Instruction: Generate impression based on findings.

Input: 69-year-old male with pancreatic cancer undergoing radiation therapy planning. ABDOMEN:LIVER, BILIARY TRACT: See below regarding probable invasion of pancreatic mass into the caudate lobe. There is a 1.8 x 1.6 cm enhancing lesion in segment 7 with restricted diffusion, most suspicious for metastasis (series 11/34). A subcentimeter T2 hyperintense lesion with rim enhancement in segment 8 is likely due to an additional metastasis (series 11/20).SPLEEN: No significant abnormality noted.PANCREAS: Large pancreatic body mass extending posteriorly and superiorly to infiltrate along the celiac trunk measures up to 6.6 x 6.5 x 7.7 cm (AP by transverse by craniocaudal, series 6/18 and series 7/15), increased in size since prior CT on 4/9/2015. Encasement by the mass causes moderate narrowing of the celiac trunk and mild deformity of the abdominal aorta at the level of the celiac trunk. A new cystic component of the mass extends superiorly along the medial portion of the caudate lobe of the liver, which is deformed and likely invaded (series 6/13). The mass is inseparable from and likely invades into the lesser curvature of the stomach near the cardia and the apex of the left adrenal gland. Hypoenhancement of the mass centrally is likely due to tumor necrosis.Again the mass causes obstruction of the portal confluence, including of the splenic vein. There is reconstitution of the main portal vein via collateral vessels.ADRENAL GLANDS: See above regarding the left adrenal gland. Normal appearance of the right adrenal gland.KIDNEYS, URETERS: Left renal cyst.RETROPERITONEUM, LYMPH NODES: Mild upper abdominal lymphadenopathy (e.g. series 11/70).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Large pancreatic body mass has increased since prior study on 4/9/2015, as detailed above.2.Two small focal hepatic lesions, suspicious for metastases.3.Mild upper abdominal lymphadenopathy.


Instruction: Generate impression based on findings.

Input: Headache [R51], Reason for Study: ^Reason: evaluate for meningeal enhancement or possible site of CSF leak History: new headache w/ ?otorrhea/rinorrhea; h/o ischemic stroke Brain MRIMotion artifact degraded exam quality.No evidence of acute ischemic or hemorrhagic lesion.There is a developmental venous anomaly on the left lateral ventricle wall. 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. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion. No abnormal enhancement.2. Normal brain MRA.Contrast reaction description: Bronchospasm, hives Supervising radiologist: Mikin Patel, M.D. Contrast type: 17 cc of gadolinium contrast was administered. Patient had completed 13 hour premedication protocol. Signs and symptoms: Hypoxia and wheezing Treatment given: 1 mg IM epinephrine 1:1000, 50 mg by mouth Benadryl, and oxygen Discharge instructions given: Dr. Cart called, patient taken to the ER.


Instruction: Generate impression based on findings.

Input: 14-year-old with history of Guillain Barre and left temporal lobe masslike lesion: 3 month follow-up exam. There is persistent diffuse T2 hyperintensity in the head and body of the left hippocampus associated with minimal swelling and poorly defined internal architecture. There is no associated restricted diffusion or contrast enhancement. There is no abnormal signal or enhancement elsewhere in the brain. There is no evidence of intracranial hemorrhage or acute infarction. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major intracranial vascular flow voids are intact. There is a small amount of residual mucosal thickening in the left sphenoid sinus. The orbits are unremarkable.

Output: 1. Persistent left hippocampus lesion. Differential considerations include a low grade neoplasm and a form of dysplasia, for example.2. Diminished findings related to sinusitis.


Instruction: Generate impression based on findings.

Input: Hematemesis [K92.0], Reason for Study: ^Reason: large cell lymphoma with mass at base of skull; eval for tx responsiveness History: see above Brain MRIRedemonstration of right side skull base enhancing mass which involves prevertebral space of C1 arch, right side foramen magnum with encircling right side occipital condyle, right jugular foramen, right hypoglossal canal, right side petrous bone encircling right carotid canal, extending toward right posterior aspect of cavernous sinus most likely through the right inferior petrosal sinus and right side of clivus. The extent of the lesion involvement appear to be unchanged, however, the central portion of the mass shows low signal intensity on T1 and slightly high signal intensity on T2 suggesting possible necrotic changes (previously the mass showed relatively homogeneous enhancement). Ventriculostomy tube inserted through right frontal burr hole.Surgical staple on the right frontal scalp creates significant metallic artifacts.Bilateral optic disc protrusion and prominence of the optic sheath indicating intracranial hypertension are redemonstrated and unchanged. The ventricles, sulci and cisterns are symmetric and unremarkable. The paranasal sinuses are clear.Unchanged right mastoid fluid collection.Brain MRV3D MRV brain post-gadolinium with maximum intensity projections of the superficial/deep intracranial venous drainage demonstrate intra luminal filling defects within the right proximal sigmoid sinus. And the venous flow through the right sigmoid sinus is diminutive and there is no venous flow identified at the level of the right jugular fossa indicating occlusion, unchanged since prior scan. Mid superior sagittal sinus and mid portion of the right transverse sinus show intra luminal filling defects without altering forward flow, unchanged since prior scan.Other major sinuses left transverse sinuses, left sigmoid sinuses, internal cerebral veins, vein of Galen and straight sinus are normal. There is no evidence of venous congestive encephalopathy.

Output: 1. Interval development of central non enhancing areas of the extensive right skull base mass lesion indicating possible central necrosis. However, overall maximum diameter of the mass does not show any significant interval change.2. Luminal occlusion at the level of the right jugular foramen with diminutive right sigmoid sinus due to intraluminal filling defects, unchanged since prior scan.3. No evidence of venous congestive encephalopathy. 4. Bilateral optic disc and optic sheath changes indicating intracranial hypertension are again seen, unchanged.


Instruction: Generate impression based on findings.

Input: 30 years, Female, seizures. Rule out structural abnormality, especially right mesial temporal sclerosis. Brain parenchyma appears within normal limits. Bilateral hippocampi demonstrate preserved volume, internal architecture, and signal characteristics. No findings to suggest mesial temporal sclerosis are appreciated. Bilateral fornices and mamillary bodies are also grossly symmetric. No findings to suggest cortical dysplasia or gray matter heterotopia. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. Major flow-voids are preserved. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: No findings to suggest a seizure focus are appreciated. No evidence of mesial temporal sclerosis.


Instruction: Generate impression based on findings.

Input: 43 year-old status post left lumpectomy in July 2015 and re-excision in September 2015 for DCIS. No current breast complaints. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.There is less parenchymal enhancement in both breasts, compared to the prior study. An enhancing focus is no longer seen in the left breast at upper outer quadrant. Post-surgical scar is present at 12:00 position in the left breast.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: There are postoperative findings related to left parietal craniotomy for resection of a subjacent mass. There is minimally increased T2 hyperintensity inferior to the resection cavity within the deep left frontal white matter that may represent treatment effect or non-enhancing tumor. There is also unchanged adjacent non-specific T2 hyperintensity as well as additional patchy foci throughout the supratentorial white matter. There is unchanged susceptibility effect within the resection cavity as well as an additional unchanged punctate focus of susceptibility effect within the right superior parietal lobule that may resent a radiation induced cavernous malformation or micro-hemorrhage. There is a new focus of enhancement anteromedial to the resection cavity within the left superior frontal gyrus that measures 8 x 17 mm and demonstrates decreased diffusion. There is unchanged thin enhancement along the margins of the resection cavity. Perfusion imaging is not reliable due to poor contrast bolus delivery. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is minimal mucosal thickening within the left maxillary sinus.

Output: New enhancement anteromedial to the resection cavity may represent true progression or a treatment effect. This area could be further characterized with MR spectroscopy if clinically indicated.


Instruction: Generate impression based on findings.

Input: Ms. Farmer is a 75-year-old female with screen-detected calcifications in the right breast for which stereotactic biopsy is recommended. Patient now presents for MRI for further evaluation. There is scattered fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.In the right central breast, mid depth, there is a segmental distribution of linear nonmass enhancement is identified measuring 2.3 x 0.8 x 1.0 cm (AP x ML x SI). This corresponds to the mammographically detected calcifications for which stereotactic biopsy will be performed.In addition, in the right medial breast, periareolar region, there is a 0.5 cm focus of enhancement.In the left medial breast, periareolar region, there is a 1.1 cm segment of linear nonmass enhancement identified. No abnormal axillary lymph nodes are identified in either axillary region.

Output: (1) 2.3 cm span of linear nonmass enhancement in the right central breast, corresponding to the mammographically detected calcifications. A stereotactic biopsy will be performed later today.(2) 0.5 cm focus of enhancement in the right medial breast. An MR directed ultrasound with possible biopsy will be performed if sonographic correlate is identified.(3) 1.1 cm span of linear nonmass enhancement in the left medial breast. An MR directed ultrasound with possible biopsy will be performed if sonographic correlate is identified.BIRADS: 5 - Highly suggestive of malignancy.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration.


Instruction: Generate impression based on findings.

