Instruction: Generate impression based on findings.

Input: Male 46 years old with elevated alkaline phosphatase. Evaluate for choledocholithiasis, biliary stricture. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in size and contour. There is no focal hepatic lesion or abnormal enhancement. No intra or extrahepatic biliary ductal dilatation. The gallbladder is normally distended without cholelithiasis. Hepatic vasculature appears patent.SPLEEN: No significant abnormality noted.PANCREAS: The pancreas enhances homogeneously. The pancreatic duct is not dilated. There appears to be a slight variant and pancreatic anatomy possibly representing pancreas divisum.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No hydronephrosis or suspicious renal lesion.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 intra or extrahepatic biliary ductal dilatation or stricture. No choledocholithiasis.


Instruction: Generate impression based on findings.

Input: Radicular pain down the right arm. There is mild reversal of the normal cervical spine lordosis centered at C3-4 without evidence of subluxation. The vertebral body heights are well-maintained. The spinal cord displays normal signal. There is multilevel degenerative spondylosis. At C2-3, there is mild bilateral facet arthropathy, but no significant spinal canal or neural foraminal stenosis. At C3-4, there is a posterior disc osteophyte complex with flattening of the ventral spinal cord, as well as right greater than left facet arthropathy and uncovertebral hypertrophy, as well as moderate right and mild left neural foraminal stenosis. At C4-5, central posterior disc osteophyte complex contacting the ventral aspect of the spinal cord, as well as left greater than right facet arthropathy and uncovertebral hypertrophy, with marked left and mild right neural foraminal stenosis. At C5-6, there is moderate central posterior disc osteophyte complex that abuts the ventral aspect of the spinal cord. In addition, bilateral facet arthropathy and uncinate hypertrophy result in marked right and moderate left neural foraminal stenosis. At C6-7, there is moderate central posterior disc osteophyte complex contacting the ventral aspect of the spinal cord. In addition, there is bilateral facet and uncinate hypertrophy with marked right and moderate left neural foraminal stenosis. At C7-T1, there is mild central disc osteophyte complex without significant spinal canal stenosis. In addition, there is moderate bilateral facet arthropathy with marked right and mild left neural foraminal stenosis. There is enlargement of the thyroid gland with multiple nodules, which appears grossly similar to prior exams, accounting for differences in technique. The paravertebral soft tissues are otherwise unremarkable.

Output: 1. Multilevel advanced degenerative cervical spondylosis with indentation upon the spinal cord at the C3-4 through C6-7 levels due to disc-osteophyte complexes, as well as multilevel neural foraminal stenoses of varying degrees, particularly on the right side at the C5-6, C6-7, and C7-T1 levels, and on the left side at C4-5.2. Incompletely evaluated enlarged thyroid gland with multiple nodules. Correlation could be made with dedicated ultrasound examination, as clinically indicated.


Instruction: Generate impression based on findings.

Input: Female, 11 years old. Reason: h/o Chiari visualized on OSH MRI and CT at UCMC; r/o cervical syrinx History: headache Examination demonstrates at least 10 mm of downward herniation of the mildly pointed cerebellar tonsils with resultant crowding of the foramen magnum, compatible with Chiari 1 malformation. CINE phase contrast CSF flow sequence shows biphasic CSF flow with ample flow ventrally along the brainstem and cervicomedullary junction. There is somewhat diminished biphasic flow posteriorly along the foramen magnum, specifically at the level of the cerebellar tonsils, as well as through the fourth ventricle and cerebral aqueduct.There is straightening of the normal cervical lordosis. The vertebral body heights are preserved. The intervertebral discs demonstrate normal T2 intensity and height with no evidence of disc herniation. The bone marrow and end plates demonstrate a normal MR appearance. The epidural space, thecal sac, and spinal cord are preserved with no evidence of spinal canal/neural foraminal stenosis, cord compression or myelopathy. There is no abnormal signal within the cord to suggest syringomyelia.The paraspinal soft tissues and musculature are unremarkable.

Output: Redemonstration of known Chiari 1 malformation with associated diminished biphasic CSF flow posteriorly at the level of the foramen magnum but without evidence of syringohydromyelia.


Instruction: Generate impression based on findings.

