body and disk heights are otherwise well-maintained. No worrisome focal marrow signal abnormality is appreciated. The distal spinal cord and conus are within normal limits with the conus terminating at the L1-L2 level. There is developmental narrowing of the lumbar spinal canal due to shortened pedicles predominantly although there also remains prominence of dorsal epidural fat along the upper lumbar spine. There is redundancy of the cauda equina nerve roots which are also thickened, due to the spinal stenosis detailed below. At T12-L1, there is no significant disc pathology or stenosis.At L1-L2, there is a trace disc bulge and minimal facet arthropathy and ligamentum flavum thickening. There is mild-moderate central spinal canal stenosis.At L2-L3, there is a stable trace disc bulge with slight left paracentral prominence. There is moderate bilateral facet arthropathy and ligamentum flavum thickening with overall mild to moderate central spinal canal stenosis.At L3-L4, there are post-surgical changes of a right laminectomy/facetectomy with fluid within the surgical bed as described above. There is trace disc bulge with left facet arthropathy. There is moderate-severe central spinal canal stenosis as well as narrowing of the lateral recesses. There is mild-moderate right foraminal narrowing and mild stenosis on the left.At L4-L5, there are post-surgical changes of a right laminectomy with fluid within the surgical bed as described above. There is a disc bulge with right-sided prominence. There is moderate-severe left facet arthropathy. There is severe central spinal canal stenosis as well as near complete effacement of the lateral recesses. There is mild to moderate left and moderate right foraminal narrowing.At L5-S1, there is no significant disk pathology or stenosis.

Output: 1. Post-surgical changes of right laminectomies/facetectomies of L3 and L4 with post-operative fluid in the surgical bed and similar to slightly improved central canal stenosis at the levels, although remaining high-grade. No evidence of an epidural hematoma.2. Developmentally narrow lumbar spinal canal with otherwise stable spondylotic changes at the other spinal levels.


Instruction: Generate impression based on findings.

Input: Male, 3 months old, status post fall with parietal skull fractures. The known parietal bone fractures are not discretely visualized on MRI. However, there is a small extracranial hematoma overlying the site of the right parietal fracture. No clear evidence of scalp injury is seen along the course of the known left parietal fracture.Intracranially, two areas of extra-axial blood product are seen in the vicinity of the right parietal fracture which measure no more than 2 to 3 mm in thickness which correlate well with findings on prior CT (see image 11 series 701). Likewise, a 2 mm thick probable epidural collection is seen in the vicinity of the left parietal bone fracture which also correlates well with hemorrhage seen on prior CT (see image 12 series 701). On susceptibility weighted images, there are three foci of dark signal seen at the high right cranial vertex (image 15 series 1101) which may represent additional areas of trace extra-axial blood product.No additional significant intracranial collections are seen. Brain parenchymal morphology is within normal limits. No evidence of edema or mass effect is seen. No restricted diffusion is evident to suggest cytotoxic edema. The ventricular system is normal in size and morphology. The pattern of white matter myelination is appropriate for stated age.

Output: The known bilateral parietal bone fractures are not discretely visualized due to technical differences between MRI and CT. However, in the vicinity of the right parietal bone fracture, there is a small extracranial hematoma and trace extra-axial intracranial blood product which correlates well with prior CT. In the vicinity of the known left parietal bone fracture, there is a thin probable epidural hematoma which also correlates well with findings on CT. Trace presumed extra-axial blood product is also seen at the high right cerebral vertex. The small size of all the above-mentioned hemorrhages precludes accurate dating by MRI.Evaluation of the brain parenchyma is within normal limits. No evidence of contusion or significant parenchymal hemorrhage is detected. No edema or mass effect is seen. Ventricles are normal in size.


Instruction: Generate impression based on findings.

Input: Back pain, occasional radiation down lower extremities Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position.There is developmental narrowing of the lumbar spinal canal with termination of the thecal sac at the upper S1 level. Individual levels as below.L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: No significant disc disease. No spinal canal or neural foraminal stenosis.L4-L5: No significant disc disease. No spinal canal or neural foraminal stenosis.L5-S1: No significant disc disease. There is prominence of the epidural fat with thecal sac termination at the upper S1 level. There is otherwise no spinal canal or neural foraminal stenosis.

Output: 1. There is mild developmental narrowing of the lumbar spinal canal. There is also prominence of the epidural fat at the L5-S1 level with thecal sac terminating just inferiorly. Epidural fat prominence is at least predominantly developmental, but would suggest correlation with possible clinical findings of spinal canal stenosis at the L5-S1 level related to epidural lipomatosis.2. Spinal canal is otherwise preserved. No significant disc disease at any level. No evidence of impingement of the nerve roots in the neural foramina at any level.


Instruction: Generate impression based on findings.

Input: Right foot ulcer There is abnormal low T1 signal with corresponding high T2 signal and enhancement of the distal portion of the fifth proximal phalanx and the proximal portion of the fifth middle phalanx consistent with osteomyelitis. No additional areas of focal osteomyelitis are identified. Abnormal T1 and T2 signal is also noted within the anterior portion of the distal tibia (series 9 images 11-13) but there is no bony erosion or overlying skin defect to suggest osteomyelitis in this is likely reactive or degenerative in nature.There is no evidence of focal fluid collection/abscess. There is diffuse soft tissue enhancement/inflammation surrounding the lateral portion of the foot both within the plantar and dorsal soft tissues. There is no evidence of a joint effusion within the fifth PIP joint to suggest septic arthritis. Diffuse increased signal is also noted within the plantar musculature which also may be reactive given the patient's history of a muscular dystrophy.

Output: Osteomyelitis about the fifth PIP joint as detailed above. There is no evidence of abscess or joint effusion within the PIP joint. If surgical intervention is being considered, repeat MRI for confirmation should also be considered.