Instruction: Generate impression based on findings.

Input: 34 year old female with pain and decrease ROM, frozen shoulder. R/o RCT vs. frozen shoulder or labral injury ROTATOR CUFF: There is minimal diffuse increased signal intensity within the supraspinatus tendon and anterior fibers of the infraspinatus tendon suggesting minimal tendinosis but otherwise the muscles appear normal. The teres minor tendon and muscle appear normal. The subscapularis tendon and muscle appear normal.SUPRASPINATUS OUTLET: The acromioclavicular joint appears normal. There is no fluid within the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is normal. Given the limitations of a non-arthrogram study, the glenoid labrum appears normal. There is no joint effusion. The articular cartilage is unremarkable.BICEPS TENDON: The tendon of the long head of the biceps muscle appears normal. ADDITIONAL

Output: Minimal rotator cuff tendinosis which may not be of any current clinical significance. We otherwise see no findings to account for the patient's pain.


Instruction: Generate impression based on findings.

Input: Ms. Brosnan is a 50-year-old female with history of bilateral mastectomies in 2012 with implant-based reconstruction for right breast IDC. Patient recently reports trauma to her implants and with subsequent implant shape changes. She presents today for MRI-evaluation to assess implant integrity. The patient is status post bilateral mastectomies with bilateral retropectoral silicone implants. The silicone implants are intact without evidence of intracapsular rupture, extracapsular rupture or associated fluid collection. No abnormal enhancement is seen in the remaining subcutaneous tissues of both breasts.No abnormal axillary lymph nodes are identified in either axillary region.

Output: Postsurgical changes of bilateral mastectomies with implant based reconstruction. No MRI evidence of implant rupture. No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: 24 year-old female with possible pancreatitis ABDOMEN:LUNG BASES: Small left-sided pleural effusion and bilateral linear atelectasis.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: Percutaneous cystostomy catheter. Bladder wall is thickened, likely secondary to cystitis.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Small amount of fluid on the right side of the anus. Small collection cannot be excluded. Pelvic MRI may be helpful if there is a clinical concern for pelvic abscess.

Output: No CT evidence of pancreatitis.Pelvic MR may be helpful helpful to exclude a pelvic abscess , if clinically suspected.Small left-sided pleural effusion.Wall thickening of the bladder, likely representing cystitis.


Instruction: Generate impression based on findings.

Input: The exam is mildly limited due to motion artifact.CERVICAL: There is minimal loss of height of C4, C5 and C6 vertebral bodies which is suspected to be developmental/degenerative. The osseous marrow signal is benign. There are multiple intracranial metastases partly imaged, similar to prior MRI of the brain. There is increased T2 signal within the cervical cord extending from C6-7 level to the lower aspect of T3 level with expansion of the cord, and enhancement predominantly in the right hemicord, extending to the posterior and lateral intradural space as well with suspected involvement of the posterior dura. There appears to be a small area of intervening normal cord signal and lack of enhancement between the more confluent areas of abnormality. Due to expansile cord, there is partial effacement of the CSF with at least mild to moderate central spinal canal stenosis at the C6-7 level predominantly.C2-3: Tiny disk osteophyte complex with no spinal stenosis.C3-4: Disk osteophyte complex with no significant spinal stenosis and mild effacement of ventral CSF. Mild bilateral uncovertebral hypertrophy causing minimal bilateral neural foraminal narrowing.C4-5: Disk osteophyte complex with bilateral uncovertebral hypertrophy with no spinal stenosis.C5-6: Disk osteophyte complex with no spinal stenosis.C6-7: Disk osteophyte complex with no spinal stenosis.C7-T1: Disk osteophyte complex with mild protrusion causing mild flattening of the ventral aspect of the cord without cord signal abnormality.There is mild right mastoid fluid.THORACIC: There is normal alignment of the thoracic spine with no significant osseous marrow lesion or signal abnormality/enhancement. There are scattered tiny hemangiomas in the vertebral bodies. The cord caliber and signal are within normal limits below the T3 vertebral level without suspicious enhancement. There is mild enhancement and root thickening of the cauda equina, left greater than right, with adjacent enhancing vessels.There is prominence of posterior epidural fat contributing to minimal diffuse narrowing without significant spinal canal stenosis in the thoracic spine. There is no significant disk herniation or significant spinal canal stenosis in thoracic spine. There is a large right lung mass measuring 34 x 40 mm consistent with known malignancy which apparently extends to the right lateral pleural surface. There are bilateral renal cysts. There is an indeterminate right adrenal nodule measuring approximately 18 x 15 mm.

Output: 1.Enhancing intramedullary lesion extending from C6-7 inferiorly to T3 level, predominantly right-sided and extending posteriorly to involve the posterior intradural space and dura is strongly worrisome for metastasis given other lesions in the brain. No other discrete cord lesions.2.At least mild to moderate spinal canal stenosis due to expansion of the cord at the C6-7.3.No definite osseous metastasis.4.There is mild enhancement and root thickening of the cauda equina, left greater than right, with adjacent vessels. This is suspected to be possibly related to metastatic leptomeningeal disease. This can be further evaluated on MRI lumbar spine if clinically indicated.5.Large right lung mass consistent with known primary malignancy.6.Incompletely evaluate right adrenal mass, concerning for metastatic disease, which can be further assessed on dedicated abdominal MRI as clinically indicated.


Instruction: Generate impression based on findings.

Input: 60-year-old man with history of HCV cirrhosis, evaluate for liver and left kidney lesions. ABDOMEN:LIVER, BILIARY TRACT: The liver is slightly nodular in contour with widened fissures. Within segment 5/6 (9/21) there is a 28 x 26 mm T2 hyperintense, T1 hypointense lesion with heterogeneous arterial enhancement (11/135) and washout of early enhancing portions (11/411). This lesion also demonstrates diffusion restriction. No additional suspicious enhancing lesions are identified.The gallbladder is normal. There is no intra or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: In the superior pole of the left kidney (9/18) there is a 16 x 16 mm mildly T2 hyperintense lesion with mild arterial enhancement (11/128) and diffusion restriction. This lesion also washes out on delayed phase of contrast. There is no loss of signal on opposed phase imaging (7/75).Immediately posterior to this lesion there is a subcentimeter cyst. No additional suspicious renal lesions are seen. There is no hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Segment 5/6 hepatic lesion, portions of which enhance on arterial phase imaging and washout. This lesion is favored to be a "nodule within nodule" appearance of hepatocellular carcinoma.2.Enhancing left upper pole renal lesion without macroscopic fat. While nonspecific, this could represent a malignant tumor such as renal cell carcinoma or benign tumor such as oncocytoma.


Instruction: Generate impression based on findings.

Input: Low back pain radiating to legs. Evaluate surgical materials. Five lumbar type vertebral bodies are presumed to be present. There is transitional morphology of the L5 vertebral body which articulates with the sacrum. The most inferior well-defined disc space is labeled L5-S1. There are postsurgical changes of laminectomy from the L3-L4 to the L5-S1 levels.Vertebral body heights are within normal limits. Alignment is within normal limits aside from mildly exaggerated lumbar lordosis. Bone marrow signal is benign. The conus medullaris is normal in position.Mild degenerative changes are seen with mild disc desiccation throughout the lumbar spine with minimal bulges. There is otherwise no significant disc disease, spinal canal stenosis, or neural foraminal stenosis at any level. There is moderate facet arthropathy at the L4-L5 and to a milder degree at L3-L4 and L2-L3 levels.Perineural cysts at the S2 vertebral level are incidentally noted and of doubtful clinical significance

Output: 1. There is no significant spinal canal or neural foraminal stenosis at any level. There is prominent facet arthropathy at the L4-L5 and to a lesser degree L3-L4 levels, which may be contributing to patient's low back pain. 2. Postsurgical changes and minimal additional degenerative changes as described above. 3. Transitional lumbosacral junction with sacralization of L5.


Instruction: Generate impression based on findings.

Input: Female, 2 months old, with abnormal movements, history of subarachnoid hemorrhage. Evaluate for structural laterality. Bilateral convexity subdural collections are seen, best visualized on series 1001. The left-sided collection is slightly larger than the right and measures up to 6 mm in thickness. There is susceptibility effect associated with the left-sided collection. The fluid is FLAIR hyperintense to CSF but relatively similar to CSF on T1 and T2-weighted images. The collections exert minimal regional mass effect on the underlying brain.A small extra-axial focus of diffusion restriction is seen along the right parietal lobe with associated susceptibility effect. Elsewhere no diffusion restriction is seen. Small foci of susceptibility effect are also present along the right sylvian fissure and right inferior frontal sulcus, as well as within the occipital horns of the lateral ventricles. No evidence of parenchymal edema is detected. Brain parenchymal morphology is within normal limits. No developmental anomalies or structural defects are identified. The pattern of white matter myelination is appropriate for age. The pituitary region is within normal limits. The corpus callosum is fully formed and intact. The brainstem and cerebellum are within normal limits. Ventricular size and morphology are normal.

Output: Bilateral convexity subdural collections are seen measuring up to 6 mm in thickness on the left. The signal characteristics of the collections would favor that these represent chronic subdural hematomas. A small focus of extra-axial diffusion restriction and susceptibility along the right parietal lobe could indicate blood at an earlier stage of evolution. Findings are also seen suggesting a small amount of hemosiderin staining in the subarachnoid spaces and the ventricles likely indicating prior subarachnoid hemorrhage. The brain itself is developmentally normal.


Instruction: Generate impression based on findings.