Input: 24-year-old male. Left knee instability and pain. Evaluate ACL and meniscus tears. MENISCI: Longitudinal tear of the periphery of the posterior horn of the medial meniscus (series 9, image 10). An abnormally small and rounded morphology of the medial posterior horn of the lateral meniscus due to a tear of its free edge extending to the root (series 8, image 19).ARTICULAR CARTILAGE AND BONE: Bone contusions in the posterior medial femoral condyle and weight-bearing component of the lateral femoral condyle. Tibiofemoral and patellofemoral articular cartilage is normal in signal and morphology.LIGAMENTS: ACL is not visualized and is torn. The PCL is intact. MCL and lateral ligament complex are intact.EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Complete tear of the ACL.2. Longitudinal tear of the posterior horn of the medial meniscus. Tear of the free edge of the posterior horn of the lateral meniscus extending into the root.3. Bone contusions in the medial and lateral femoral condyles.


Instruction: Generate impression based on findings.

Input: Reason: follow PSC History: PSC ABDOMEN:LIVER, BILIARY TRACT: Focal narrowing of the distal common hepatic duct. The intrahepatic biliary ducts are not well visualized, which may be secondary to underlying stricture formation. In the right lobe of the liver, small subcentimeter T2 hyperintense focus that is difficult to characterize due to small size, although there is subtle peripheral nodule progressive enhancement suggestive of a small hemangioma. No suspicious focal hepatic lesion. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left renal cyst. 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.Focal distal common hepatic duct narrowing compatible with a stricture. Intrahepatic biliary ducts are not well visualized, likely secondary to underlying stricturing. 2.Small hepatic hemangioma suspected. No suspicious focal hepatic lesion.


Instruction: Generate impression based on findings.

Input: Syringomyelia, and spastic diplegia, 3 month follow up for changes. There is syrinx formation throughout much of the spinal cord, with more focal enlargements centered at C6-7, measuring up to 7 mm in diameter, and at T5-6, measuring 7 mm in diameter also, which is not vastly different from the last exam. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The paravertebral soft tissues are unremarkable. However, there is bilateral enlargement of the renal collecting systems.

Output: 1. Extensive syrinx formation throughout much of the spinal cord, with more focal enlargements centered at C6-7 and at T5-6 do not appear vastly different from the prior exam.2. Bilateral hydronephrosis.


Instruction: Generate impression based on findings.

Input: Exam is limited by patient motion. The spine is in normal alignment. The vertebral body heights are well-maintained. There is multilevel mild disc narrowing and desiccation along the cervical and thoracic spine. There is a mildly heterogeneous appearance of the bone marrow which is nonspecific. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal. There is apparent increased signal along the medulla and upper cervical cord, although this is favored to be artifactual in etiology. The visualized spinal cord and conus are grossly within normal limits. There is no MR evidence of cord compression or high-grade central spinal canal stenosis. Cauda equina nerve roots do appear to be somewhat dorsally located along the distal spinal canal, to be further assessed on the lumbar spine MRI.Mild degenerative changes are suggested along the cervical spine.Incidental note is made of a large CSF signal intensity structure along the sacrum at the S2-S3 level adjacent to the distal thecal sac, with associated bone remodeling. This structure measures 2.9 cm AP x 3.7 cm CC, corresponding to the area of concern on CT. Of note, there also appear to be prominent nerve root sleeve cysts along the mid to lower thoracic foramina bilaterally.

Output: 1. No MR evidence of cord compression.2. CSF signal intensity prominent cystic lesion along the sacrum at the S2-S3 level, corresponding to cystic structure on CT with bone remodeling. Given its CT appearance with more midline positioning and lack of sacral foraminal expansion, this is favored to represent an occult intrasacral meningocele as opposed to a Tarlov cyst. This is to be further detailed on subsequent MRI of the lumbar spine.3. Somewhat dorsal positioning of the cauda equina nerve roots along the distal spinal canal, to be further evaluated on dedicated MRI of the lumbar spine.


Instruction: Generate impression based on findings.

Input: History of Sally lipase an abscess of the left posterior lower leg. Burning sensation in the right lower leg today. Exam is limited due to overlying soft tissue from patient's body habitus.Left tibia/fibula: Severe degenerative changes affect the left knee and ankle with near bone-on-bone apposition of the medial compartment of the knee. There is no acute fracture or malalignment. Visualization and evaluation of the proximal medial tibia is limited due to overlying soft tissue. If there is clinical concern in this region, CT or MRI may be considered. Otherwise, no definite erosions or periosteal reaction to suggest osteomyelitis.Right tibia/fibula: Moderate to severe degenerative changes affect the right knee. No acute fracture or malalignment. Visualization and evaluation of the proximal medial tibia and distal tibia/fibula is limited by overlying soft tissues. If there is clinical concern in these regions, CT or MRI may be considered. Otherwise, no definite erosions or periosteal reaction to suggest osteomyelitis.