Input: Reason: 72 y/o male with amyloidosis. CT findings of possible 2 cm IPMN. MRCP requested to further evaluate. History: as above ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis without evidence of cholecystitis.SPLEEN: No significant abnormality noted.PANCREAS: There is a large cystic lesion in the pancreatic head measuring 1.9 x 1.1 cm which appears to communicate with the main pancreatic duct, likely a side branch IPMN. Multiple smaller cystic lesions are seen throughout the pancreas, also likely small side branch IPMNs.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts. There is layering intrinsic T1 hyperintensity within an exophytic left renal cyst, likely hemorrhagic/mucinous.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Mild diverticulosis without evidence of diverticulitis. The transverse colon in the region of the hepatic flexure is unremarkable.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Cystic lesion in the pancreatic head likely represents a sidebranch IPMN.2.Multiple additional smaller cystic lesions along the main pancreatic duct also likely represent side branch IPMNs.


Instruction: Generate impression based on findings.

Input: Male; 28 years old. Reason: 28yo male w/ frequent bowel movements and cramping. Evaluate for small bowel Crohn's. History: cramping and frequency ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant bowel or colonic wall thickening or enhancement.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Unremarkable examination with no significant bowel or colonic wall thickening or enhancement.


Instruction: Generate impression based on findings.

Input: Dysphagia for 2 years. Sjogren syndrome and prior optic neuritis. The images are generally degraded by patient motion to a considerable degree. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is a punctate focus of encephalomalacia in the left thalamus. There is also mild periventricular white matter T2 hyperintensity. The brainstem appears to be unremarkable. There is no abnormal intracranial enhancement. There is mild diffuse cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is a left lens implant. There is a miliary nodule appearance of the bilateral parotid glands.

Output: 1. Chronic lacunar infarct in the left thalamus and mild probable chronic small vessel ischemia in the bilateral cerebral hemispheres, but no evidence of intracranial hemorrhage, mass, or acute infarct. The brainstem appears to be unremarkable, although the exam is limited by patient motion.2. Findings related to parotid Sjogren.


Instruction: Generate impression based on findings.

Input: 60-year-old female with supraglottic larynx cancer. Initial staging scan. LUNGS AND PLEURA: Peribronchial thickening and right basilar mild reticular nodular pattern compatible with aspiration bronchiolitis. Scattered micronodules largest of which measures 3 mm, (image 62, series 5) too small to characterize. Mild bilateral apical emphysema.MEDIASTINUM AND HILA: Tracheostomy tube in appropriate position. Mediastinal lymph nodes are not enlarged by CT criteria. Debris in the right mainstem bronchus. Elongated right thyroid lobe extends inferiorly to the right of the trachea and contains cystic areas, nonspecific by CT. Small adjacent lymph nodes (2R) just below this area, image 18. Mild inflammatory change of the proximal intrathoracic esophagus. 1cm right hilar lymph node image 57 could be reactive.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Left adrenal nodule is measuring 7 x 12 mm, (image 23, series 3) is too small to characterize but does not contain measurable fat, atypical for an adenoma. This may be further evaluated with MRI.

Output: 1. Bronchiolitis pattern compatible with aspiration.2. No conclusive evidence of metastatic disease, however several small 2R lymph nodes are ill defined and enhance. Short term CT or PET follow up suggested to rule out nodal metastases.3. Indeterminate left adrenal nodule as above may be evaluated with in and out of phase MRI if it would affect clinical management of the patient.4. Probable radiation esophagitis of the proximal intrathoracic segment.


Instruction: Generate impression based on findings.

Input: Diagnosis: Hemangioma of intracranial structuresClinical question: multiple ccm brain please do on 3t SCANNER WITH CCM PROTOCOL-qsm and permeability studySigns and Symptoms: yearly surveillanceComments: CCM PROTOCOL ON 3T WITH QSM/PERMEABILITY STUDY PLEASE | Patient had been on metformin but last dose was in 2014. She denies being diabetic and stated she used metformin for another purpose | The CSF spaces are appropriate for the patient's stated age with no midline shift. On susceptibility there are multiple small foci of susceptibility effect scattered in both hemispheres of the brain as well as in the brainstem and cerebellum. These are also identified on the prior exam and have not changed in number. On T2-weighted imaging there is a left frontal lobe periventricular white matter lesion with a popcorn-like appearance which currently measures 5x4mm axial dimensions. On the prior exam it measured the same.On T2-weighted imaging, in the left superior parietal lobule there is a 4 mm x 14 mm similar appearing lesion which previously measured the same. On T2-weighted imaging in the left occipital pole there is a 5 mm x 4 mm lesion.In the right temporal lobe adjacent to the temporal horn of the right lateral ventricle there is a lesion with a popcorn-like appearance on T2WI measuring 7 x 4 mm axial dimensions. It measured the same on the prior exam from July 2014.In the pons there is a lesion with a popcorn-like appearance on T2WI measuring 5x5 mm axial dimensions. It measured the same on the prior exam from July 2014.In the right inferior parietal lobule there is a lesion with a popcorn-like appearance on T2WI measuring 3x3 mm axial dimensions. It measured the same on the prior exam from July 2014.In the left caudate nucleus there is a lesion with a popcorn-like appearance on T2WI measuring 2.5x2.5 mm axial dimensions. It measured the same on the prior exam from July 2014.Other lesions identified on susceptibility weighted imaging are present which are under 2 mm in size or readily identified.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 mucosal thickening in the right maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Compared to prior examination from 7/14/2014 there is no interval change in the number or size of the patient's multiple cerebral cavernous malformations.


Instruction: Generate impression based on findings.

Input: Female, 6 years old, with history of neonatal hypoxic ischemic encephalopathy from fetal maternal hemorrhage with bilateral infarcts, history of neonatal seizures, now with recurrence of generalized tonic clonic seizures. Large areas of encephalomalacia are seen involving the bilateral parietal lobes and to a lesser degree the bilateral frontal lobes. The residual gyri in these areas are shriveled and dysmorphic. Abnormal T2 signal is evident within the adjacent white matter at these locations.No evidence to suggest active parenchymal edema or mass effect is seen. No restricted diffusion is identified. There are no abnormal extra-axial collections and no evidence to suggest acute intracranial hemorrhage. Ex vacuo dilatation of the ventricular atria, left side more than right is seen. Otherwise, the ventricular system is within normal limits.

Output: Fairly extensive and bilaterally symmetric encephalomalacia of the parietal and to a lesser degree frontal lobes compatible with chronic sequelae of hypoxic ischemic injury.No evidence of active parenchymal edema, intracranial hemorrhage or any other acute finding.


Instruction: Generate impression based on findings.

Input: Mass along th upper spine soft tissue. Evaluate for liposarcoma. There is a 16 x 47 x 40 mm T1 and T2 hyperintense lesion in the left posterior upper back at the level of T2. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are otherwise unremarkable.

Output: A fat-containing left upper back subcutaneous lesion measuring up to 47 mm, most likely represents a lipoma. No aggressive features are seen on this noncontrast study.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, 36 years old, with history of cavernous malformation status post resection on 02/14/16, three month follow-up exam. Postoperative findings are seen compatible with prior right pterional craniotomy. The previously demonstrated acute postoperative findings have resolved.The partially resected right basal ganglia cavernous malformation is again seen. There remains a subcentimeter locule of fluid signal surrounded by a rim of susceptibility artifact appearing similar to the prior postoperative study. No associated pathologic enhancement is seen.Encephalomalacia of the right anterior temporal lobe is demonstrated representing evolution of postoperative cytotoxic edema. A thin band of T2 hyperintensity also extends superiorly from the basal ganglia lesion into the corona radiata likely representing encephalomalacia. No other parenchymal lesions are seen. A small left frontal developmental venous anomaly is redemonstrated.

Output: Postoperative findings are redemonstrated status post partial resection of a cavernous malformation from the inferior right basal ganglia. The residual lesion has not progressed from the prior exam.


Instruction: Generate impression based on findings.

Input: Unspecified intracranial hemorrhage [432.9], Reason for Study: ^Reason: SAH History: see above Brain MRIThere are multifocal restricted diffusion lesions on subcortical white matter involving bilateral frontoparietal lobes, bilateral temporal lobes, bilateral insular and bilateral occipital lobes. In addition, bilateral basal ganglia and thalami also show restricted diffusion lesions.On the right cerebellar hemisphere, there is 9.1mm x 37mm x 8mm parenchymal hemorrhage. Constellation of these findings suggest global hypoxic injury.Multifocal high signal intensities on cortical sulci on FLAIR images indicate acute subarachnoid hemorrhage which is corresponding to prior CT scan. No significant interval change in terms of extent of SAH and cerebellar ICH since prior CT scan.The ventricles, are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.Brain MRA:3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal.

Output: 1. Multifocal restricted diffusion lesions indicating global hypoxic injury.2. Acute bihemispheric SAH and right cerebellar ICH as described above, no significant interval change since prior CT scan. 3. Normal brain MRA.


Instruction: Generate impression based on findings.