Input: History of HTN, HLD, SLE, DVT with positive lupus anticoagulant with right submandibular region swelling. There is persistent asymmetric enlargement of the right submandibular gland, perhaps with a nodular area inferiorly, but no significant ductal dilatation. There are also enlarged right submandibular lymph nodes, but the left cervical lymph nodes do not appear to be particularly enlarged. The left submandibular and bilateral parotid glands are unremarkable. The thyroid gland is unremarkable. The osseous structures appear to be intact. The orbits, paranasal sinuses, and upper aerodigestive tract are unremarkable. There is diffuse cerebral volume loss and scattered areas of cerebral white matter T2 hyperintensity.

Output: Persistent asymmetric enlargement of the right submandibular gland and enlarged right submandibular lymph nodes. Differential considerations include an autoimmune process versus neoplasm.


Instruction: Generate impression based on findings.

Input: Male 33 years old with cirrhosis please screen for HCC, has lesion seen on imaging in past. ABDOMEN:LIVER, BILIARY TRACT: The liver contour is smooth. There is no biliary ductal dilatation, ascites or enhancing liver lesion. The previously described segment 4 lesion is not seen on today's exam. Subcentimeter nonspecific T2 bright lesions in hepatic segment 8 are unchanged.The transjugular intrahepatic portosystemic shunt is redemonstrated however patency cannot be evaluated on this exam.SPLEEN: No significant abnormality noted.PANCREAS: The body of the pancreas is obscured by artifact from coils in the left upper abdomen.ADRENAL GLANDS: The left adrenal gland is not well visualized due to susceptibility artifact from the left upper quadrant coils.KIDNEYS, URETERS: No renal lesions or hydronephrosis.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: No enhancing liver lesion.


Instruction: Generate impression based on findings.

Input: Left ankle pain after trauma, assess for torn ligament. TENDONS: There is increased signal within the tendon of the peroneus longus at the level of the patient placed marker and consistent with the previously identified or recurrent mild to moderate tenosynovitis of peroneus longus. The appearance is similar in size and internal characteristics, again with a questionable focal short internal longitudinal split tear. The extensor tendons appear intact. The flexor tendons appear intact. The Achilles tendon is normal in appearance.LIGAMENTS: The lateral collateral ligament complex appears intact. The distal tibiofibular syndesmotic complex appears intact. The visualized components of the deltoid ligament appear intact.ARTICULAR SURFACES AND BONE: No bone marrow signal abnormality is identified. No articular cartilage defects are seen. ADDITIONAL

Output: Recurrent or residual mild to moderate tenosynovitis of the peroneus longus tendon with questionable short internal split tear. Essentially unchanged from prior exam


Instruction: Generate impression based on findings.

Input: History of cirrhosis with HCC status post TACE/RFA. ABDOMEN:LIVER, BILIARY TRACT: Nodular cirrhotic liver morphology.Post ablation changes in segment 8 of the liver measuring 2.2 x 1.7 cm (series 10/133) with intrinsic proteinaceous/hemorrhagic debris. Minimal thin enhancement around the ablation cavity without nodular enhancement. No specific evidence of residual or recurrent tumor. No new suspicious lesion.Cholelithiasis without cholecystitis. Recannulized umbilical vein. The common hepatic artery arises from the aorta. The vessels are patent.SPLEEN: Mild splenomegaly measuring 13.8 cm in length.PANCREAS: Cystic lesion in the pancreatic head measuring up to 1.3 cm (series 8/12) unchanged and demonstrates no suspicious postcontrast features.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Simple appearing bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Post ablation changes of the segment 8 lesion without evidence of residual or recurrent disease. No new lesions.2. Stable cystic lesion of the pancreatic head may represent a side-branch IPMN. Consider MRCP images in addition to standard liver protocol on follow-up imaging to confirm communication with the main pancreatic duct.


Instruction: Generate impression based on findings.

Input: Patient with recurrent Ewing sarcoma and status post hemipelvectomy. Please reevaluate BONE AND BONE MARROW: Similar postsurgical changes are again observed involving the right internal hemipelvectomy 2011, including portion of the right iliac wing and ischium resection and superior displacement of the femoral head. Correlation of the osseous structures and prior exams are similar, including deformity of the femoral head. Scattered postsurgical changes including susceptibility artifact and soft tissue deformity appear unchanged in contour and gross appearance. Specifically the surgical incision scar is noted along the right paraspinal musculature extending anterolaterally.And irregular shaped focus of abnormal signal intensity involving the right ischium again appears similar to the prior study with an abnormal signal intensity seen in the right sacral wing. Suspected post treated tumor with mild heterogeneity of the remaining bone marrow appears similar compared to prior studies and again suggesting red marrow recruitment.SOFT TISSUES: Of special note is the abnormal enhancement and signal characteristics observed within the right adductors and piriformis anteriorly and gluteus maximus posteriorly. The edema like appearance remains similar to 11/28/14 and again without a discreet focal mass observed, yet there is a loss of muscle bundle distinction with mild enlargement/fullness without clear evidence of encapsulation. No clear distinct changes to suggest internal hemorrhage. The appearance remains most suggestive of post treatment changes and overall stability from past November.JOINTS: Status post hemipelvectomy and pseudoarticulation appears similar. Suspected reactive synovitis like changes involving the residual articulation. Left hemipelvis is intact.

Output: Extensive postoperative changes as described similar to prior exam. Surrounding edema and enhancement of right hip muscles remain uncertain but presumably related to prior treatment and possibly radiation. No new focal mass or discrete lesion/changes are observed.


Instruction: Generate impression based on findings.

Input: Metastatic esophageal cancer with new brain metastasis. There is a lesion in the left precentral gyrus that measures up to 8 mm and contains susceptibility effect. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Preoperative planning MRI demonstrates a subcentimeter metastasis in the left precentral gyrus.


Instruction: Generate impression based on findings.

Input: Parkinson's tremors. There is blurring of the bilateral substantia nigrosomes. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Preoperative planning MRI for Parkinson's disease deep brain stimulator insertion.


Instruction: Generate impression based on findings.

Input: Known bilateral breast cancers present for staging prior to surgery. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.The proven left breast cancer in the 11:00 position is an irregular mass with suspicious kinetics and measures 2.7 x 1.7 x 2.0 cm. No additional suspicious left breast enhancing lesion.The proven right breast cancer at the 11:00 position measures 2.0 x 1.4 x 1.5 cm. Additionally, there is an 8 mm area of enhancement posterior/medial to the index lesion that is suspicious. Total extent including this finding is up to 4.6 cm. There are mildly prominent but symmetric lymph nodes in each axilla, but none are uniquely suspicious. Note is made that based on this exam, the ultrasound image of concern in the right axilla was most likely an artifact.

Output: 1. Proven left cancer measures up to 2.7 cm. No additional suspicious left breast lesion. A six month follow up for the left breast calcifications could be considered given this exam's findings (though if old studies can prove stability, this might not be needed).2. Proven right cancer measures up to 2.0 cm. An additional 8 mm area of enhancement is present posterior/medial to the proven cancer, for an extent of 4.6 cm.3. Symmetric mildly prominent axillary nodes, but no suspicious correlate to the questioned ultrasound finding in the right axilla. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Diagnosis: Localized swelling, mass and lump, neckClinical question: right supraclavicular mass , low grade vascular neoplasmSigns and Symptoms: eval extent of mass to vessels MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries. MRI neck:There is a 48 x 28 mm heterogeneous mass centered in the right supraclavicular area which is surrounded by adjacent vasculature including the subclavian artery and vein as well as thyrocervical trunk. Along its superior medial aspect there is a 12 x 9 mm axial dimension fluid collection present there is infiltration of the surrounding fat planes. There are punctate foci of signal loss within this lesion with slight susceptibility effect. The skin surface superficial to the lesion is irregular and somewhat disrupted. Some blood products are present within the adjacent subcutaneous tissues.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.Within the visceral space the thyroid gland appears intact.The airway appears patent.The visualized intracranial structures which include the posterior fossa are intact. The visualized portions of the orbits and paranasal sinuses are intact. The paranasal sinuses and mastoid air cells are clear.The parotid and the submandibular glands appear intact.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.

Output: 1.There is a right supraclavicular mass associated with surrounding inflammatory changes and findings suggesting recent surgery. No arterial blood supply is appreciated. A biopsy of this lesion indicates that this represents a hemangioma. Given this biopsy information, certainly the findings are consistent with a recent biopsy of a hemangioma. A follow-up cross-sectional exam after the inflammatory changes regress may help further evaluate this.


Instruction: Generate impression based on findings.

Input: 89 years Female (DOB:7/10/1926)Reason: stroke eval History: r weakness, NIHSSS=22, ASPECTS =2PROVIDER/ATTENDING NAME: MICHAEL A WARD MICHAEL A WARD MRI of the brainThere is a large area of diffusion restriction present in the left middle cerebral artery territory which involves the full extent of the left middle cerebral artery territory as well as left internal capsule and left caudate nucleus..There is susceptibility effect present within the left distal internal carotid artery and proximal left middle cerebral artery.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.MRA brain:Antegrade flow is present in the distal right internal carotid artery, the distal left vertebral artery, the basilar artery and the proximal anterior, right middle and posterior cerebral arteries. The right posterior cerebral artery has fetal origin. Anterior communicating artery is small. The left posterior communicating artery is identified and demonstrates minimal flow into the left anterior cerebral artery territory.There is no flow identified in the left vertebral artery in the distal right vertebral artery.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. The posterior communicating arteries are not readily identified. The vertebral arteries are similar in size.