Output: 1.Osteoarthritis.2.Exam is limited by overlying soft tissues, if there is clinical concern in the region of the proximal medial tibia bilaterally or the distal right tibia/fibula, CT or MRI may be considered. Within these limitations there is no evidence to suggest osteomyelitis.


Instruction: Generate impression based on findings.

Input: There are postoperative changes related to left frontal craniotomy for resection of a left frontal lobe mass. There is marginal susceptibility along the resection cavity as well as along the residual anterior left frontal lobe parenchyma, consistent with chronic hemosiderin deposition likely from the prior surgery. There is also diffuse smooth dural enhancement in the left frontal region with mild thickening, also likely postoperative in etiology. There has been interval near-resolution of enhancement along the margins of the resection cavity otherwise. There is no significant interval change in the extent of the mildly expansile T2 hyperintense infiltrative mass in the left frontal lobe surrounding the resection cavity with extension across the corpus callosum into the right frontal lobe. However, there is also increased patchy T2 hyperintensity in the white matter of the bilateral cerebral hemispheres, which may be treatment related. There is mild mucosal thickening in the right frontal sinus and left ethmoid air cells. The orbits are unremarkable.

Output: Evolution of postoperative findings related to left frontal mass resection without convincing evidence of tumor progression.


Instruction: Generate impression based on findings.

Input: 34 weeks pregnant with 2 prior C-sections. Known placenta previa and suspicion for placenta accreta. PELVIS:UTERUS, ADNEXA: Single intrauterine pregnancy. Examination is not specifically protocoled for evaluation of fetal anatomy. No gross abnormality is identified. There is apparent paucity of amniotic fluid.Anterior low-lying uterus completely covering the internal cervical os compatible with placenta previa.The uterine wall is again noted to be markedly thinned and not well defined along the lower anterior third suspicious for placenta accreta/increta. For example on image 33 of series 4 the uterine myometrium/serosal surface is now visualized with placental signal stenting at outside the uterine contour without definite abdominal wall invasion. This is at the level of the C-section scar.No specific evidence of local soft tissue invasion.BLADDER: No significant abnormality noted.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.Suspected placenta increta at the level of the C-section scar with extension of placental signal intensity beyond the visualized uterine margin, raising the possibility of percreta of the parametrial fat without definite invasion into the abdominal wall.2.Apparent paucity of amniotic fluid. If there is clinical concern a fetal ultrasound should be considered for evaluation for oligohydramnios.


Instruction: Generate impression based on findings.

Input: Male; 82 years old. Reason: eval for MRCP History: epigastric pain ABDOMEN:LIVER, BILIARY TRACT: Multiple small gallstones within a distended gallbladder. Trace pericholecystic free fluid. No significant gallbladder wall thickening or enhancement. The common bile duct is slightly dilated measuring up to 9 mm. In the distal common bile duct at the level of the ampulla, there is a small T2 dark filling defect seen best on true axial T2 fat saturation sequence, compatible with a stone (series 601/8). Together, the findings are most suspicious for mild obstructive choledocholithiasis.SPLEEN: No significant abnormality noted.PANCREAS: Prominence of the pancreatic duct. No focal pancreatic lesions.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left renal cyst and other too small to characterize T2 hyperintense lesion, likely an additional cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Mild bibasilar dependent subsegmental atelectasis.

Output: Findings most suspicious for mild obstructive choledocholithiasis as detailed above.Findings discussed with ER resident at 1:30 PM on 4/10/15.


Instruction: Generate impression based on findings.

Input: Clinical question: Metastatic prostate and renal cancer, evaluate brain lesions. Signs and symptoms: As above. Pre and post enhanced brain MRI:Examination redemonstrated few scattered tiny enhancing metastatic lesions in the parenchyma and superficially of bilateral cerebral hemispheres. There is no convincing evidence of any interval change in the size or number of lesions since prior exam. Also similar to prior exam none of the lesions demonstrate any appreciable surrounding edema or mass effect.Small foci of calvarial enhancement also remains nearly identical to prior study.Unremarkable cerebral cortex, cortical sulci, ventricular system and CSF spaces and maintained midline.Unremarkable images through the orbits and including axial fat sat post enhanced series.Paranasal sinuses and bilateral mastoid air cells demonstrate normal pneumatization signal pattern.