Input: Male, 62 years old, history of renal cell carcinoma with solitary metastasis to the brain, status post surgery and postoperative SRS. Although dedicated pituitary sequences were not acquired on this exam, there has been a clear interval decrease in the size of enhancing sellar and suprasellar mass. The lesion demonstrates progressive T2 hypointensity which may represent hemosiderin staining or mineralization. Sequelae of prior and spinal sellar surgery are noted.Elsewhere intracranially, no pathologic enhancement is seen. No areas of edema or mass effect are detected. No acute intracranial hemorrhage or any abnormal extra-axial fluid collection is seen. The ventricles are normal in size and morphology.

Output: 1.Interval decrease in size of the sellar/suprasellar tumor. 2.No additional intracranial lesions are seen.


Instruction: Generate impression based on findings.

Input: An episode of incontinence in September. Continued left lateral hip pain. For the purpose of numbering, 5 lumbar type vertebrae are present with the last rib being at T12. In addition to straightening, there is lumbar levoscoliosis which can be better assessed with standing radiographs if indicated. The grade 1 anterolisthesis of L3 on L4 is grossly similar to prior with severe loss of disc height at the right aspect of the disc space and contributing to the levoscoliosis. Severe disc height and T2 signal loss at L3-L4 and L4-L5 has not significantly changed. Less severe degenerative disease at L1-L2, L2-L3 and L5-S1 discs is stable to minimally worse as described below. Heterogeneity of the marrow is most pronounced at L3, L4 and L5 vertebral bodies and is most likely degenerative in nature. Small Schmorl's node at the superior endplate of L4 is new since the previous examination. There is no suspicious marrow abnormality. The tip of the conus medullaris is at the mid L2 level, which is unchanged. The conus medullaris shows normal signal and morphology, as well as the included caudal spinal cord. Partially exophytic T1-hypointense, T2-hyperintense lesion arising from the inferior pole of the left kidney is incompletely assessed but was present previously and has not significantly changed in size.T10-T11, T11-T12 and T12-L1 (only in the sagittal plane): There are minimal disc bulges but no significant spinal canal stenosis. There is mild left T11-T12 neural foraminal stenosis.L1-L2: There is a minimal disc bulge associated with a tiny left foraminal protrusion but no significant spinal canal or left foraminal stenosis. There is mild, right more than left, facet arthropathy but no significant foraminal stenosis.L2-L3: Disc bulge is eccentric to the left. There is also ligamenta flava thickening and facet arthropathy. There is no significant spinal canal stenosis. There is no foraminal stenosis.L3-L4: Small disc bulge and disc uncovering related to grade 1 anterolisthesis which combined with advanced bilateral facet arthropathy and ligamentum flavum thickening result in moderate spinal canal stenosis which is stable to minimally worse in the interval. There is also no significant change in moderate to severe right and mild left foraminal stenosis, with possible impingement on the right L3 nerve root.L4-L5: Mild disc bulge and endplate osteophytes. The left greater than right facet arthropathy and the ligamenta flava thickening are not significantly changed. Mild central spinal and left subarticular recess stenoses are unchanged. There is moderate-to-severe left and mild right foraminal stenoses, which are unchanged with possible impingement of the left L4 nerve root. L5-S1: There is a disc bulge associated with a left foraminal and extraforaminal extrusion. Ligamentum flavum thickening and facet arthropathy with mild joint distention again seen. There is resulting in mild spinal canal stenosis. Severe left and mild-to-moderate right foraminal stenoses are also present. There may be impingement of the left L5 nerve root.

Output: Multilevel degenerative changes in the lumbar spine are again seen which are stable to minimally worse in the interval. There is up to moderate spinal canal stenosis at the L3-L4 level. There is also significant neural foraminal stenosis on the right at L3-L4 and on the left at L4-L5 and L5-S1. There may be impingement of the left L4 and L5 nerve roots. Please see details above.


Instruction: Generate impression based on findings.

Input: History of PSC. Assess for any dominant stricture or cholangiocarcinoma. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology, signal intensity and enhancement without a suspicious lesion.The hepatic and portal veins are patent.There is intrahepatic and extrahepatic irregular narrowing, including involvement of Klatskin point, the proximal common hepatic duct and distal common bile duct, overall appearing similar to the prior study. No new dominant stricture, abnormal postcontrast enhancement or filling defect.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Findings compatible with PSC without a focal suspicious lesion or new dominant stricture.


Instruction: Generate impression based on findings.

Input: Crohn's disease, eval for stricture/inflammation. RLQ pain, intermittent obstructive episodes. ABDOMEN:LIVER, BILIARY TRACT: Small left hepatic T2 hyperintense lesion likely representing a simple cyst.SPLEEN: Spleen is unremarkable.PANCREAS: No focal pancreatic lesion.ADRENAL GLANDS: No adrenal nodularity or thickening.KIDNEYS, URETERS: Kidneys enhance symmetrically without focal lesion. No hydronephrosis or hydroureter.RETROPERITONEUM, LYMPH NODES: No significant retroperitoneal lymphadenopathy.BOWEL, MESENTERY: Postsurgical changes of ileocecectomy are redemonstrated. There is mild diffuse dilation of the colon, appearing similar to that seen on prior studies. This is of uncertain etiology, as there is no evidence of stricturing or wall thickening. No abnormal enhancement or other features of active Crohn's disease.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Tampon noted in the vagina.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: As above.BONES, SOFT TISSUES: Previously demonstrated granulation tract in the left anus/perineum is no longer evident.OTHER: No significant abnormality noted.

Output: Mild diffuse colonic dilatation of unclear etiology without specific evidence of either acute or chronic inflammatory bowel disease.


Instruction: Generate impression based on findings.

Input: 59 year old woman with history of lung cancer s/p right pneumonectomy/chemotherapy/chest wall radiation, as well as diabetes, hypertension and hyperlipidemia who presents for cardiac MRI to evaluate for etiologies of LV dysfunction noted on recent echocardiogram.MEDICATIONS: lovenox, furosemide, lantus, lisinopril, nadolol First Pass PerfusionDuring hyperemia, no perfusion defects were present. Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable. There is no evidence for myocardial iron overload. The native T1 relaxation time is ~1030-1040ms, which is within normal limits.Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 54%, the LV end diastolic volume index is 48 ml/m2 (normal range: 65+/-11), the LVEDV is 92 ml (normal range 109+/-23), the LV end systolic volume index is 22 ml/m2 (normal range 18+/-5), the LVESV is 43 ml (normal range 31+/-10), the LV mass index is 37 g/m2, and the LV mass is 71 g. There is abnormal septal motion noted. Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 55%, the RV end diastolic volume index is 57 ml/m2 (normal range 69+/-14), the RVEDV is 111 ml (normal range 110+/-24), the RV end systolic volume index is 26 ml/m2 (normal range 22+/-8), and the RVESV is 50 ml (normal range 35+/-13). Right AtriumThe right atrium is moderate to severely dilated. The interatrial septum bulges towards the left suggestive of elevated right atrial pressure.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is trace mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is trace pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is at least mild tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsTwo left sided pulmonary veins drain normally into the left atrium; the right sided pulmonary veins were ligated during pneumonectomy. Pulmonary ArteryThe main pulmonary artery is normal in size. The right pulmonary artery abruptly ends, consistent with previous ligation during pneumonectomy. Venous AnatomyThe SVC is not well visualized. The IVC is dilated.PericardiumThe pericardium measures ~4mm which is within normal limits. There is no increased T2 signal to suggest pericardial edema. With real-time imaging, there is no exaggerated septal bounce to suggest constrictive physiology is present.Extracardiac FindingsThere is low signal intensity throughout the liver and spleen. Specifically, the T2* relaxation time in the liver is reduced at 14ms. This combined with heterogenous low signal of the liver could suggest hepatic iron overload. The hepatic veins are dilated. There is volume loss of the right lung due to previous surgery with associated mediastinal shift. There are borderline (9 x 10mm) enlarged lymph nodes in the right axilla which appears morphologically abnormal and is of unclear significance. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. No perfusion defects/ "ischemia" present during hyperemia.2. No prior myocardial infarction. The entire myocardium is viable. There is no myocardial iron overload.3. Normal LV size and systolic function (LVEF 54%)4. Normal RV size and systolic function (RVEF 55%).5. No evidence of pericardial thickening, edema or constrictive physiology.6. Dilated IVC, hepatic veins and interatrial septum bulging all suggestive of elevated right atrial pressures. 7. At least mild tricuspid regurgitation. 8. Extensive right lung/chest wall abnormalities following surgical pneumonectomy. Additionally, there is heterogenous low signal of the liver and spleen with reduced hepatic T2* decay time which supports a diagnosis of hepatic iron overload.9. There are borderline (9 x 10mm) enlarged lymph nodes in the right axilla which appears morphologically abnormal and is of unclear significance.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Chronic diarrhea with negative EGD/colonoscopy and increased fecal fat. ABDOMEN:LIVER, BILIARY TRACT: Normal liver morphology without focal hepatic lesion, biliary ductal dilatation or vascular abnormality. Normally distended gallbladder.SPLEEN: Normal morphology without a focal lesion.PANCREAS: Normal pathology without any focal lesion or pancreatic ductal dilatation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No focal lesion or hydroureteronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The small and large bowel are normal in caliber, wall thickness and enhancement. No adjacent inflammatory changes. No discrete fluid collections.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Bilateral physiologic adnexal follicles/cysts.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Trace pelvic fluid is within normal limits.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Normal MRI enterography without findings to account for the patient's chronic diarrhea.