Output: 1.Left ICA occlusion2.Large left MCA and anterior choroidal territory acute ischemic infarction3.Findings suggest occlusion of the distal right vertebral artery


Instruction: Generate impression based on findings.

Input: Brain: The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. 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. MRA Brain: There is antegrade flow within the distal bilateral vertebral arteries, within the basilar artery, distal bilateral internal carotid arteries and carotid siphons and bilateral anterior, middle and posterior cerebral arteries. A 2 mm saccular aneurysm is seen in the left cavernous carotid artery (image 59, series 301). No arterial stenoses or occlusions are identified. No arteriovenous malformations are identified and there is no evidence for cerebral vasculitis. Cervical spine: Alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign. The cervical cord is normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable. No central canal or neural foraminal stenoses.Thoracic spine: There is a smooth, physiologic thoracic kyphotic curve. The vertebral body heights and disc spaces are maintained. Marrow signal intensity is benign throughout.The spinal cord has a smooth contour and is without focal atrophy, edema, or myelomalacia. There are no masses. No significant central canal or neural foraminal stenoses.Lumbar spine: There is abnormal signal intensity within the CSF space and appears hypointense on T2 images. This is likely due to pulsation artifact. Widening of the anterior epidural space is seen along the L4-L5 levels. This measures up to 6 mm in thickness and is not fat signal intensity. This is believed to be secondary to engorged venous plexus. Alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign. The conus is normal in signal and morphology and terminates at an appropriate level. The visualized intra-abdominal and paraspinal contents are unremarkable. No significant central canal or neural foraminal stenoses.

Output: 1.Widening of the anterior epidural space is seen along the L4-L5 levels. While this is believed to be secondary to an engorged venous plexus, repeat imaging of the lumbar spine with intravenous contrast is recommended to exclude blood products.2.T2 hypointense CSF only on lumbar images is likely secondary to pulsation artifact.3.2mm left cavernous carotid artery aneurysm. No intracranial arteriovascular malformation identified.


Instruction: Generate impression based on findings.

Input: Abdominal pain and bloating. ABDOMEN:LIVER, BILIARY TRACT: Normal liver morphology without a focal lesion, biliary ductal dilatation or vascular abnormality. Normally distended gallbladder.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Normal morphology without a discrete 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 loculated fluid collection.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small amount of free pelvic fluid is within physiologic limits.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Normal MR enterography.


Instruction: Generate impression based on findings.

Input: 65-year-old female with cholelithiasis and LFT elevation. Concern for CBD stone. ABDOMEN:LIVER, BILIARY TRACT: Hepatic steatosis.The gallbladder is distended with T1 hyperintense biliary sludge and large intraluminal stones. No significant wall thickening. No pericholecystic fluid. Focal T2 hyperintense appearance of the gallbladder wall most compatible with adenomyomatosis (coronal series 4 image 32). There is mild dilatation of the common bile duct measuring 8 mm in diameter (axial series 5 image 32) with smooth tapering at the ampulla (series 11 image 43). Punctate central intraluminal hypointense signal (axial series 5 image 33) is only seen on the axial view and linear appearance, and flow related artifact is favored. No discrete intraluminal stones are identified. No intrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Normal right adrenal gland. A small left left adrenal nodule with loss of signal intensity on out of phase imaging consistent with a lipid rich adenoma.KIDNEYS, URETERS: Subcentimeter right renal cyst. No hydronephrosis or nephrolithiasis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Uterine fibroids (coronal series 4 images 16, 19).

Output: 1.Mild dilatation of the common bile duct without evidence of intraluminal stones. No intrahepatic biliary ductal dilatation. Hepatic steatosis.2.Cholelithiasis without convincing evidence for acute cholecystitis.3.Finding consistent with a benign lipid rich adenoma of the left adrenal gland.


Instruction: Generate impression based on findings.

Input: Male, 53 years old, with chronic low back pain, right leg pain, left leg weakness. Spinal alignment is anatomic. Vertebral body heights are preserved. A lumbosacral transitional morphology is evident at L5.Fatty degenerative endplate signal abnormality is seen at L2-3 and to a lesser extent at L3-4, similar to prior study. Both disc levels demonstrate degeneration with endplate irregularity and progressive loss of disc height at L3-4. Small Schmorl's nodes are evident T12-L1. The visualized distal spinal cord and conus are within normal limits.The spinal canal remains congenitally slender. Prominent dorsal epidural fat is seen. Multilevel superimposed degenerative findings are as follows:T12-L1: Mild facet hypertrophy. Mild disc bulge. Mild spinal canal narrowing. Mild bilateral foraminal narrowing. No significant interval changes. L1-2: Progressive facet hypertrophy and ligamentum flavum thickening. Minimally progressive disc bulging. Moderate generalized spinal canal narrowing with crowding of the cauda equina, slightly worse than prior. Mild bilateral foraminal narrowing, unchanged. L2-3: Facet hypertrophy and ligamentum flavum thickening, slightly progressed. Loss of disc height and disc bulging with osteophytic ridging. Moderately severe spinal canal stenosis with crowding of the cauda equina. Moderate bilateral foraminal narrowing. No significant interval changes. L3-4: Marked facet arthropathy and ligamentum flavum thickening, slightly progressed from prior. Progressive loss of disc height with bulging and osteophytic ridging. Severe spinal canal stenosis with exclusion of CSF and crowding/impingement of the cauda equina, not definitely changed. Severe bilateral foraminal narrowing, slightly progressed on the left. L4-5: Marked facet arthropathy and ligamentum flavum thickening, slightly progressed. Disc bulging, similar to prior. Severe spinal canal stenosis with exclusion of CSF and crowding/impingement of the cauda equina, similar to prior. Severe bilateral foraminal narrowing, unchanged. L5-S1: Facet arthropathy, slightly progressed. Disc bulging asymmetric to the left with effacement of the left lateral recess. Mild spinal canal stenosis, progressed. Severe bilateral foraminal narrowing, progressed on the left.

Output: Multilevel degeneration of the disks and posterior elements is redemonstrated with mild progression at most levels when compared to the prior examination. In particular, there is a severe degree of spinal canal stenosis at L3-4 and L4-5 with crowding/impingement of the cauda equina.


Instruction: Generate impression based on findings.

Input: 37-year-old male with abnormal findings on CT scan. Here with severe atrophy of pancreas. MRCP with secretin requested to further evaluate. Has epigastric and left upper quadrant pain. ABDOMEN:LIVER, BILIARY TRACT: Normal enhancement of the hepatic parenchyma. No intra or extrahepatic biliary ductal dilatation.SPLEEN: Small splenule.PANCREAS: No pancreatic ductal dilatation. The morphology and signal intensity/enhancement of the pancreatic head, neck, and proximal body are within normal limits. Absence versus atrophy of part of the pancreatic body and tail are again noted. There is a normal secretin response.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Absence versus atrophy of part of the pancreatic body and tail are again noted. Normal secretin response. Normal morphology and enhancement of the remainder of the pancreas.


Instruction: Generate impression based on findings.

Input: Clinical question: Stroke, critical stenosis requiring surgery. Signs and symptoms: Right hemianopsia. Nonenhanced brain MRI:Diffusion weighted images demonstrate mildly restricted diffusion in the distribution of distal the left PCA in the left occipital lobe. This finding demonstrate flairand T2 weighted hyperintensity without hemorrhage or appreciable mass effect.Additionally examination demonstrate minimal periventricular and subcortical tiny foci of FLAIR hyperintensity which are nonspecific and nonhemorrhagic and could represent minimal chronic small vessel ischemic strokes. The findings are entirely in the subcortical and periventricular white matter and without detectable abnormality of the basal ganglia, thalami, pons or the cerebellum/vermis.Prominence of cortical sulci and cerebellar-vermian folia is detected however likely within normal range for patient's stated age of 86.The signal void of major intracranial arterial branches are identified.The signal intensity of the intracranial venous sinuses are unremarkable.Calvarium and soft tissues of the scalp are unremarkable.Unremarkable images through the orbits.All paranasal sinuses are visualized and unremarkable.On coronal T2-weighted images there is diffuse signal abnormality on the right mandibular condyle with internal foci of T2 hyperintensity. Review of prior head CT from 7-7-15 conference presence of cystic-like lesions in the right condyle suspected of subcortical cysts and degenerative disease. Correlate with clinical finding and consider follow-up with dedicated imaging.Findings and concerns on this exam were discussed by phone with Dr. Matthew Burn #1840 of neurology department at the time of review of exam.Nonenhanced brain MRA Patent and unremarkable bilateral vertebral arteries, bilateral height, branches, basilar artery and its distal branches.Patent and unremarkable visualized internal carotid arteries in the upper cervical, across the skull base and in their supraclinoid segments. Patent and unremarkable bilateral anterior and middle cerebral arteries and their branches.A right posterior communicating artery is identified and there is no detectable left posterior communicating artery which is an anatomical variation.Nonenhanced cervical MRI:Examination demonstrates extensive degenerative changes of cervical spine.Foramen magnum is unremarkable.C2-C3 demonstrate advanced disc disease with significant loss of disc height, mild facet and ligamentum flavum hypertrophy (left greater than right). Findings results in significant right neural foraminal compromise and mild central spinal stenosis.C3-C4 demonstrate advanced disc disease with significant loss of disc height, mild bilateral hypertrophic changes of the articulating facets and mild ligamentum flavum hypertrophy. Constellation of changes results in moderate central spinal stenosis and significant bilateral neural foraminal compromise.C4-C5 demonstrate advanced disc disease and loss of disc height, large ventral disc-osteophyte complex results in significant flattening and posterior displacement of the cord and significant central spinal stenosis. Significant bilateral neural foraminal compromise is also noted.C5-C6 demonstrate advanced disc disease, complete loss of disc height and fusion at the level of the disc. Finding results in mild central spinal stenosis and significant bilateral neural foraminal compromise.C6-C7 demonstrate advanced disc disease with complete loss of disc height and fusion at the level of this. Findings results in significant right and moderate to significant left neural foraminal compromise and no central spinal stenosis.C7-T1 demonstrate moderate to advanced disc disease and significant loss of disc height and mild hypertrophic changes of posterior elements. Constellation of changes results in significant left and mild right neural foraminal compromise and without central spinal stenosis.Examination demonstrate questionable T2 hyperintensity within the cervical cord at C3 and C4 levels suspected myelitis.Upper most visualized thoracic spine demonstrate extensive degenerative disc disease however without central spinal stenosis. The signal intensity of visualized thoracic cord is unremarkable.