Output: 1.No evidence of an acute or new findings since prior study.2.Stable tiny scattered metastatic lesions in size and number without evidence of edema or mass effect.3.Stable small foci of calvarial enhancement since prior exam.


Instruction: Generate impression based on findings.

Input: 51 year old female with hypertension, hyperlipidemia, and chest pain with a history of LVH, abnormal stress test, and negative coronary angiogram. Referred for cardiac MRI. Left VentricleThere is mild qualitative thickening of the left ventricular apical walls. The left ventricle is normal in size and systolic function otherwise. The overall LV ejection fraction is 60%, the LV end diastolic volume index is 67 ml/m2 (normal range: 65+/-11), the LVEDV is 121 ml (normal range 109+/-23), the LV end systolic volume index is 27 ml/m2 (normal range 18+/-5), the LVESV is 49 ml (normal range 31+/-10), the LV mass index is 37 g/m2 (normal range 67+/-11), and the LV mass is 68 g (normal range 114+/-24). There are no regional wall motion abnormalities present. There is transmural, diffuse late gadolinium enhancement in the anterior apex and apical walls that is atypical in pattern for infarction but may represent myocarditis or suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. The pre-contrast native T1 myocardial relaxation time is ~1050 ms (normal). There is no evidence of myocardial iron overload. Left AtriumThe left atrium is normal sized. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 64%, the RV end diastolic volume index is 56 ml/m2 (normal range 69+/-14), the RVEDV is 101 ml (normal range 110+/-24), the RV end systolic volume index is 20 ml/m2 (normal range 22+/-8), and the RVESV is 37 ml (normal range 35+/-13). Right AtriumThe right atrium is normal sized. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size and systolic function (LVEF 60%) except for wall thickening within the apical LV. There is transmural, diffuse late gadolinium enhancement in the anterior apex and apical walls that is atypical in pattern for infarction but may represent myocarditis or suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. Recommend repeat cardiac MRI in 4-6 months or sooner if clinically warrented. 2. The right ventricle is normal in size and systolic function (RVEF 64%). I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Male, 88 years old, status post stroke with pure motor syndrome, right face arm and leg, dysarthria. A gyriform band of restricted diffusion is seen along the lower aspect of the left postcentral gyrus. Questionable minimal diffusion bright signal is seen along the superior margin of the right caudate, but without clear ADC.Moderate patchy periventricular, subcortical and pontine T2 hyperintensity is seen. No evidence of significant parenchymal edema or mass effect is detected. No intracranial hemorrhage or any abnormal extra-axial fluid collection is detected the ventricles sulci mildly prominent compatible with cortical volume loss at this

Output: 1.Acute ischemia affecting the lower aspect of the left postcentral gyrus. Equivocal diffusion signal abnormality is seen along the right caudate which may represent a very small region of ischemia or an imaging artifact.2.Moderate chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: Elevated PSA. Previous negative biopsy. PELVIS:PROSTATE:Prostate Size: 2.8 x 4.4 x 4.5 cmPeripheral Zone: No suspicious focus of T2 weighted hypointensity or restricted diffusion.Central Gland: Centered within the anterior mid gland transitional zone and extending into the anterior fibromuscular stroma and left anterior peripheral zone is a poorly defined 2.2 x 1.3 cm (series 801/16) lesion demonstrating T2 weighted hypointensity, restricted diffusion and early arterial enhancement. The lesion abuts and bulges the anterior capsule. Indeterminate right lateral base T2 weighted hypointense focus measuring 6 x 6 mm (series 1/20) without restricted diffusion.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: The anterior mid gland lesion abuts and bulges the anterior capsule.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Suspicious 2.2 cm anterior mid gland lesion bulging the anterior capsule.2. Indeterminate 6 x 6 right lateral base focus.


Instruction: Generate impression based on findings.