Instruction: Generate impression based on findings.

Input: Progressive weakness of right hand. MRI: There is a punctate focus of mildly restricted diffusion in the right superior frontal gyrus subcortical white matter. There is a background of diffuse cerebral white matter and small areas of encephalomalacia in the right pons, right corona radiata, and left basal ganglia. There is no evidence of acute intracranial hemorrhage or mass. There is a partially empty sella. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The orbits, skull, and scalp soft tissues are grossly unremarkable. There appears to be secretions and mucosal thickening in the bilateral maxillary sinuses.MRA: The exam is partly degraded by patient motion. There is a paucity of flow related enhancement in the distal right PCOM and proximal right PCA. There is no evidence of significant steno-occlusive lesions in the rest of the proximal cerebral arteries. There is apparent mild focal dilatation of the proximal right PICA and diminished flow related enhancement just distal to this. Otherwise, there is no evidence of cerebral aneurysms.

Output: 1. Suggestion of a punctate recent infarct in the right superior frontal gyrus subcortical white matter.2. Probable diffuse chronic white matter small vessel ischemic disease and chronic lacunar infarcts in the right pons, right corona radiata, and left basal ganglia. 3. A paucity of flow related enhancement in the distal right PCOM and proximal right PCA may be secondary to significant steno-occlusive disease. 4. Apparent mild focal dilatation of the proximal right PICA and diminished flow related enhancement just distal to this.


Instruction: Generate impression based on findings.

Input: BRAIN: Two foci of periventricular T2 hyperintensity are again seen which were present previously. The more posterior lesion has slightly enlarged. There are no new foci of T2 hyperintensity. There is no abnormal enhancement within the brain. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. There is no mass effect or midline shift. The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. The pituitary gland is normal in size. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. CERVICAL SPINE: Alignment is normal. The marrow signal is benign. A previously demonstrated C4-5 intramedullary T2 hyperintense lesion is less conspicuous on this exam. No new lesions and no abnormal enhancement in the cervical spine. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable. No significant spinal canal stenosis or neuroforaminal narrowing of the visualized cervical and upper thoracic spine.

Output: 1.Redemonstration of two foci of periventricular T2 hyperintensity which were present previously, one of which is slightly larger. No new lesion or enhancement of the brain.2.A previous C4-5 intramedullary T2 hyperintense lesion is less conspicuous on this exam. No new lesions or abnormal enhancement of the cervical spine.


Instruction: Generate impression based on findings.

Input: History of terminal ileal strictures. Presents with nausea and vomiting. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The small bowel is adequately distended with oral contrast. The small bowel fold pattern is unremarkable.Changes secondary to quiescent Crohn disease involving the terminal ileum.No specific evidence of sinus tract or fistula formation.No significant free fluid or loculated fluid collection.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Changes secondary to quiescent Crohn disease involving the terminal ileum. No evidence of active small bowel inflammation or fibrostenotic disease.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 87 years Female (DOB:8/17/1929)Reason: stroke History: fallPROVIDER/ATTENDING NAME: SANGEETA S SAKARIA THOMAS J. KELLY MRI of the brainNo diffusion weighted abnormalities are appreciated. The lateral ventricles are fairly large as is the third ventricle.There is a moderate degree of periventricular and subcortical punctate hyperintense white matter lesions as well as hyperintense lesions within the brainstem of a moderate degree identified on the FLAIR and T2 images. Compared to prior exam these brainstem lesions appear to have accumulated further whereas the periventricular and subcortical white matter lesions appear relatively stable.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries. There are infundibula at the origins of the callosomarginal arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is very small.. There is fetal origin of the right posterior cerebral artery. The left posterior communicating artery is medium-sized. The right P1 segment is hypoplastic. There is infundibulum at the origin of the right posterior cerebral artery and left posterior communicating arteries. The right vertebral artery is larger than the left vertebral artery.Visualized images of the upper cervical spine demonstrate degenerative changes which are best seen on the recent CT of the cervical spine.

Output: 1.No evidence for intracranial cerebrovascular occlusive disease.2.No evidence for intracranial aneurysm.3.Periventricular and subcortical white matter lesions of a moderate degree as well as a moderate degree of brainstem lesions are nonspecific. At this age they are most likely vascular related. Compared to prior exam from June 2014 these brainstem lesions appear to have accumulated further whereas the periventricular and subcortical white matter lesions appear relatively stable.4.Large ventricular system could be related to atrophy though it is possible it is related to normal pressure hydrocephalus. Please correlate clinical symptoms.5.Refer to CT of the cervical spine for further comments.


Instruction: Generate impression based on findings.

Input: History of knee hemarthrosis and instability after slipping injury. Postoperative changes of ACL repair are present.MENISCI: The menisci are intact.ARTICULAR CARTILAGE AND BONE: Mild edema within the lateral aspect of the posterior tibial plateau may represent a bone contusion. Mild deepening of the articular surface of the lateral femoral condyle above the anterior horn of the meniscus likely reflects an old impaction injury with mild heterogeneity of the overlying articular cartilage. The articular cartilage of the medial and lateral tibiofemoral compartments otherwise appears intact. There is a large full-thickness tear involving the articular cartilage along the medial facet of the patella which may be acute. There is superficial tearing of the articular cartilage along the patellar median eminence with relative preservation of the articular cartilage along the medial patellar facet.LIGAMENTS: The ACL graft appears thickened with increased signal intensity. There appears to be disruption of the mid fibers suggestive of complete tear. The PCL appears intact. The collateral ligaments are intact. EXTENSOR MECHANISM: Mild deformity of the patellar tendon and its bony attachments is compatible with ACL graft harvesting. The extensor mechanism otherwise appears intact.ADDITIONAL

Output: 1.Findings compatible with complete tear of patient's ACL graft.2.Large full-thickness tear of the articular cartilage of the medial facet of the patella.3.No evidence of meniscal tear. 4.Joint effusion and other findings as described above.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for nerve impingement/radiculopathySigns and Symptoms: Patient with LUE limited ROM, shooting pains from nape of neck down into arm The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is mild reversal of the normal cervical curvature present. There is mild loss of disc space height and disc desiccation at C3-4 and C4-5.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: 1.There is no compromise of cervical spinal canal or exiting nerve roots. There are minor degenerative disc changes present.2.Mild reversal of normal cervical curvature is nonspecific. It could relate to muscle spasm or patient positioning in the magnet.


Instruction: Generate impression based on findings.

Input: Pituitary adenoma and TSH: surveillance. There are postoperative findings related to transsphenoidal resection of a pituitary macroadenoma, with patchy enhancement within the right clivus and sphenoid sinus mucosal thickening. There is residual tumor in the left sella and medial left cavernous sinus that measures up to approximately 14 mm. There is no longer mass effect upon the optic apparatus. The infundibulum remains deviated to the right.

Output: Postoperative findings related to transsphenoidal resection of a pituitary macroadenoma, with unchanged residual tumor in the left sella and medial left cavernous sinus.


Instruction: Generate impression based on findings.

Input: 56-year-old male with brain lesions. Redemonstrated is a medial left cerebellar enhancing lesion that measures up to 18 mm, a left lateral cerebellar enhancing lesions that measures up to 10 mm, a medial right cerebellum enhancing lesion that measures up to 4 mm, and a left middle frontal gyrus enhancing lesion that measures up to 9 mm, are unchanged in appearance. A left superior frontal gyrus lesion and a left hippocampal tail enhancing lesion, demonstrated previously, are not apparent on the current study perhaps secondary to timing of acquisition. As before, there is confluent T2 hyperintensity surrounding the larger lesions, which is decreased involving the cerebellum. There are no new lesions. Partial effacement of the fourth ventricle has resolved. There is no midline shift or herniation. There is mild scattered subcortical and confluent periventricular white matter T2 hyperintensity without associated enhancement. The major cerebral flow voids are intact. The orbits are grossly unremarkable. There is a subcentimeter exophytic cystic lesion in the skin along the left lateral eyelid region, which may represent a hidrocystoma, unchanged in appearance. There is a stable apical scalp lipoma that measures 7 mm in thickness. Redemonstrated are small bilateral maxillary sinus retention cysts.

Output: Multiple supratentorial and infratentorial metastases with vasogenic edema, some of which appear less conspicuous which may be related to a timing of acquisition phenomenon. Edema and mass effect within the posterior fossa has decreased, with resolution of previously demonstrated fourth ventricular partial effacement.


Instruction: Generate impression based on findings.