Output: 1.Nonenhanced brain MRA demonstrate no evidence of any significant foci of vascular lumen compromise or distal occlusion.2.Nonenhanced brain MRI demonstrate focus of restricted diffusion involving the cortex of left occipital lobe without hemorrhage or any mass effect consistent with acute ischemic stroke. Minimal tiny foci of FLAIR hyperintensity in the in the subcortical and periventricular white matter of cerebral hemispheres although nonspecific considering patient's stated age of 86 likely representing chronic nonhemorrhagic microvascular ischemic changes. Mild prominence of cortical sulci and cerebellar-acromion folia likely within normal range for the stated age and unremarkable nonenhanced brain MRI otherwise.3.Nonenhanced MRI of cervical spine demonstrate extensive degenerative disc disease throughout the cervical spine with multilevel disc fusion. There are significant central spinal stenosis at C3-C4 and C4-C5 levels and to a lesser degree at other levels as detailed. There are multilevel bilateral significant neural foraminal compromise as detailed per level above. Highly suspected subtle increased T2 signal intensity of the cord at C3 and C4 suspected of myelitis.


Instruction: Generate impression based on findings.

Input: History of right MCA and PCA strokes. Evaluate vasculature. MRA neck:Conventional arch anatomy. The common carotid artery origins are widely patent. The vertebral artery origins are poorly visualized, but the vertebral arteries are otherwise normal caliber. The left internal carotid artery is normal in caliber throughout. The right internal carotid artery is occluded at its origin. MRA brain:There is partial reconstitution of the ophthalmic and supraclinoid right ICA likely from collateral circulation through the anterior communicating artery. There is minimal flow along the M1 segment of the MCA with no opacification of the m2 segment. The right PCOMA is small. The posterior cerebral arteries are normal in caliber.

Output: 1. Complete occlusion of the right internal carotid artery at its origin with occlusion of the right middle cerebral artery with a minor opacification of the right M1 segment only. An underlying cause is not readily identified on this exam.


Instruction: Generate impression based on findings.

Input: Abnormal movements, hearing loss, abnormal MRI. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears unremarkable, aside from terminal zones of myelination. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Internal auditory canals: The bilateral cranial nerve 7 and 8 complexes are intact. There is no evidence of mass lesions. Aside from partial dehiscence of the right posterior semicircular canal, the inner ear structures, including the cochlea, vestibule, endolymphatic duct, and semicircular canals, appear unremarkable. The bilateral mastoid air cells and middle ears also appear unremarkable.

Output: 1. No evidence of intracranial hemorrhage, mass, or acute infarct. 2. No evidence of gross inner ear anomalies, aside from partial dehiscence of the right posterior semicircular canal.


Instruction: Generate impression based on findings.

Input: 71 years Male (DOB:7/14/1944)Reason: exclude acute stroke. H/o Afib, old PCA territory stroke, and R SDH s/p burr hole History: new RUE weakness and AMSPROVIDER/ATTENDING NAME: GREGG M HELLAND THOMAS J KELLY There is ventriculomegaly present. There is mild confluent periventricular T2 and FLAIR signal hyperintensity present. There is encephalomalacia present along the right occipital lobe involving the lingual gyrus. This is associated with gyriform susceptibility effect.No foci of diffusion restriction are identified on the current exam.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.A small craniotomy defect is present along the right parietal bone.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 left eyeball lens is thin.

Output: 1.There is no evidence for acute ischemic cerebral infarction.2.There is mild ventriculomegaly present which is a nonspecific finding.3.There is a focus of encephalomalacia in the right lingual gyrus of the occipital lobe.


Instruction: Generate impression based on findings.

Input: Female 73 years old Reason: Recurrent ovarian cancer with rising tumor marker. Assess for progressive disease. History: Increasing CA-125. Artifact from right hip prosthesis somewhat obscures evaluation of the pelvis.PELVIS:UTERUS, ADNEXA: Status post hysterectomy and bilateral oophorectomy.BLADDER: No significant abnormality noted.LYMPH NODES: The soft tissue lesion in the region of the left common iliac vessels likely corresponds to reference left common iliac node and is unchanged measuring 1.2 x 1.0 cm (series 301, image 52).BOWEL, MESENTERY: Colonic diverticular disease. Mild thickening at the anorectal junction may represent proctitis.BONES, SOFT TISSUES: Degenerative changes of the left hip. Right total hip prosthesis.OTHER: No significant abnormality noted.

Output: 1. No evidence of recurrence within the pelvis.2. Mild thickening at the anorectal junction may represent proctitis.Please note patient was found to have enlarged upper abdominal nodes on prior exam which is not included in today's study.


Instruction: Generate impression based on findings.

Input: 61-year-old male with shoulder pain. Rule out rotator cuff tear. ROTATOR CUFF: There is thickening and increased signal abnormality within the supraspinatus tendon consistent with moderate tendinosis. There is increased fluid signal abnormality within the supraspinatus at the level of the myotendinous junction consistent with interstitial and partial thickness undersurface tearing. There is also increased fluid signal abnormality within the posterior fibers of the supraspinatus tendon just proximal to the level of its insertion on the greater tuberosity consistent with interstitial tearing (image 12; series 701). The supraspinatus muscle appears intact. The infraspinatus muscle and tendon appear intact. The teres minor and subscapularis muscle and tendons appear intact.SUPRASPINATUS OUTLET: There is fluid within the subacromial subdeltoid bursa and acromioclavicular joint. Moderate degenerative changes affect the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: Moderate to severe degenerative changes affect the glenohumeral joint including joint space narrowing and osteophyte formation. Although this examination was not protocoled for evaluation of the glenoid labrum, there is extensive increased signal abnormality within the superior labrum which extends to involve the biceps anchor, consistent with degenerative tearing of the labrum. Again seen is a 1 cm ossicle along the anterior-inferior margin of the glenoid which may reflect prior remote trauma.BICEPS TENDON: There is a small amount of fluid within the tendon sheath of the long head of the biceps which may represent fluid extension from the glenohumeral joint versus tenosynovitis. There is thickening and signal abnormality of the long head of the biceps tendon consistent with mild to moderate tendinosis.ADDITIONAL

Output: 1. Rotator cuff tendinosis and interstitial tearing of the supraspinatus, without evidence of a full-thickness rotator cuff tear.2. Findings consistent with subacromial bursitis.3. Degenerative changes and other findings, as described above.


Instruction: Generate impression based on findings.

Input: Intracranial hemorrhage. Brain MRI:The heterogeneously T1 isointense, T2-hypointense acute hematoma in the right frontal lobe with extension into the overlying sulci has not significant changed since the CT scan on the day prior. The associated adjacent parenchymal edema and mass-effect are also unchanged, including mild midline shift and compression of the frontal horn of the right lateral ventricle. The minimal hemorrhage within the posterior lateral ventricles is slightly increased or redistributed but there is no hydrocephalus. There are foci of susceptibility effect along the sulci bilaterally, reflecting the presence of blood products, which are new since previous CT scan. Postcontrast images are significantly limited by motion artifact. Grossly, there is no abnormal brain contrast-enhancement to suggest an underlying vascular lesion.There is a T2-hyperintense area along the right cortical spinal tract, which shows no diffusion restriction and has inferior extension into the posterior limb of the internal capsule and the right cerebral peduncle, compatible with chronic infarct with associated Wallerian degeneration. There is no acute infarct. Moderate cerebral white-matter T2-hyperintensity is nonspecific but likely represent chronic microvascular ischemia. There are chronic infarcts involving the cerebellar hemispheres, left more than right.There has been bilateral lens replacement. There is trace ethmoid sinus mucosal thickening. Fluid intensity fills both mastoid air cells which can be congestive. There is mild diffuse skull thickening but no destructive lesion.Cranial MRA:The study is at least moderately limited by patient motion. There is no large vessel occlusion or severe stenosis. There is no large aneurysm, however, there is incomplete coverage of the intracranial arteries. The left posterior cerebral artery is fetal in origin, which is a common normal variation.

Output: 1.The acute right frontal intraparenchymal hemorrhage has not significantly changed since the CT scan of the head on the day prior. Also, the associated mild surrounding edema and mass-effect are unchanged. The associated intraventricular and subarachnoid hemorrhages are increased but there is no hydrocephalus. Accounting for motion artifact, there is no abnormal brain contrast-enhancement to suggest an underlying vascular lesion.2.Cranial MR angiogram is at least moderately limited by patient motion and incomplete head coverage. There is no large vessel occlusion, severe stenosis or large aneurysm.3.Otherwise, there are chronic infarcts and moderate cerebral white-matter chronic microvascular ischemia.