Input: Reason: history brain mets s/p SRS to pituitary met please compare History: none Dedicated pituitary sequences were not again acquired on this exam. Images are somewhat limited by patient motion as well. Available imaging demonstrates there has been further slight interval decrease in the size of the previously seen slightly irregular mildly enhancing sellar/suprasellar mass. The lesion demonstrates diffuse T2 hypointensity which may relate to hemosiderin staining and/or mineralization. Postoperative changes from previous transphenoidal sellar surgery are again noted. The pituitary infundibulum and optic chiasm are better visualized than on previous exam, with relative hypoenhancement suggested to the left of midline along the upper margin of the pituitary gland.The ventricles and sulci are within normal limits for age. The cisterns remain patent. There is no midline shift or mass effect. There are no new areas of abnormal signal or pathological enhancement. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The remainder of the midline structures and craniocervical junction are within normal limits. The patient's known left masseter mass visualized on coronal T1 postcontrast images, measuring 1.1 cm transverse by 1.5 similar CC. It is overall T1 hypointense with mild patchy enhancement as well as a more prominent halo of ill-defined enhancement surrounding it. Is not entirely included within the previous field-of-view on dedicated MR brain exams.

Output: Exam limited due to lack of dedicated pituitary imaging as well as motion artifact. Further interval decrease in size of the sellar/suprasellar mass, with improved visualization of the suprasellar cistern, pituitary infundibulum, and optic chiasm.


Instruction: Generate impression based on findings.

Input: 21-year-old male with knee dislocation which was reduced during football yesterday. Previous patellar dislocation and MCL injury. Evaluate for knee damage. MENISCI: The medial and lateral meniscus appear intact.ARTICULAR CARTILAGE AND BONE: There is heterogeneity of the articular cartilage of the lateral facet and median eminence of the patella indicating degeneration. There is also focal degeneration of the articular cartilage of the lateral aspect of the lateral facet of the femoral trochlea with underlying subchondral cyst formation. There are small foci of bone marrow edema, likely representing contusions within the lateral tibial plateau and lateral femoral condyle, just above the anterior horn of the lateral meniscus. The cartilage overlying the femoral contusion appears slightly thin.LIGAMENTS: There is rupture of the ACL through its mid/distal substance. There is perhaps slight thickening of the superficial band of the MCL perhaps representing prior injury. The PCL appears intact. The LCL appears intact.EXTENSOR MECHANISM: The medial patellofemoral ligament appears slightly thickened at its femoral attachment suggesting prior injury, but we see no increased signal abnormality to suggest an acute injury. The extensor mechanism appears intact.ADDITIONAL

Output: 1. ACL tear with bone contusions.2. Patellofemoral cartilage degeneration.3. Joint effusion, Baker's cyst, and other findings as described above.


Instruction: Generate impression based on findings.

Input: Relapsed neuroblastoma treated with 4 cycles chemotherapy. Orbits: The lobulated heterogeneous mass arising from the left lateral orbital wall has not significantly changed in size, measuring up to approximately 3.0 cm, previously also approximately 3.0 cm, with extension into the left lateral extraconal space and bulging into the left masticator space via subperiosteal extension. There is mass effect upon the left orbital contents, but the optic nerve is not directly compressed. The tumor displays less enhancement and restricted diffusion overall. The right orbit is unremarkable.Brain: There are postoperative findings related to left pterional craniotomy. There is tumor involving the left greater wing of the sphenoid, pterygoid process, and body of the sphenoid, which measures up to approximately 35 mm, with associated mass effect upon the adjacent brain parenchyma and parapharyngeal space contents. The tumor also protrudes into the left sphenoid sinus and abuts the left internal carotid artery. The tumor displays less enhancement and restricted diffusion overall. There is no evidence of intracranial hemorrhage or acute infarct. There is a left cerebellar hemisphere developmental venous anomaly. The ventricles are normal in size and configuration. There is no midline shift. There is diffuse paranasal sinus mucosal thickening and secretions. There is fluid and mucosal enhancement within the bilateral middle ears and mastoid air cells.

Output: 1. No significant interval change in size of the metastasis arising from the left lateral wall of the orbit. However, the tumor displays less enhancement overall, perhaps due to treatment-related necrosis. 2. No significant interval change in size of the metastasis involving the left greater wing of the sphenoid, pterygoid process, and body of the sphenoid. However, the tumor displays less enhancement overall, perhaps due to treatment-related necrosis. 3. Diffuse paranasal sinus mucosal thickening and secretions.4. Persistent fluid within the left middle ears and mastoid air cells likely attributable to obstruction of the Eustachian tube by tumor.