Input: 35-year-old male with suspicious lesions on prior imaging. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in size and morphology. Redemonstrated is a segment 4A/B lesion with mild T1 isointense signal and mild T2 hyperintense (although intrinsic T2 signal difficult to assess given marked hypointensity of background liver) and demonstrating early arterial enhancement without evidence of washout on portal venous or equilibrium phase. There has been no significant change in size of this lesion when compared to recent prior imaging but increased size noted when comparison made to more remote imaging. There is also arterial enhancement of a peripheral satellite lesion that was identified on the prior study, also without definite washout on portal venous or equilibrium phase. No new focal liver lesions are identified.There is no intrahepatic or extrahepatic biliary ductal dilatation. The gallbladder is within normal limits. There is paradoxical increase in signal in the liver and spleen on out of phase imagesSPLEEN: No significant abnormality noted.PANCREAS: Atrophic distal pancreatic body and tail with cystic lesion in the tail of the pancreas stable to slightly decreased in size since the prior examination measuring 10 mm, previously 12 mm. It is difficult to determine whether this lesion communicates with the main pancreatic duct.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.INDEX LESION MEASUREMENTS (Current exam date/time: 11/18/2016 13:58:42)SEGMENT 4A-B LESION: 1.8 x 1.4 cm (Image 12, Series 7); 1.8 x 1.4 cm on prior (1/12/2016) (Image 12, Series 3).ADJACENT SATELLITE NODULE: (Image 12, Series 7); on prior (1/12/2016) (Image 13, Series 3).PANCREATIC TAIL CYSTIC LESION: 1.0 cm (Image 27, Series 7); 1.2 cm on prior (1/12/2016) (Image 27, Series 3).

Output: 1.No significant change in size of a segment 4A/B lesion with additional peripheral satellite lesion as described above, when compared to recent prior imaging. Differential includes FNH although a dysplastic nodule is not excluded especially given degree of postcontrast enhancement and increased size when compared to remote imaging; continued follow up recommended. Hemangioma another consideration but expected corresponding T2 hyperintense signal not seen.2.Stable to slight decrease in size of a cystic pancreatic tail lesion. It is difficult to determine whether this lesion communicates with the main pancreatic duct. Differential continues to include sidebranch IPMN or a small pseudocyst.


Instruction: Generate impression based on findings.

Input: 71 years Female (DOB:8/9/1944)Reason: eval known occipital tumor History: meningiomaPROVIDER/ATTENDING NAME: KRISTINA K GALLOW PETER C. WARNKE MRI of the brainThe patient is undergone left parietal craniotomy for removal of an extra-axial mass involving the superior sagittal sinus. The superior sagittal sinus is not present at the craniectomy site. There is redemonstration of a fluid collection at the craniectomy site.Since the prior exam the dural nodular thickening at the posterior aspect of the falx has increased. On axial it measures approximately 25mm width and on sagittal imaging it measures 53 x 24 mm it is stable compared to the 5/31/2016 exam.Within the brain parenchyma adjacent to the craniotomy site there is signal change within the subcortical white matter in a contiguous fashion which has not changed substantially since the prior exam and has not changed since the preoperative exam.Incidental note is made of partial empty sella.There is mild anterior subluxation of C1 on C2.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.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells demonstrate opacification of the right mastoid air cells. The visualized portions of the orbits are intact.MRV brain:There is no flow present along the posterior aspect of the superior sagittal sinus along the craniotomy site with the exception of a 3 cm segment proximal to the torcula.The dural venous sinuses with the exception of the superior sagittal sinus are patent. Straight sinus, internal cerebral veins and basal veins are identified and appear patent.

Output: 1.Since the prior exam from 5/31/2016 an extra-axial dural based mass involving the falx cerebri has not changed. Most likely this represents residual/recurrent meningioma.2.There is occlusion of the superior sagittal sinus along its posterior aspect at the tumor site.3.There is mild anterior subluxation of C1 on C2 which appears unchanged since the prior exam.4.T2 signal change centered within the subcortical white matter of the parietal lobes is stable when compared to the prior exam. It's possible that this represents edema.


Instruction: Generate impression based on findings.

Input: 51-year-old female status post ACL reconstruction x 2 with positive Lachman's and knee pain.IMAGE ACQUISITIONS: Computed tomography of the right knee, nonenhanced, with transverse, coronal, and sagittal reformatted images As stated on the requisition, the patient is status post reconstruction of the anterior cruciate ligament as evidenced by surgical tunnels in the proximal tibia and distal femur. Although not visible on this study, the graft appears intact on the recent MRI examination. As seen on prior radiographs, there is a horizontally oriented fixation screw within the posterior aspect of the lateral femoral condyle at the superior margin of the femoral tunnel. Its pin exits the posterior femoral cortex and extends superomedially such that its tip lies immediately anterior to the popliteal artery. A small tapering focus of low to intermediate attenuation is seen immediately inferior to the pin, which may either represent a ganglion or focus of scarring; I do not believe that it is vascular in etiology.The tibial tunnel penetrates the anteromedial cortex of the proximal tibia. Additional lucent tracts are seen in the distal femur and proximal tibia compatible with more remote ACL reconstruction.Tiny patellar osteophytes indicate mild osteoarthritis. The remaining visualized bone and soft tissue structures are within normal limits.

Output: Postoperative changes as described above.


Instruction: Generate impression based on findings.

Input: Clinical question: Cervical stenosis. Evaluate for stenosis, abnormality. Signs and symptoms: Clumsiness in hands. Nonenhanced cervical MRI:There is degenerative changes of cervical spine with resultant mild reversal of cervical lordosis however without significant change since prior exam. Foramen magnum is unremarkable.C2-C3 demonstrate mild degenerative changes and unremarkable otherwise.C3-C4 demonstrate mild degenerative changes with resultant mild left neural foraminal compromise and unremarkable otherwise.C4-C5 demonstrate moderate disc disease and loss of disc height and broad-based Central and rightward disc protrusion results in flattening and posterior displacement of the cord (right greater than left) and moderate central spinal stenosis. No significant change is detected. Increased T2 signal intensity within the cord on the right is again also noted with suggestion of subtle interval progression. Significant bilateral (right greater than left) neural foraminal compromise is noted.C5-C6 demonstrate moderate disc disease and loss of disc height, disc osteophyte complex on the right paramedian results in flattening and posterior displacement of the cord on the right and mild to moderate central spinal stenosis. There is significant (left greater than right) neural foraminal optimize at this level. This finding demonstrate no definitive interval change since prior exam. Presence of cord signal abnormality at this level is questionable.C6-C7 demonstrate moderate disc disease and loss of disc height and mild bilateral ligamentum flavum hypertrophy. Mild central spinal stenosis, significant bilateral (left greater than right) neural foraminal compromise is present.C7-T1 demonstrate mild degenerative disc disease, a central disc protrusion with interval decreased size is noted. Mild central spinal stenosis persist and neural foramina remain patent.

Output: 1.Extensive degenerative changes of cervical spine with resultant mild reversal of cervical lordosis centered at C4-C5 without significant change.2.Degenerative changes at C4-C5 with resultant central spinal stenosis and bilateral neural foraminal compromise is noted. There is suggestion of subtle interval increase T2 signal intensity of the cord on the right since prior exam as detailed above.3.Multi additional levels of central spinal stenosis without significant change as detailed.4.Multilevel bilateral neural foraminal compromise (some significantly) as detailed per level.


Instruction: Generate impression based on findings.

Input: Golfer's elbow. Tennis elbow. LIGAMENTS: The ulnar collateral ligament is intact and attaches to the sublime tubercle. The lateral collateral complex is also intact.TENDONS: Examination of the flexor tendons is unremarkable. There is some increased signal at the common extensor tendons consistent with arterial tear or inflammation the biceps tendon is attachedARTICULAR SURFACES AND BONE: No significant abnormality noted. SURROUNDING STRUCTURES: No significant abnormality noted.ADDITIONAL

Output: Marked extravasation of contrast material. There is however increased signal in the common extensor tendons. Ulnar collateral ligament is intact.


Instruction: Generate impression based on findings.

Input: History of ulcerative colitis with elevated alkaline phosphatase and transaminases. Evaluate for PSC. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology and size measuring 20 cm in craniocaudal dimension. Punctate hepatic cyst is noted in segment 8. No suspicious liver lesion.There is mild luminal irregularity of the intrahepatic bile ducts without a dominant stricture or mass.SPLEEN: Normal splenic morphology and size without a focal lesion.PANCREAS: Findings of pancreas divisum. The pancreatic parenchyma is normal in signal intensity. No pancreatic ductal dilatation or focal lesion.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter right superior and left inferior pole simple cysts. No hydronephrosis or suspicious lesion.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Numerous small mesenteric and pericolonic lymph nodes measuring less than 1 cm. Incomplete evaluation of the colon demonstrates diffuse mild wall thickening.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Mild luminal irregularity of the intrahepatic bile ducts without a dominant stricture or mass suspicious for primary sclerosing cholangitis given the history of ulcerative colitis. 2. Note is made of pancreas divisum without evidence of active inflammation. 3. Increased number of small pericolonic and mesenteric lymph nodes with mild diffuse clonic wall thickening, correlate for active ulcerative colitis.