Instruction: Generate impression based on findings.

Input: Medial knee pain Evaluation is limited by motion artifact particularly of the axial sequences.MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: There is severe degeneration of the articular cartilage of the patella, particularly of the medial facet where there is full-thickness cartilage loss. There are degenerative subchondral marrow changes in the underlying patella. There is relatively focal degeneration of the articular cartilage of the femoral trochlea inferiorly along the medial facet. There is also focal full-thickness degeneration of the articular cartilage of the weightbearing portion of the medial femoral condyle with adjacent cartilage thinning and delamination. Cysts within the medial tibial plateau posteriorly are of questionable clinical significance. The articular cartilage of the lateral compartment is relatively spared.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Cartilage degeneration as detailed above which most severely affects the patella.


Instruction: Generate impression based on findings.

Input: Medial knee pain MENISCI: There is a horizontal cleavage type tear of the body and posterior horn of the medial meniscus with additional fraying/degenerative tearing of the free edge of the posterior horn. The anterior horn of the medial meniscus is intact. The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is edema within the medial femoral condyle that surrounds a small focus of low signal intensity in the subchondral bone just above the body of the medial meniscus. This edema type signal may be degenerative in etiology but could also represent a small subchondral insufficiency fracture. There is relatively mild edema within the medial tibial plateau. Subjectively, the articular cartilage of the weightbearing portion of the medial compartment appears thinned particularly along the medial tibial plateau but we see no fluid-filled articular cartilage defects. A tiny superficial defect is noted along the articular cartilage of the lateral tibial plateau. The articular cartilage of the patellofemoral compartment is relatively spared.LIGAMENTS: There is edema along the superficial band of the MCL. This is nonspecific in nature and could represent a sprain in the appropriate clinical context but may also be secondary to the underlying medial compartment pathology described above. The remaining cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Horizontal cleavage type tear of the medial meniscus with other findings described above.


Instruction: Generate impression based on findings.

Input: Reason: L knee pain History: Left knee pain Due to the patient's body habitus, the high definition knee coil could not be utilized. An alternative coil was used instead resulting in slightly suboptimal image quality.MENISCI: The lateral meniscus appears intact. The medial meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is focal near full-thickness degeneration of the articular cartilage of the medial facet of the patella and superficial degeneration of the articular cartilage of the lateral facet of the patella. There is also mild focal degeneration of the articular cartilage of the femoral trochlea, centrally. The tibiofemoral cartilage appears relatively preserved. There is slight lateral translation of the patella relative to the center of the femoral trochlea, but the tibial tubercle trochlear groove distance is within normal limits.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: Patellofemoral cartilage degeneration and small joint effusion.


Instruction: Generate impression based on findings.

Input: 69-year-old male with lung cancer and brain metastasis treated via SRS. There is a punctate focus of susceptibility effect in the left cerebellar hemisphere, which is not conspicuous on the T1 or T2 weighted sequences. Punctate foci of susceptibility are also present in the right thalamus and right putamen, which are unchanged. There is unchanged moderate periventricular and subcortical white matter punctate T2 hyperintense foci, compatible with chronic small vessel ischemic disease. There is no evidence of intracranial hemorrhage, new mass, or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unchanged.

Output: Limited exam due to lack of intravenous contrast shows a punctate treated lesion in the left cerebellar hemisphere and no evidence of new metastatic 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: 72-year-old male with meningiomas, evaluate for interval change Redemonstrated is a dural based extra-axial left parafalcine mass in left anterior parietal region with homogeneous enhancement, measuring 19 x 13 x 17 mm (AP x TR x CC), unchanged in size or morphology. As before, there is very subtle indentation on the adjacent brain parenchyma without detectable signal abnormality. It abuts the superior sagittal sinus, which demonstrates normal contrast enhancement.There is an additional smaller meningioma in the right posterior frontal region measuring 10 x 10 mm (AP x TR), unchanged in size or morphology, also resulting in very subtle indentation of adjacent parenchyma without signal abnormality. As before, there is adjacent calvarial hyperostosis.There is no evidence of intracranial hemorrhage or acute infarct. There is parenchymal volume loss, but the brain parenchyma otherwise appears unremarkable. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. Redemonstrated is a partially empty sella. The skull and extracranial soft tissues are unremarkable. There is new mild mucosal thickening within the right sphenoid sinus.

Output: No significant interval change in left parietal parafalcine and right posterior frontal meningiomas.


Instruction: Generate impression based on findings.

Input: There is interval decrease in the size of some of the cystic components of the craniopharyngioma. The cystic component that was noted in the previous study and indenting of the undersurface of the right frontal lobe decreased in size from 12 mm previously to 6 mm currently, deforming the lateral right cerebral peduncle has decreased in size from 19 x 13 mm previously to 11 x 7 mm currently. The cystic components along the anterior aspect of the right cerebral peduncle and along the anterior aspect of the left cerebral peduncle have also decreased in size. There continues to be involvement of the prepontine, cerebellopontine angle cistern, right ambient and right quadrigeminal cisterns, as well as the right middle cranial fossa, with associated mass effect upon the brainstem, right medial temporal lobe, and hypothalamus-optic apparatus complex. There is asymmetric volume loss of the left cerebellar hemisphere associated with increased T2 signal, which may be attributable to crossed cerebellar diaschisis versus chronic ischemic effects. The basilar artery is tortuous and encased by the tumor. There are postoperative findings related to right temporal craniotomy and stable position of right transfrontal catheter with the tip in the right prepontine cyst. The ventricular system appears to be unchanged. There are foci of susceptibility effect within the right temporal lobe resection cavity, consistent with hemosiderin deposition, and within portions of the tumor, which likely represent calcifications.

Output: Further regression of some of the peripheral cystic components of the complex suprasellar and posterior fossa craniopharyngioma.


Instruction: Generate impression based on findings.

Input: Reason: Evaluate for microfracture or tendon dysfunction History: R hand pain and decreased ROM LIGAMENTS: No significant abnormality noted.TRIANGULAR FIBROCARTILAGE COMPLEX: Not well evaluated.TENDONS: The tendons are intact. BONES: No fracture or microfracture is identified.ADDITIONAL

Output: Normal examination.


Instruction: Generate impression based on findings.

Input: Bilateral knee pain and swelling Left kneeMENISCI: The menisci are well visualized and other than a mild globular signal in the posterior horn of the medial meniscus without a distinct linear component or extension to an articular surface, and a small posterior para meniscal cyst. No additional acute abnormalities observed other than mild fraying of the inner edge of both menisci.ARTICULAR CARTILAGE AND BONE: Moderate diffuse thinning of the cartilage more pronounced in the lateral compartment and patellofemoral surfaces. Associated heterogeneous signal abnormality and shallow focal defects identified involving the lateral patellar facet. No underlying abnormal marrow signal or osseous additional abdomen malleolus and previously described minimal degenerative changesLIGAMENTS: No abnormality noted and well visualized. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Bilateral mild scattered degenerative changes including cartilaginous changes that are age inconsistent. Menisci also demonstrate similar mild changes as described without distinct focal changes to suggest an acute or subacute tear


Instruction: Generate impression based on findings.

Input: Reason: coagulopathic, s/p LESI 12/8 while on coumadin, new symptoms of LB pain/weakness -- R/O bleed History: new c/o of perineal pain, worsening R>L LBP Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are normal. There is levoscoliosis of the lumbar spine with apex at the L2-L3 level. Alignment is otherwise maintained. Conus is in normal position. Bone marrow signal is benign. No evidence of hematoma in the spinal canal. There are multilevel degenerative changes which are again seen, individual levels as below:T12-1: No significant spinal canal or neural foraminal stenosis.L1-L2: Tiny left foraminal/extraforaminal disc protrusion similar to prior. There is minimal narrowing of the left neural foramen and contact of the left L1 nerve root. Otherwise no significant spinal canal or neural foraminal stenosis.L2-3: There is disc bulge, similar to prior, and moderate bilateral facet arthropathy. There is decrease in facet effusions. There is mild right neural foraminal stenosis similar to prior. No significant central canal or left neural foraminal stenosis.L3-4: Mild disc bulge similar to prior, ligamentum flavum thickening, and moderate bilateral facet arthropathy. There is decrease in facet effusions. There is mild bilateral neural foraminal stenosis. Minimal associated central canal narrowing. L4-5: Moderate bilateral facet arthropathy. No significant spinal canal or neuroforaminal stenosis. Again seen is evidence of a prior left-sided laminectomy.L5-S1: No significant spinal canal or neural foraminal stenosis. Small right posterior annular fissure again seen. Mild bilateral facet arthropathy.

Output: 1. No evidence of hematoma in the spinal canal. No significant spinal canal stenosis in the lumbar spine, aside from minimal central canal narrowing at L3-L4 and to an event lesser degree at L2-L3.2. Degenerative changes, which primarily involve multilevel facet arthropathy and relatively worse at the L2-L3 and L3-L4 levels. There is mild bilateral L3-L4 and right L2-L3 neural foraminal stenosis. No high-grade neural foraminal stenosis. There is levoscoliosis of the lumbar spine with apex at the L2-L3 level. Please see details above.


Instruction: Generate impression based on findings.

Input: There is motion artifact on almost every sequence limiting evaluation for subtle abnormalities.The thoracic spine is in normal alignment, with a slightly exaggerated 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 abnormal T2 or STIR signal and no diffusion restriction.There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the thoracic spine. Bulky anterior osteophytes are noted at multiple levels. Bilateral pleural effusions and the known aortic dissection and stent graft are partially imaged.