Instruction: Generate impression based on findings.

Input: 59 year old with history of atrial fibrillation and left ventricular systolic dysfunction presenting for Left VentricleThe left ventricle is severely dilated. The overall LV ejection fraction is 48%, the LV end diastolic volume index is 112 ml/m2 (normal range: 65+/-11), the LVEDV is 236 ml (normal range 109+/-23), the LV end systolic volume index is 59 ml/m2 (normal range 18+/-5), the LVESV is 123 ml (normal range 31+/-10). LV dysfunction is global without regional wall motion abnormalities. There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is mild to moderately enlarged. Right VentricleThe right ventricle is mildly enlarged. The overall RV ejection fraction is 60%, the RV end diastolic volume index is 99 ml/m2 (normal range 69+/-14), the RVEDV is 207 ml (normal range 110+/-24), the RV end systolic volume index is 39 ml/m2 (normal range 22+/-8), and the RVESV is 83 ml (normal range 35+/-13). Right AtriumThe right atrium is mildly dilated. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1.The left ventricle is severely dilated. The overall LV ejection fraction is 48%2 No delayed enhancement3. Normal RV systolic function


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: Reason: eval for fx lis franc History: foot pain sports. There is bone marrow edema involving the bases of the first through fourth metatarsals as well as the middle and lateral cuneiforms and the cuboid, although the cuboid is incompletely imaged on this study. There is questionable step-off along the base of the third metatarsal that is suspicious for a nondisplaced fracture. Portions of the base of the second metatarsal are also ill defined which may reflect an additional nondisplaced fracture, but this is equivocal.The dorsal, interosseous and plantar components of the Lisfranc ligament itself are poorly visualized with edema noted between the middle cuneiform and the base of the second metatarsal, suggesting a tear. However, the alignment of the tarsometatarsal joints is within normal limits.Mild edema within the surrounding soft tissues and along the dorsum of the foot as well.The visualized tendinous structures appear intact.The phalanges appear unremarkable.

Output: Findings compatible with a Lisfranc ligament injury and possible nondisplaced fractures through the bases of the second and third metatarsals that could be further evaluated with CT if clinically warranted.


Instruction: Generate impression based on findings.

Input: Known left temporal meningioma. Surveillance to rule out progression. The dural-based round extra-axial lesion overlying the left anterior temporal lobe which demonstrates a dural tail and intense homogeneous enhancement measures 11 x 13 x 14 mm. This measured 9 x 10 x 10 mm in similar dimension previously on the original exam, but demonstrates similar dimensions to the most recent comparison. There is unchanged minimal local mass effect on the adjacent superior temporal gyrus. There is focus of FLAIR hyperintensity in the left temporal lobe, which may represent edema and/or gliosis and stable to minimally increased from prior allowing for differences in technique.Scattered foci of high T2/FLAIR in periventricular and subcortical white matter are unchanged and compatible with mild chronic small vessel ischemic changes. There is unchanged focus of susceptibility in the right frontal lobe consistent with chronic microhemorrhage. There is no new intracranial mass, fluid collection, hemorrhage, hydrocephalus or ischemia. Normal flow-voids are demonstrated within major intracranial vessels. Incidental note is made of a stable right parietal DVA. Unchanged small osseous protuberance posterior to the right frontal sinus. Small fluid levels within the left sphenoid sinus, small right maxillary mucous retention cyst, and minimal left maxillary mucosal thickening are noted.

Output: No significant change in size of small left anterior temporal meningioma compared to 10/22/2013. There is minimal interval enlargement when compared to earliest available study from 8/26/2010. Mild adjacent FLAIR hyperintensity in the left anterior superior temporal gyrus is stable to minimally increased and may represent minimal amount of edema and/or gliosis.


Instruction: Generate impression based on findings.