Instruction: Generate impression based on findings.

Input: Fever and back pain. Evaluate for discitis. Diffusion-weighted images demonstrate mild diffusion restriction involving the L4-L5 disc space and adjacent endplates suspicious for discitis-osteomyelitis (sagittal series 601 images 72, 88, 104). No abnormal diffusion signal is appreciated in the epidural space or paraspinous soft tissues.

Output: Mild diffusion restriction at the L4-L5 level is suggestive of early discitis-osteomyelitis. Please refer to separate report from same day regarding additional findings in the lumbar spine.


Instruction: Generate impression based on findings.

Input: Reason: Patient w/ prostate CA here w/ diffuse weakness, please eval for cervical spinal stenosis/ cord compression Alignment is anatomic. There is edema centered on the L3-4 and L4-5, likely related to disc degeneration. Vertebral body heights are maintained. The conus is normal in signal and morphology and terminates at an appropriate level. No epidural hematoma or mass. The visualized intra-abdominal and paraspinal contents are unremarkable.T12/L1: There is a compression deformity of T12 without significant spinal canal stenosis or foraminal narrowing. T12 superior endplate Schmorl's node is noted.L1/2: Mild bulging disc. No significant spinal canal stenosis or foraminal narrowing. L2/3: Mild bulging disc and facet arthropathy. No significant spinal canal stenosis. Mild bilateral foraminal narrowing. L3/4: Moderate disc bulge is seen centered on the right, with superimposed foraminal protrusion. There is facet arthropathy and ligamentum flavum thickening. Spinal canal is narrowed mostly affecting the right lateral recess. Severe right foraminal narrowing. No significant left foraminal narrowing.L4/5: There is facet arthropathy, ligamentum flavum thickening, and diffuse disc bulge. There is moderate circumferential spinal canal narrowing. Mild right foraminal narrowing. Severe left foraminal narrowing. L5/S1: Mild ligamentum flavum thickening and facet arthropathy. No significant spinal stenosis or foraminal narrowing.

Output: Multilevel degenerative changes of the lumbar spine most severe at L3-4 and L4-5 levels. No definite spinal metastasis.


Instruction: Generate impression based on findings.

Input: Elevated PSA. Negative prostate biopsy 12/14/2009 PELVIS:PROSTATE:Prostate Size: 4.1 x 6.8 x 6.5 cmPeripheral Zone: The peripheral zone is homogeneously T2 hyperintense with an ovoid T2 hypointense lesion in the lateral base (series 501/70) measuring 7 x 6 mm associated with mild decreased ADC signal (series 704/324). There is mild T1-weighted hyperintensity in this region however on pre- and post-contrast images there is early nodular enhancement (series 1401/2011).Central Gland: Moderate changes of benign prostatic hyperplasia without a suspicious lesion.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: The lesion abuts the prostatic margin which appears mildly retracted without specific evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 7 x 6 mm lesion in the left lateral mid gland is suspicious for prostatic adenocarcinoma. No specific evidence of extraprostatic tumor extension.


Instruction: Generate impression based on findings.

Input: Female, 13 years old. Anti NMDA Receptor Encephalitis, seizures. Evaluate for ovarian teratoma. PELVIS:UTERUS, ADNEXA: A 3.5 x 3.3 x 4.0 cm simple left ovarian cyst is noted. No associated solid component or abnormal enhancement. No other pelvic mass lesion is identified. The uterus is normal in appearance. Trace free pelvic fluid is likely physiologic.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No specific evidence of bowel obstruction.BONES, SOFT TISSUES: A subcentimeter lesion located eccentrically in the right proximal femur, peripherally T2 hyperintense, is not significantly changed from multiple prior studies and is of doubtful clinical significance.OTHER: No significant abnormality noted.

Output: 1.A 4 mm left ovarian cystic lesion is compatible with a follicular cyst.2.No other mass is identified in the pelvis.


Instruction: Generate impression based on findings.

Input: 78-year-old male with a history of hypertension, hyperlipidemia, paroxysmal nocturnal dyspnea, coronary artery disease with PCI of ostial right coronary artery, now with ostial left anterior descending disease. MRI evaluation prior to PCI of ostial LAD versus TECAB of LAD.MEDICATIONS: Aspirin, clopidogrel, isosorbide mononitrate, losartan, metoprolol, simvastatin. First Pass PerfusionDuring hyperemia, no perfusion defects were present. Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable.Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 73%, the LV end diastolic volume index is 57 ml/m2 (normal range: 74+/-15), the LVEDV is 100 ml (normal range 142+/-34), the LV end systolic volume index is 16 ml/m2 (normal range 25+/-9), the LVESV is 28 ml (normal range 47+/-19), the LV mass index is 33 g/m2, and the LV mass is 58 g. There are no regional wall motion abnormalities present. Stent artifact is noted in the mid right coronary artery.Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 56%, the RV end diastolic volume index is 64 ml/m2 (normal range 82+/-16), the RVEDV is 112 ml (normal range 142+/-31), the RV end systolic volume index is 28 ml/m2 (normal range 31+/-9), and the RVESV is 49 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. There is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsHepatic cyst is noted. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. No perfusion defects/ "ischemia" present during hyperemia.2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and systolic function (LVEF 73%).4. Normal RV size and systolic function (RVEF 56%).5. Mild mitral regurgitation6. Moderate left atrial dilation. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 24-year-old with history of VHL and pancreatic cysts. ABDOMEN:LIVER, BILIARY TRACT: The liver appears normal in signal and morphology. The gallbladder is normal. There is no intra or extrahepatic biliary duct dilatation.SPLEEN: The spleen appears normal.PANCREAS: Innumerable cysts throughout the pancreatic parenchyma are again seen. The largest, reference lesion seen on the prior study is now not visualized. Multiple additional, smaller cysts seen on the prior study have also resolved. The largest cyst on the current study measures 32 x 20 mm in the pancreatic tail (series 9, image 18) with a thin septation and is unchanged. No enhancing, solid components are identified.ADRENAL GLANDS: The adrenal glands are normal.KIDNEYS, URETERS: Multiple, enhancing, solid/cystic lesions are noted in the right kidney. There is an 18 x 13 mm septated, enhancing lesion in the mid right renal pole (series 1602, image 42), previously 14 x 12 mm. Additionally, there is an enhancing mass in the right lower renal pole (series 1602, image 51) which avidly enhances and measures 14 x 9 mm, previously 11 x 7 mm. Additional renal cysts are seen bilaterally. Renal veins appear normal.RETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: T2 hyperintensity within the central spinal cord in the lower thoracic spine is again noted.OTHER: No significant abnormality noted.

Output: 1.Two enlarging heterogeneously enhancing right renal lesions highly suspicious for renal cell carcinoma.2.Stable and decreased size of pancreatic cysts as above.


Instruction: Generate impression based on findings.

Input: There is no diffusion abnormality to suspect acute stroke. Susceptibility weighted images are unremarkable. The ventricles and sulci are within normal limits. The basal cisterns remain patent. There is no midline shift or mass effect. There are no areas of abnormal signal or enhancement. No extra-axial fluid collection is identified. The major intracranial vascular structures enhance normally. The midline structures and craniocervical junction are within normal limits. There is bilateral maxillary sinus opacification, right greater than left. Additional patchy opacification of the remaining paranasal sinuses is also noted. The soft tissue along the adenoids and lingual tonsils are prominent, probably within normal limits given the patient's age.

Output: 1.Normal MRI of the brain.2.Opacification of bilateral maxillary sinuses, right greater than left. Please correlate clinically for sinusitis.


Instruction: Generate impression based on findings.

Input: Mrs. Cyrus is a 39-year-old female with a family history of breast cancer in her sister at the age of 40 and a maternal aunt. She has a personal history of benign left upper outer breast MRI guided biopsy in 2014. She has no current breast related complaints. There is heterogeneous amount of fibroglandular tissue in both breasts. Multiple foci of enhancement are seen in both breasts, compatible with moderate background parenchymal enhancement. No one focus is more suspicious than the rest. Multiple T2 intense nonenhancing lesions are identified in both breasts, compatible with simple cysts. Susceptibility artifact from benign biopsy marker clip is seen in the left upper outer breast. Scattered foci of enhancement are seen in both breasts, stable in size and appearance when compared back to prior examinations. No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Male 16 years old; Reason: Right knee injury November 2014, patient jumped for a block during basketball, knee buckled, came down and fell, evaluate for ligament injury vs meniscus injury Due to the patient's body habitus, the high-definition MRI coil could not be used. An alternative coil was used, which slightly limits image quality and evaluation. MENISCI: There is a complex tear of the lateral meniscus, with attenuation of the posterior horn and displacement of meniscal tissue into the intracondylar notch. An additional vertical tear is present in the body of the lateral meniscus. There is a complete longitudinal tear of the posterior horn of the medial meniscus, which is seen on 6 consecutive sagittal slices. The body and anterior horn of the medial meniscus appear intact.ARTICULAR CARTILAGE AND BONE: Edema within the lateral tibial plateau likely represents bone contusion. A small subchondral cyst in the posterior aspect of the lateral tibial plateau with minimal depression of the overlying bone plate may represent additional sequelae of prior injury. Mild edema is present in the lateral femoral condyle and medial tibial plateau. Slight depression of the articular surface of the lateral femoral condyle above the free edge of the anterior horn of the lateral meniscus likely represents impaction deformity sustained at the time of injury. Evaluation of the cartilage is limited, but no focal fluid-filled cartilage defect is seen.LIGAMENTS: There is a complete tear of the anterior cruciate ligament. The posterior cruciate ligament is intact. The medial and lateral collateral ligaments are intact.EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Medial and lateral meniscal tears as described above, with displacement of the lateral meniscus into the intercondylar notch.2. Complete tear of the anterior cruciate ligament.3. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Clinical question: Rule out stroke. Signs and symptoms: Focal weakness, altered mental status. Nonenhanced head CT:Examination demonstrate mild-to-moderate degree of small vessel ischemic disease of indeterminate age. There is a left frontal periventricular white matter foci of low-attenuation which is believed to represent a lacunar infarct. Prominence size of this lesion (8 times 14-mm) may suggest acute state of this lesion. Please correlate with clinical exam and follow-up with an MRI if clinically is warranted.The cortical sulci, ventricular system and CSF cisterns remain within normal limits.There is no evidence of hemorrhage, mass-effect, midline shift or hydrocephalus.