Output: Motion artifact on almost every sequence limits evaluation for subtle abnormalities. However, there is no evidence of spinal cord infarct or cord compression.


Instruction: Generate impression based on findings.

Input: Exam is mildly limited by motion artifact. There is no evidence for intracranial hemorrhage or diffusion-weighted abnormalities. There are no masses, mass effect or midline shift. The ventricles and sulci are normal in size. Scattered hyperintensity of the subcortical and periventricular white matter compatible with mild small vessel ischemic disease. There are no extraaxial fluid collections. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain. There is nonspecific bone marrow heterogeneity of the clivus and imaged cervical spine with overall lower signal than expected. Specifically, calvarial bone marrow signal appears within normal limits.

Output: 1.No evidence of intracranial metastasis.2.Nonspecific bone marrow heterogeneity of the clivus and imaged cervical spine. Correlation with bone scan can be obtained if clinically indicated.


Instruction: Generate impression based on findings.

Input: Recurrent headaches consistent with migraine (exam normal). MRI: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.MRA: There is no discernible arteriovenous malformation. There appears to be a slightly prominent left superior hypophyseal artery infundibulum. Otherwise, there is no evidence of saccular cerebral aneurysms. There is no evidence of significant steno-occlusive lesions.

Output: 1. No evidence of acute intracranial hemorrhage, mass, or acute infarct.2. No discernible arteriovenous malformation, within the limits of MRA.


Instruction: Generate impression based on findings.

Input: Clinical question: Follow-up acoustic neuroma status post resection 4/28. Signs and symptoms: None surveillance study. Pre and post enhanced MRI of the IACs:The examination redemonstrates stable irregular T2 hypointense enhancing lesion within the left IAC fairly similar to prior exam. Additionally there is a thin linear dural based enhancement along the dorsal aspect of the left petrous bone at the surgical site. None of the lesions is highly suggestive of tumor and likely representing postsurgical scarring and less likely possibility of residual tumor cannot be entirely excluded. Further follow-up is recommended.There is widening of left cerebellopontine angle cistern secondary to prior surgery and long standing mass effect secondary to previously removed large tumor at this site.Focus of T2 and FLAIR hyperintensity involving the left brachium pontis reaching the left lateral aspect of the pons and without enhancement similar to prior exam and representing gliosis.Pre and post enhanced brain MRI:No diffusion-weighted abnormality.Examination demonstrates punctate size foci of nonspecific FLAIR hyperintensity in the subcortical and periventricular white matter of bilateral cerebral hemispheres and minimally within the left basal ganglia, left thalamus and pons without hemorrhagic changes or abnormal enhancement. Considering patient's stated age of 72 findings are likely representing chronic microvascular ischemic changes of mild degree.Focus of FLAIR hyperintensity in the left brachium pontis with evidence parenchymal volume loss consistent with a focus of encephalomalacia and gliosis as detailed on MRI of IACs. Unremarkable post enhanced brain MRI otherwiseExpected chronic postoperative changes of left suboccipital craniectomy for removal of tumor. Unremarkable calvarium, orbits and paranasal sinuses. There is however evidence of opacification of a single left posterior ethmoid air cell similar to prior exams.

Output: 1.Pre- and post enhanced MRI of IACs demonstrate persistent irregular enhancement within the left internal auditory canal and with a thin dural based enhancement in the left cerebellopontine angle suggestive of post surgical changes/scarring. Less likely possibility of residual tumor within the left IAC cannot be entirely excluded and further follow-up is needed.2.Pre- and post enhanced brain MRI demonstrate no evidence of acute intracranial process. Findings suggestive of mild chronic nonhemorrhagic small vessel ischemic strokes and expected postoperative changes of left suboccipital small craniectomy defect.


Instruction: Generate impression based on findings.

Input: History of multiple myeloma. Pre-auto SCT evaluation. SKULL: Two views of the skull. No discrete myelomatous lesions.CERVICAL SPINE: Two views of the cervical spine. No discrete myelomatous lesions. Severe degenerative disk disease and anterior osteophyte formation is noted within the mid cervical spine.THORACIC SPINE: One view of the thoracic spine. No discrete myelomatous lesions are identified.LUMBAR SPINE: Two views of the lumber spine. No discrete myelomatous lesions. There is disk space narrowing of L3/L4 and L5/S1. RIBS: Single view of the ribs. No discrete myelomatous lesions.PELVIS: AP view of the pelvis. No discrete myelomatous lesion is identified. A previously seen lesion in the right ilium is not seen on this exam. Multiple surgical clips are noted within the pelvis.UPPER EXTREMITY: Right humerus: Two views are provided. No discrete myelomatous lesions.Left humerus: Two views are provided. Lucencies within the mid-diaphysis may represent myelomatous deposits. Right forearm: One view is provided. No discrete myelomatous lesion.Left forearm: One view provided. No discrete myelomatous lesions.LOWER EXTREMITY: Right femur: Two views are provided. No discrete myelomatous lesion.Left femur: Two views are provided. No discrete myelomatous lesion.Right tibia/fibula: One view is provided. No discrete myelomatous lesion.Left tibia/fibula: One views is provided. No discrete myelomatous lesion.

Output: 1. Question lesions in the diaphysis of the left humerus may represent myelomatous deposits. 2. A known lesion within the right ilum is not seen on this exam.3. Degenerative changes as described above.


Instruction: Generate impression based on findings.

Input: Reason: Right hip pain, s/p labral repair PLEASE INJECT WITH KENALOG 40MG AT TIME OF ARTHROGRAM History: right hip pain ACETABULAR LABRUM: There is blunting of the anterior superior labrum that may reflect prior debridement. There is intermediate signal intensity undercutting the superior labrum from the 11-12 o'clock position which may reflect prominent hyaline cartilage. The anterior superior labrum from the 1 to 2 o'clock position, in addition to being attenuated, has an irregular contour with heterogeneous signal intensity. While we see no gadolinium entering the labrum, we cannot exclude chronic tearing at this location. There is intermediate signal intensity along the undersurface of the labrum from the 2 to 3 o'clock position which may represent prior debridement undersurface tearing/fraying. There is a focus of susceptibility artifact at the 2 o'clock position which is presumably postsurgical in etiology. There is intermediate signal intensity within the posterior labrum likely reflecting intrasubstance degeneration.ARTICULAR CARTILAGE AND BONE: Linear foci of low signal intensity are noted within the anterior acetabulum extending to the rim, reflecting prior repair of the labrum. There is scalloping of the anterior aspect of the femoral neck likely representing prior osteotomy.SOFT TISSUES: There is mild edema lateral to the greater trochanter associated with discontinuity of the iliotibial band at this location, likely reflecting iliotibial band release. There is atrophy of the iliopsoas muscle, on the left, presumably also reflecting surgical release. ADDITIONAL

Output: Although we see no gadolinium entering the substance of the labrum, there is abnormal labral morphology and signal intensity as described above likely representing a combination of postoperative changes and chronic tearing. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Other specified disorders of muscle [M62.89], Reason for Study: ^Reason: R sided weakness History: R face/arm/leg pure motor deficit Brain MRI:Motion artifacts significantly degraded image quality.Thus, only very limited sequences are obtained.There is evidence of midline suboccipital craniectomy.There are high signal intensity on DWI at bilateral cerebellar tonsils (left more than right) are seen which are corresponding to prior surgery.Patchy multifocal FLAIR high signal intensity lesions on bilateral periventricular white matter and bilateral trigone area (left more than right) are non-specific and could be related to small vessel ischemic disease.There is no evidence of acute ischemic or hemorrhagic lesionVentricular system appears to be slightly enlarged but no change since prior scan.There is no mass, mass effect, edema, midline shift, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation are performed.In flow related enhancement are seen on bilateral distal ICAs and vertebrobasilar system indicating patent and maintaining craniopetal flow. However, due to significant motion artifacts, this brain MRA is non-diagnostic especially in terms of arterial lumen evaluation and screening for intracranial arterial aneurysm.Brain Perfusion:Although there are motion artifacts during the perfusion scan, reasonable quality MR perfusion analysis is created.The arterial input function was measured at the right distal ICA.Calculated MTT, CBV, CBF and TTP maps show no evidence of asymmetry or focal perfusion defect.

Output: 1. Evidence of midline suboccipital craniectomy and bilateral cerebellar tonsilar surgery.2. No acute ischemic or hemorrhagic lesion in limited sequences.3. Mild non specific FLAIR high signal intensity lesions.4. Normal brain perfusion study.5. Non diagnostic brain MRA.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for CNS lupus. Signs and symptoms: Cognitive issues, balance. Pre-and post-enhanced brain MRI:No diffusion weighted abnormalities.There is normal anatomical development and morphology of the brain with normal signal intensity on all MRI sequences. Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination.There is no detectable abnormal parenchymal, leptomeningeal or calvarial enhancement.Multiple images through the orbits and including axial fat sat post enhanced series.The signal intensity of paranasal sinuses and bilateral mastoid air cells and middle ear cavities are unremarkable.

Output: Negative pre and post enhanced brain MRI.


Instruction: Generate impression based on findings.

Input: 59-year-old female with bilateral leg weakness and bilateral horizontal segments. Evaluate for progress of metastatic disease. Brain MRI: There are multiple supratentorial and infratentorial intra-axial and extradural metastatic lesions with associated vasogenic edema, which have overall increased in size. The largest lesion, which is in the left cerebellopontine angle has also increased significantly in size. This lesion now measures 2.3 x 2.4 cm, compared to 1.5 x 2.2 cm previously. The surrounding edema which causes effacement of the fourth ventricle and mass effect on the adjacent brainstem. For reference, the largest lesion in the supratentorial brain is a left paramedian lesion measuring 1.9 x 1.9 cm, which has increased compared to 1.1 x 14.0 cm previously. Some of the smaller metastatic lesions demonstrate susceptibility abnormality, indicating probable previous hemorrhage. There is no evidence of acute infarct. The lateral ventricles and third ventricles remain unchanged in size compared to the brain MRI exam from 3/22/2016. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses are unremarkable. There is an enhancing subcentimeter right scalp nodule. Lumbar Spine MRI: There is no evidence of tumor within the lumbar spine. The vertebral column alignment is within normal limits. There are mild multilevel degenerative changes including endplate degenerative changes at the superior aspect of L1 and inferior aspect of T12 anteriorly. There is variable disc desiccation and disc height loss most prominently involving the T12-L1, L3-4 and L4-5 levels. There is a minimal to mild generalized disc bulge involving the L3-4 and L4-5 levels with at most minimal to mild spinal canal stenosis at the L3-4 level, There is no significant spinal canal stenosis elsewhere. However, there is mild bilateral neural foraminal narrowing at the L3 through S1 levels. There is enhancement within the anterior L3-4 and posterior L4-5 discs, which are likely degenerative in nature. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable. There is a partly imaged enlarged fibroid uterus.

Output: 1.Overall increasing size of the multiple supratentorial and infratentorial metastatic intracranial lesions. 2.Stable size of the lateral and third ventricles compared to the brain MRI from 3/22/2016.3.Mild multilevel degenerative spondylosis, but no evidence of metastatic disease involving the lumbar spine.4.Partly imaged enlarged fibroid uterus, which is better evaluated on the CT abdomen and pelvis from 5/20/2015.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 63-year-old man with history of suspicious mass concerning for prostate malignancy. Additional history as per chart: Last PSA of 8 ng/mL, biopsy on 10/8/2015 with Gleason 7 adenocarcinoma. PELVIS:PROSTATE:Prostate Size: 48 x 31 mm.Peripheral Zone: There is poorly defined, diffusely low T2 signal in the peripheral zone which limits the lesion detection. No abnormalities are seen on the ADC map. However, on the high B value images (series 509, image 220) the entire right lobe of the prostate gland demonstrates restriction. Additionally, there is a small focus of restriction in the mid/apical left lobe (series 509, image 180).Central Gland: No significant abnormality noted.Seminal Vesicles: The seminal vesicles appear normal.Extracapsular Extension: No evidence of extracapsular extension.BLADDER: The bladder is normal.LYMPH NODES: Small fat-containing inguinal lymph nodes are present, but no suspicious lymphadenopathy is seen.BONES, SOFT TISSUES: Fat-containing hernias are noted.OTHER: No significant abnormality noted.

Output: 1.Abnormal signal involving the entire right prostate gland which, when correlated with the biopsy results, is thought to represent infiltrating tumor.2.No evidence of extracapsular extension or regional lymphadenopathy.


Instruction: Generate impression based on findings.

Input: Female, 63 years old, history of metastatic lung cancer status post 5 cycles of carbo/paclitaxel. An enhancing lesion is present within the left occipital lobe measuring 8 x 5 mm (image 28 series 13) which, accounting for differences in technique, is approximately unchanged relative to the prior head CT. Mild local T2 hyperintense edema is seen.An enhancing lesion is present within the right inferior lateral cerebellum measuring 8 x 7 mm (image 13 series 13). This lesion cannot be identified on prior exams due to limitations of the CT technique. This lesion demonstrates minimal T2 hyperintensity and no significant edema or mass effect.Two enhancing lesions are demonstrated within the subcutaneous tissues of the occipital scalp. The midline lesion has clearly increased in size from prior examinations, measuring 12 x 7 mm on today's study, while on the first head CT it was no more than 4 mm in maximal diameter. The lesion to the right of midline is probably mildly increased from prior exams as well.A few small foci of T2 hyperintensity are evident within the periventricular and subcortical white matter and these are nonspecific. No additional areas of pathologic intracranial enhancement are seen. No evidence of significant mass effect is demonstrated. No acute intracranial hemorrhage or any abnormal extra-axial fluid is detected. Ventricles are normal in size and morphology.The marrow signal characteristics are within normal limits. Mucosal thickening is seen at the floor of the left maxillary sinus.

Output: 1. A metastatic lesion within the left occipital lobe has probably not significantly changed in size relative to prior exams and accounting for differences in technique.2. A second lesion suspected to represent a metastasis is seen in the right inferior cerebellum. This lesion could not be identified on prior CT exams due to limitations of the technique and therefore interval change cannot be assessed.3. Two enhancing subcutaneous nodules in the occipital scalp, also very suspicious for metastases, are seen. Both of these lesions have likely increased in size from prior exams, most notably the midline lesion.


Instruction: Generate impression based on findings.

Input: Reason: History of multiple myeloma, lower back and bilateral hip pain, r/o lesions History: bilateral hip and lower back pain 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. No abnormal enhancing lesions are appreciated in the lumbar spine.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is loss of disk space height, disk desiccation and a disk bulge present at this level. There is mild facet and ligamentum flavum hypertrophy present at this level. Overall this is not changed substantially compared to the previous examAt L4-5 there is bilateral facet and ligamentum flavum hypertrophy present associated with a disk bulge, loss of disk space height and some partial effacement of the fat at the lateral recess is compared overall there is a moderate degree of spinal stenosis present at this level. There is redemonstration of ill define contrast enhancement and increased signal on T2 STIR images adjacent to the facet joints and ligamentum flavum at this level which is suspected to be inflammatory in origin.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is a bulge present at this level associated with ligamentum flavum hypertrophy.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina. There is disk desiccation and a disk bulge at this level.Incidental note is made of fatty filum terminally.There is a 15-mm well-circumscribed the lesion present along the right posterior lateral aspect of the L1 vertebral body which is bright signal on T1 appear to be stable compared to the prior exam and most likely represents hemangioma.A small cyst is present in the right kidney which is stable since the prior exam.

Output: 1.There is redemonstration of degenerative changes in the lumbar spine which are stable compared to the previous exam. This is worst at L4-5 where there is a moderate degree of spinal stenosis present .2.There is no MRI evidence for multiple myeloma involvement of the lumbar spine.


Instruction: Generate impression based on findings.

Input: 56 years Male (DOB:6/4/1960)Reason: L MCA stroke - MRI brain stroke protocol History: as abovePROVIDER/ATTENDING NAME: KEEGAN CHECKETT KEEGAN CHECKETT MRI of the brainThere is diffusion restriction present along the left lentiform nuclei involving predominantly the putamen and extending to the adjacent left centrum semiovale.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Exam is mildly degraded due to patient motion especially on the FLAIR MRI . 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.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, right middle and posterior cerebral arteries.There is occlusion of the left middle cerebral artery at the M1 segment.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. The posterior communicating arteries are not readily identified. The vertebral arteries are similar in size.

Output: 1.Findings are compatible with acute ischemic infarction involving left putamen and centrum semiovale.2.Occlusion of the left middle cerebral artery at the proximal M1 segment.3.Examination is somewhat degraded by patient motion which may obscure more subtle abnormalities.4.Findings are discussed with Dr. Kramer at the time of exam.


Instruction: Generate impression based on findings.

Input: Optic gliomas and optic hypothalamic glioma status post chemotherapy. Off therapy evaluation. There has been interval mixed response of enhancing FLAIR hyperintense lesions along the left optic pathway. There has been no significant interval change in the enhancing lesion along the posterior left optic tract, at the level the left ventricular atrium. The lesion along the left optic tract, just posterior to the left optic chiasm is slightly decreased in size. Direct comparison is best made on the coronal T1 fat-sat postcontrast images through the orbits, measuring 5 mm on 1601/13, compared to previous remeasurement of 7 mm. There is also been interval reappearance of an oval enhancing nodule centered just medial to the left pelvis as seen on 1701/13, which had resolved on the March 2015 exam although is smaller than the current size on the December 2014 exam.There is interval further improvement of the enhancing right optic pathway lesions. For reference, enhancing lesion adjacent to the right basal ganglia currently measures 0.4 x 0.4 cm (1701/13), further decreased from previous 0.7 x 0.7 cm. The subtle right hypothalamic punctate lesion is less conspicuous than on the prior exam (1601/14).There is a stable appearance of the intraorbital component of the optic nerve gliomas, right larger than left, again noted to have mild enhancement of the right intraorbital optic nerve and persistent dilatation of the right optic nerve sheath. There is persistent faint intrinsic T1 hyperintensity of the bilateral basal ganglia and dentate nuclei, which may be metabolic in etiology. There is no evidence of acute infarct. The ventricles are mildly prominent, which is unchanged. There is no midline shift. There are punctate foci of susceptibility along the left basal ganglia region likely relating to minimal chronic hemosiderin. There is stable linear FLAIR hyperintensity along the left frontal white matter extending towards basal ganglia.

Output: 1.Interval fluctuation in appearance of enhancing lesions along the left optic pathway.2.Interval further improvement of enhancing lesions along the right pathway. 3.Subtle right hypothalamic punctate lesion is unchanged.4.Stable appearing intraorbital component of the optic nerve gliomas.


Instruction: Generate impression based on findings.