Output: 1.Small vessel ischemic disease of indeterminate age.2.A lacunar infarct in the left frontal periventricular white matter appears prominent in size and measuring 8 times 14-mm. This finding could represent an acute lacunar infarct due to its large size. Please correlate with history and physical exam and if clinically warranted follow-up with an MRI.


Instruction: Generate impression based on findings.

Input: There is mild motion limitation. The thoracic spine is in normal alignment, with a normal thoracic kyphosis. The vertebral body and disk heights are well maintained. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal. There is no pathological enhancement.There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the thoracic spine.The counting sequences again demonstrate partial visualization of the known expansile T2 hyperintense cystic appearing lesion centered at the C6 level with surrounding hemosiderin staining of the cord parenchyma. Prominent central spinal canal stenosis is noted along the mid cervical spine as there are superimposed spondylotic changes, with these findings detailed on prior dedicated MRI of the cervical spine.LUMBAR SPINE

Output: 1. Unremarkable MRI of the thoracic spine. No evidence of additional cord lesion, with partial visualization of previously described intramedullary lower cervical lesion.2. Questioned smooth enhancement along the cauda equina nerve roots, which may in part be artifactual/technical in nature. Confirmation of axial T1 post contrast images is limited secondary to artifact. However, the possibility of arachnoiditis is raised, and correlation with clinical history and CSF sampling is recommended.3. No significant spondylotic changes except for mild disk desiccation along the mid lumbar spine


Instruction: Generate impression based on findings.

Input: Midline low back pain without sciatica MRI thoracic spine:At T8-T9 there is a T1 and T2 hypointense lesion present within the left anterior aspect of the spinal canal measuring 11 x 7 mm axial dimensions and 18 x 9 mm sagittal dimensions. It tracks behind the adjacent vertebral bodies. It extends towards the left T8-9 neural foramen and abuts the left pedicle of T9. This lesion mildly displaces the spinal cord towards the right.The T8-T9 disc is mildly desiccated and there is mild loss of disc space height at T8-T9. There is some loss of disc space height at T6-T7.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. Lumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is a broad-based central disc protrusion present at L5-S1 which impresses on the ventral aspect of the thecal sac. It does extend into the inferior aspects of the neural foramina. It abuts the nerve roots at the right lateral recess but does not compress them. It extends across the midline and minimally abuts the nerve roots at the left lateral recess. The disc protrusion itself this contains some high signal material.At L4-5 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.There is a lesion present along the left lateral recess at T8-T9 which appears represent a partially calcified mass. It is most likely discogenic in origin. A CT of the thoracic spine may help further evaluate it if information on calcification is needed.2.There is a small central disc protrusion eccentric to the right present at L5-S1 without significant compromise spinal canal or neural foramina. It abuts the nerve roots at the right lateral recess.


Instruction: Generate impression based on findings.

Input: 44-year-old female with pain. Evaluate medial meniscus. Suboptimal examination secondary to inability to use a dedicated knee coil due to the patient's body habitus. A flex coil was utilized for this examination.MENISCI: There is deformity and increased signal abnormality which extends to the femoral and tibial articular surfaces within the anterior horn of the lateral meniscus consistent with a complex tear which extends to involve the body of the meniscus. The posterior horn of the lateral meniscus appears intact. There is globular increased signal abnormality within the posterior horn of the medial meniscus which does not extend to either articular surface, consistent with intrasubstance degeneration. The medial meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is focal near full-thickness articular cartilage degeneration along the weightbearing portion of the medial femoral condyle. There is thinning of the articular cartilage along the weightbearing portion of the lateral femoral condyle. The articular cartilage of the patellofemoral compartment is relatively spared. There is medial and lateral compartment osteophyte formation.LIGAMENTS: There is minimal increased signal abnormality within the ACL which appears intact. The PCL appears intact. The collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Tearing of the lateral meniscus as described above. 2. Degenerative osteoarthritic changes including near full-thickness articular cartilage degeneration as described above. 3. Small joint effusion.


Instruction: Generate impression based on findings.

Input: Vaginal discharge. Evaluate for fistula. History of recurrent urothelial cancer. High grade pT2bN0 urothelial cancer invasive to the lamina propria, s/p cystectomy/bilateral pelvic lymph node dissection, and ileal conduit (5/2014), later c/b enterovaginal fistula and recurrence in 10/2014 with vaginectomy, small bowel resection, colonic resection, and pubic symphysis excision (11/2014). ABDOMEN:LIVER, BILIARY TRACT: A subcentimeter T2 hyperintensity in the posterior right lobe is nonspecific and may represent a cyst or hemangioma (series 6, image 15). Otherwise, no significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Expected mild hydronephrosis with diversion into a right lower quadrant ileal conduit.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted in the upper abdomen.BOWEL, MESENTERY: Postsurgical findings in the small bowel and colon from partial resection. The anterior mesenteric soft tissue nodule, likely representing metastasis (series 14, image 28), is similar to prior. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Postsurgical findings of total vaginectomy.BLADDER: Postsurgical findings of cystectomy and right lower quadrant ileal conduit.LYMPH NODES: Left inguinal lymphadenopathy and soft tissue nodules in the left lower abdominal wall are again seen, likely metastatic.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: There is an extensive enhancing amorphous necrotic mass in the central lower pelvis, with frond-like projections insinuating throughout the pelvis and into the pelvic sidewalls. The mass is difficult to measure similarly, though measures 4.2 x 4.3 cm (series 1902, image 50) centrally with a 3.0 x 2.7 cm extension in the right pelvic soft tissues. The mass overall is increased in extent compared to 3/17/15. The mass extends into the right and left superficial pelvic soft tissues and extends into the vaginal pouch, likely accounting for the clinical history of vaginal discharge. Additional enhancing soft tissue about this mass is non-specific and may represent fibrotic post-surgical changes or additional tumor. There is artifact, likely from the prior surgery, in the pelvis which slightly limits evaluation. The patient is status post pubic symphysis resection. T2 hyperintense lesions in the T11 and L1 vertebral bodies with internal fat signal are compatible with hemangiomas. OTHER: No significant abnormality noted.

Output: Interval growth of the extensive necrotic pelvic tumor, with extension throughout the pelvic soft tissues and into the vaginal pouch, likely accounting for the patient's history of vaginal discharge.


Instruction: Generate impression based on findings.

Input: 78-year-old man with history of chronic pancreatitis. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in signal and morphology. Mild extrahepatic biliary duct dilatation appears stable. There is no intrahepatic biliary duct dilatation. The gallbladder appears normal.SPLEEN: The spleen is normal.PANCREAS: The pancreatic region, is atrophied and there is stable, irregular pancreatic ductal dilatation. Additionally, there is a new ductal calcification (series 10, image 19) in the body of the pancreas. No pancreatic masses identified.Sequences obtained following secretin administration demonstrate diminished compliance of the main pancreatic duct with at least one ectatic side branch. The duodenum is seen opacifying to the ligament of Treitz.ADRENAL GLANDS: The adrenal glands are normal.KIDNEYS, URETERS: Multiple simple renal cysts are seen bilaterally, unchanged from prior exams.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The partially visualized small bowel and colon appears normal. Multiple varices are again noted with occlusion of the SMV near the portal confluence.BONES, SOFT TISSUES: There is a hemangioma in the L2 vertebral body.OTHER: No significant abnormality noted.

Output: Findings compatible with chronic pancreatitis including main pancreatic duct dilatation, decreased compliance shown status post secretion administration, and ductal calcifications. No focal pancreatic mass identified.


Instruction: Generate impression based on findings.