Input: Female, 49 years old, with left thigh pain. Alignment is anatomic. Vertebral body height and morphology are within normal limits. No evidence of marrow replacement or marrow edema is seen. The visualized distal spinal cord, conus and nerve roots of the cauda equina are unremarkable. No epidural abnormalities are suspected.L1-2: Unremarkable. L2-3: Small left foraminal disc protrusion. No significant spinal canal stenosis. Mild left foraminal narrowing. L3-4: Small right foraminal disc protrusion. No significant spinal canal stenosis. Mild right foraminal narrowing. L4-5: Mild facet arthropathy. The intervertebral disc is preserved. No significant spinal canal or foraminal stenosis. L5-S1: Mild facet arthropathy. Minimal left foraminal protrusion/annular fissuring. No significant spinal canal stenosis. Minimal left foraminal narrowing.

Output: Mild disc degeneration is seen with small foraminal protrusions at L2-3, L3-4 and questionably at L5-S1. No high-grade spinal canal or foraminal stenosis is detected.


Instruction: Generate impression based on findings.

Input: Cirrhosis. HCC screening. ABDOMEN:LIVER, BILIARY TRACT: No suspicious hepatic mass. Cirrhotic liver morphology with fatty infiltration. Diffuse reticular enhancing T2 hyperintensity consistent with fibrosis that is focally confluent in the right hepatic lobe, unchanged. Patent hepatic vasculature. Mildly complex small left hepatic lobe cyst with a thin septation, unchanged. Right hepatic lobe small cyst, unchanged. Trace perihepatic fluid.No biliary ductal dilatation. Cholelithiasis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Scattered renal cysts.RETROPERITONEUM, LYMPH NODES: Calcified atherosclerotic disease of the abdominal aorta with eccentric mural thrombus.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No varices are identified.

Output: Cirrhosis with no suspicious hepatic mass.


Instruction: Generate impression based on findings.

Input: LumbagoClinical question: Reason for low back painSigns and Symptoms: low back pain left thigh pain reduced left patellar reflex 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. There is loss of disc space height, disc desiccation, chronic endplate reactive changes in the disc bulge present at this level. Some mild ligamentum flavum hypertrophy present at this level. There is partial effacement of the fat at the left lower recess at this level. There is effacement of the fat surrounding the left-sided exiting nerve root at this level and some mild narrowing of the right neural foramen. When compared to the prior exam these findings have progressed.At L4-5 there is no significant compromise to spinal canal. There is loss of disc space height, disc desiccation and chronic endplate reactive change at this level associated with a diffuse disc bulge and mild-to-moderate facet and ligamentum flavum hypertrophy left worse than right where with subchondral cyst formation. There is some narrowing of the spinal canal at this level with some mild partial effacement of the fat at the lateral recesses sees. There is effacement of the fat surrounding the left-sided exiting nerve root within the neural foramen and some mild narrowing of the right neural foramen.At L3-4 there is no significant compromise to spinal canal. There is loss of disc space height, disc desiccation and diffuse disc bulge associated with chronic endplate reactive changes. There is some mild triangulation of the thecal sac and some ligamentum flavum hypertrophy bilaterally. There is narrowing of the right neural foramen at this level associated with effacement of fat surrounding the right-sided exiting nerve rootAt L2-3 there is no significant compromise to spinal canal. There is a diffuse disc bulge present at this level associated with mild ligamentum flavum hypertrophy.At L1-2 there is no significant compromise to spinal canal or neural foramina.There is a right renal cyst present which currently measures 13 mm and previously measured 5 mm in diameter. Breathing artifact partially obscures visualization of the kidneys on this exam.

Output: 1.There are degenerative changes present in the lower lumbar spine with encroachment of the left-sided exiting nerve roots within the neural foramina of L5-S1 and L4-5 and right-sided exiting nerve root within the neural foramen of L3-4. When compared to the prior exam from 2010 the encroachment at L5-S1 has progressed.2.A right-sided cortically based renal cyst has enlarged when compared to the prior exam.


Instruction: Generate impression based on findings.

Input: Right knee pain MENISCI: Horizontal signal abnormality is noted within the lateral meniscus extending from the anterior horn to the body and into the posterior horn. The medial meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is moderate diffuse thinning of the articular cartilage of the lateral compartment without local thickness defect. Milder articular cartilage thinning is noted of the medial and patellofemoral compartments.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Horizontal tear of the lateral meniscus.2. Mild diffuse tricompartmental thinning of the articular cartilage which is most evident in the lateral compartment. There is no focal full-thickness defect.


Instruction: Generate impression based on findings.

Input: 60-year-old female with reported pancreatic lesion on outside imaging ABDOMEN:LIVER, BILIARY TRACT: There is loss of signal within the liver, consistent with hepatic steatosis. There is focal fatty sparing affecting segment 4 and along the gallbladder fossa.SPLEEN: No significant abnormality noted.PANCREAS: No increased signal abnormality, abnormal enhancement, or restricted diffusion is identified within the pancreas. The area of low attenuation described on the recent CT examination performed at an outside hospital appears to correspond to an area of signal loss on out of phase sequences appearing most consistent with focal fat deposition in the pancreas. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Filling defect in the right gonadal vein consistent with the known history of right gonadal vein thrombosis.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: Outside exam read:1.Area of signal loss on opposed phase imaging sequence, corresponding to the previously described area of hypoattenuation in the pancreatic head/uncinate process on outside CT study, appearance consistent with focal fat deposition. No suspicious mass lesion identified in the pancreas otherwise.2.Right gonadal vein thrombus.3.Hepatic steatosis with sites of sparing as above.


Instruction: Generate impression based on findings.

Input: Personal history of breast cancer status post left mastectomy on an AI. There is scattered fibroglandular tissue in the right breast.Mild parenchymal enhancement is noted in the right breast. The patient is status post left mastectomy. No suspicious chest wall enhancement. No abnormal enhancement is seen in the right breast. A stable 3 mm probable intramammary lymph node is present in the upper outer breast. A few other scattered foci are present, none suspicious. A right retropectoral silicone implant is present.No abnormal axillary lymph nodes are identified in either axillary region. Postoperative change in the left axilla is present.

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


Instruction: Generate impression based on findings.

Input: 65-year-old woman with history of pancreatic body mass, follow-up. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in signal and morphology. The gallbladder is normal. There is no intra or extrahepatic biliary ductal dilatation.SPLEEN: Mildly T2 hyperintense, T1 hypointense lesions throughout the spleen are again seen without enhancement. These lesions are not significantly changed from the prior examination.PANCREAS: A multilobulated T2 hyperintense lesion in the pancreatic body (701/24) measures 21 x 20 mm, previously 21 x 20 mm. Additional, smaller T2 hyperintense lesions are noted in the pancreas with an uncinate process lesion (701/22) measuring 8 mm, previously 8 mm. There is no main pancreatic ductal dilatation. There is no abnormal enhancement.ADRENAL GLANDS: Subcentimeter nodular focus in the left adrenal gland (701/24) with loss of signal on out of phase imaging is most likely an adenoma. The right adrenal gland appears normal.KIDNEYS, URETERS: In the superior pole of the right kidney (1103/182) there is a 19 mm T2 hypointense, T1 hyperintense, mildly enhancing lesion, stable in size from the prior examination. No additional focal renal lesions are identified. There is no hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Stable pancreatic body and uncinate process cystic lesions favored to represent IPMNs.2.Nonspecific splenic lesions appear stable, possibly a sequela of prior infectious or inflammatory process.3.Mildly enhancing right renal lesion which could represent neoplasm, stable but can be followed on subsequent imaging.


Instruction: Generate impression based on findings.

Input: 4-year-old male with history of pilocytic astrocytoma status post laser ablation, surveillance imaging. Redemonstrated are postoperative findings related to laser ablation with no interval change in size of a tectal plate mass, as measured with T2 technique, measuring approximately 16 x 20 mm in the same location utilized previously. However, previously demonstrated more diffuse enhancement centrally within the mass has decreased. There is no evidence of acute intracranial hemorrhage or acute infarct. There is a right transfrontal ventricular catheter that terminates adjacent to the right caudate nucleus, unchanged in position. Also redemonstrated are postoperative findings related to endoscopic third ventriculostomy, with an apparent jet of cerebrospinal fluid into the third ventricle, unchanged in appearance. Nevertheless, the third and lateral ventricles remain enlarged, unchanged in extent. There is no midline shift or herniation. There is a left cerebellar hemisphere developmental venous anomaly. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues appear unchanged.

Output: 1.Redemonstrated are postoperative findings related to laser ablation with no interval change in size of a tectal plate mass, as measured with T2 technique, measuring approximately 16 x 20 mm in the same location utilized previously. However, previously demonstrated more diffuse enhancement centrally within the mass has decreased.2.Stable findings related to endoscopic third ventriculostomy, with an apparent jet of cerebrospinal fluid into the third ventricle. 3.Stable third and lateral ventricular enlargement.


Instruction: Generate impression based on findings.

Input: Reason: right knee osteochondral lesion. MENISCI: The medial and lateral meniscus are intact. ARTICULAR CARTILAGE AND BONE: There is osteochondral defect in the condyle, somewhat unusual that it is not located in the weightbearing location. Mild bone marrow edema is noted. The defect appears stable with overlying cartilage and no fluid separating the defect from the cartilage. The articular surface is intact.LIGAMENTS: Cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: Extensor mechanism is intact.ADDITIONAL

Output: Osteochondral defect in the condyle, somewhat unusual given the location in the weightbearing area. The lesion is not separated and cortical surfaces are intact, indicating a stable lesion.