Input: 60 year-old male status post heart transplant, with altered mental status Examination demonstrates ill-defined hypoattenuation change in the tip of right temporal lobe in associated with a coarse calcification mass. The mass appears wrapping around the greater wing of sphenoid on the right side. It shows no significant change when compared to previous MRI study. Patchy area of low attenuation change is identified in the left frontal lobe with associated prominence of the sulci, consistent with encephalomalacia. There is no new density change in the remainder parenchyma. No evidence of hemorrhage or midline shift is detected. Cortical sulci, ventricular system and all CSF cisterns are symmetric and mild prominent secondary to parenchymal volume loss. Calvarium and skull base is negative for metastatic disease. The visualized paranasal sinuses and mastoid air cells are unremarkable.

Output: 1. Right temporal tip coarse calcification mass with associated vasogenic edema. Differential diagnosis includes slow growing meningioma, calcified metastatic lesion. The finding is stable when compared to previous MR study.2. Left frontal lobe encephalomalacia. There is no evidence of acute intra-or extra-axial hemorrhage.


Instruction: Generate impression based on findings.

Input: Male, 73 years old, history of sellar meningioma, s/p transphenoidal resection, follow-up surveillance imaging. A bulky, partially resected tumor is redemonstrated situated within and expanding the sella. The lesion remains T1 isointense and slightly T2 hyperintense relative to gray matter with fairly homogeneous enhancement.Slow interval growth of tumor is suspected, particularly in the right aspect of the lesion where there is some suggestion of cavernous sinus involvement. On coronal imaging, the tumor measures 21 x 14 mm (image 10 series 9) which compares to 18 x 11 mm in 2012. Comparison with the 2013 examination is less reliable due to motion artifact on that study.Although the tumor abuts both of the cavernous ICAs, there is no evidence of significant vascular narrowing. The right aspect of the suprasellar cistern is encroached upon by tumor similar to prior. The pituitary stalk deviates slightly towards the right and enters this rightward portion of the lesion. The optic chiasm and optic nerves are unaffected by the lesion.

Output: Slow interval increase in the size of the residual sellar tumor, particularly when comparison is made over multiple prior exams.


Instruction: Generate impression based on findings.

Input: 42 years Female (DOB:4/14/1973)Reason: Evaluate for brain metastases History: History of metastatic breast cancer with new onset of headaches and vomitingPROVIDER/ATTENDING NAME: RITA NANDA RITA NANDA There are numerous spherical enhancing foci scattered throughout both hemispheres of the brain as well as the cerebellar hemispheres and to a lesser degree brainstem and basal ganglia. There is a greater concentration of these enhancing lesions in the cerebellum compared to the rest of the brain. The largest lesions appear to be in the cerebellar hemispheresThere is a left parafalcine dural based extra-axial small calcified lesion present measuring approximately 8 x 6 mm most likely representing a burned out meningioma.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.Findings are compatible innumerable metastatic lesions throughout the brain. These are new since the prior exam. There is a greater concentration of lesions in the cerebellum compared to the rest of the brain.


Instruction: Generate impression based on findings.

Input: History of right mandibular mass, s/p sclerotherapy 1/5/16Signs and Symptoms: Right mandibular mass Within the suprahyoid neck on the basis of size criteria for lymphadenopathy no lymphadenopathy is appreciated. Within the infrahyoid neck on the basis of size criteria for lymphadenopathy no lymphadenopathy is appreciated.There is a mass centered in the right mandible associated with contrast enhancement and some mild enlargement. There is disruption of the cortex along the right anterior lateral aspect of the mass with some mild protrusion of the mass through this defect. Mass has predominantly high signal on T2 and low signal on T1 and is without diffusion restriction. Compared to the previous exam there are now patchy areas of nonenhancement and low T2 signal within the lesion which were not previously present suggesting some interval change with some fibrous tissue deposition.The visualized intracranial structures which include the posterior fossa are intact. There are patchy high signal foci on T2 imaging in the brainstem which are most likely vascular related. The visualized portions of the orbits and paranasal sinuses are intact. The paranasal sinuses and mastoid air cells are clear. There is a mild to moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.The parotid and the submandibular glands appear intact.The carotid and vertebral vasculature visualized on this exam appears intact.The cervical vertebral bodies in general are intact with no evidence for canal stenosis. There are multilevel degenerative changes present in the cervical spine with reversal of the normal cervical curvature at C3-4, loss of disc space height, disc desiccation and endplate and uncovertebral osteophytes resulting in encroachment of right-sided exiting nerve roots at C6-7 and C5-6 and some narrowing of the spinal canal due to endplate osteophytes at C3-4, C4-5 and C5-6 . This is stable compared to prior exam.The eyeball lenses are thin.

Output: 1.Since the prior exam there is some retraction of a portion of the patient's right mandibular hemangioma indicating a partial response to treatment.2.Multilevel degenerative changes are present in the cervical spine.3.Periventricular and subcortical white matter lesions are nonspecific. At this age they are most likely vascular related. Similar-appearing lesions in the brainstem and thalami are also likely vascular related.


Instruction: Generate impression based on findings.

Input: 36 years Female (DOB:8/16/1979)Reason: eval for demyelinating disease History: paresthesiasPROVIDER/ATTENDING NAME: ADIL JAVED ADIL JAVED Cervical spine:There is a T2 hyperintense lesion present along the right hemicord at the C2 vertebral body level which measures 14 x 4 mm sagittal dimensions. There is a T2 hyperintense lesion present along the posterior aspect of the cervical spinal cord at the C3 vertebral level measuring 14 x 7 mm sagittal dimensions. There is a T2 hyperintense lesion along the left posterior lateral spinal cord at the C5-6 level measuring 12 x 3 mm sagittal dimensions. There is a right hemicord lesion at the C7 vertebral body level measuring 10 x 4 mm sagittal dimensionsThe cervical vertebral bodies are appropriate in overall alignment and height. 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.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. There is a 5 mm right hemicord lesion at the T2 vertebral level there is a 11 mm and present spinal cord at the level of the conus medullaris at the T12 vertebral level. There are patchy lesions present in the thoracic spinal cord at the T10 and T11 levels.

Output: 1.There are multiple lesions scattered in the cervical and thoracic spinal cord which are compatible with demyelinating disorder as detailed above.


Instruction: Generate impression based on findings.

Input: Diagnosis: Neoplasm of uncertain behavior of pituitary gland and craniopharyngeal ductClinical question: h/o pituitary abnormality; evaluate pituitarySigns and Symptoms: visual field cut brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a 5 x 8 mm extra-axial mass present adjacent to the superior sagittal sinus and adjacent to the left superior frontal gyrus.pituitary:There is a mass present in the sella which extends suprasellar and it measures 14 x 13 mm coronal dimensions and 14 x 8 mm sagittal dimensions. It abuts and superiorly displaces the optic chiasm. It does not appear to have any significant cavernous sinus extension. The infundibulum of the pituitary gland is midline. The cavernous sinuses are intact bilaterally.

Output: 1.There is a sellar and suprasellar mass which displaces the optic chiasm superiorly. Most likely this represents a pituitary adenoma.2.There is a small subcentimeter extra-axial mass present adjacent to the left superior frontal gyrus which most likely represents a meningioma.


Instruction: Generate impression based on findings.

Input: There is no restricted diffusion to suggest acute ischemic infarction. Again noted are postsurgical changes of the right frontal partial lobectomy for tumor resection. The right frontal surgical cavity with surrounding T2/FLAIR hyperintensity is unchanged. There is associated ex vacuo dilatation of the right frontal horn. There is stable mild epidural thickening and enhancement subjacent to the craniotomy, an expected postsurgical change. There is no abnormal enhancement in the parenchyma. The remainder of the brain parenchyma is negative for new signal abnormality. There is no midline shift or herniation. The major cerebral flow voids are intact. The paranasal sinuses are unremarkable. The midline structures and craniocervical junction are within normal limits.

Output: Stable postsurgical changes in the right frontal lobe with no evidence of residual or recurrent tumor.


Instruction: Generate impression based on findings.

Input: This exam is degraded by motion artifact. There are postoperative findings related to recent left temporal craniotomy and left pial synangiosis procedure. There are multiple foci of susceptibility effect along the left cerebral convexity and a grossly unchanged left-sided extra-axial fluid collection that measures up to 6 mm in thickness. There is a small focus of diffusion restriction involving the anterior left frontal cortex and subcortical white matter. There is a large chronic left hemispheric MCA distribution infarction with extensive encephalomalacia, gliosis, and areas of cortical T1 hyperintensity compatible with laminar necrosis. There are smaller chronic infarcts within the right basal ganglia and centrum semiovale as well as the right occipital lobe. There are a few scattered additional punctate foci of T2 hyperintensity throughout the supratentorial white matter that are most compatible with chronic small vessel ischemic disease. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact.

Output: 1.Small acute infarct involving the anterior left frontal cortex and subcortical white matter.2.Postoperative findings related to recent left pial synangiosis procedure with unchanged extra-axial fluid along the left cerebral convexity.3.Unchanged large left hemispheric chronic infarction as well as smaller right basal ganglia/centrum semiovale and right occipital lobe infarcts.