Input: 22 year old woman with history of atrial tachycardia and PVC's and Crohn's disease referred for evaluation of structural heart disease. Left VentricleThe left ventricle is mildly dilated with normal systolic function. The overall LV ejection fraction is 54%, the LV end diastolic volume index is 94 ml/m2 (normal range: 65+/-11), the LVEDV is 129 ml (normal range 109+/-23), the LV end systolic volume index is 43 ml/m2 (normal range 18+/-5), the LVESV is 59 ml (normal range 31+/-10). Wall thickness is normal. There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of a focal underlying fibrosing, infiltrative, or inflammatory process. There is no evidence of myocardial edema.The native T1 myocardial relaxation time is 1130ms, which is mildly abnormal. Left AtriumThe left atrium is small.Right VentricleThe right ventricle is normal in size with normal systolic function . The overall RV ejection fraction is 58%, the RV end diastolic volume index is 92 ml/m2 (normal range 69+/-14), the RVEDV is 126 ml (normal range 110+/-24), the RV end systolic volume index is 38 ml/m2 (normal range 22+/-8), and the RVESV is 53 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Mildly dilated LV with normal systolic function (EF 54%). While there is no late gadolinium enhancement to suggest the presence of an underlying focal infiltrative, inflammatory or fibrotic process, the native myocardial T1 relaxation time is mildly elevated which may point to possible mild diffuse myocardial fibrosis.2. Normal size RV with normal systolic function (EF 58%).3. No significant valvular disease.


Instruction: Generate impression based on findings.

Input: Male 50 years old Reason: 50M with pain in rectum and soft tissue mass between scrotum and rectum seen on US History: soft tissue mass PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Bilateral enlarged external iliac lymph nodes. A node on the right side measures 1.6 x 1.1 cm (series 11, image 33). Enlarged left femoral and inguinal lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: There is a 7.2 x 11.6 x 11.1-cm infiltrating, enhancing, mildly T2 hyperintense mass centered in the left perineum/medial adductor region. The mass is mildly hypointense to muscle on T1-weighted images. There is a somewhat cystic component posteriorly. The mass invades the penile base, and extends into the left adductor musculature and into the lower pelvis. A satellite component extends along the left hamstring tendon. There are scattered central flow voids within the lesion. The cortex of the overlying left inferior pubic ramus is intact without remodeling.OTHER: No significant abnormality noted.

Output: Infiltrating left perineum/groin mass extending into the pelvis and the adjacent soft tissues with enlarged pelvic lymph nodes. Differential considerations includes a sarcoma, infiltrative tumor of neural origin, aggressive hemangioma. Other soft tissue malignancies are not excluded and orthopedic oncology consultation is recommended.


Instruction: Generate impression based on findings.

Input: Diagnosis: Migraine, unspecified, without mention of intractable migraine without mention of status migrainosusClinical question: Refractory headacheSigns and Symptoms: Headache The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: MRI of the brain is within normal limits


Instruction: Generate impression based on findings.

Input: 53 years Female (DOB:1/3/1963)Reason: MS, follow up progression History: paresthesiasPROVIDER/ATTENDING NAME: ADIL JAVED ADIL JAVED There is redemonstration of periventricular white matter lesions as well as lesions in the corpus callosum, thalami, midbrain, right middle cerebellar peduncle and pons which are high signal on proton density imaging and FLAIR imaging. These lesions can be identified on the prior exam and have not changed substantially.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: Periventricular white matter lesions, corpus callosum lesions, thalamic lesions and brainstem lesions are stable and compared to the prior exam. These are compatible with the patient's clinical history of multiple sclerosis.


Instruction: Generate impression based on findings.

Input: Right retro-orbital pain. Orbit MRI: The globes and ocular adnexa are unremarkable. Brain MRI: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are a few scattered foci of T2 hyperintensity in the white matter. 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 skull, paranasal sinuses, and scalp soft tissues are unremarkable.Brain MRA: There is no evidence of significant steno-occlusive lesions or aneurysms.

Output: 1. The orbits appear unremarkable.2. A few scattered foci of T2 hyperintensity in the white matter are nonspecific, but may be related to cluster headaches, for example. No evidence of intracranial hemorrhage, mass, or cerebral edema.3. No evidence of significant cerebrovascular steno-occlusive lesions.


Instruction: Generate impression based on findings.

Input: Reason: Assess for medial meniscal tear; patient is s/p R medial and lateral partial meniscectomies in 11/2013 History: R knee pain, locking symptoms MENISCI: There is blunting of the posterior horn of the medial meniscus as well as irregularity of the undersurface of the posterior horn which extends to involve the body of the meniscus. The anterior horn appears intact. There is globular increased signal abnormality within the anterior horn of the lateral meniscus indicating intrasubstance degeneration. There is blunting of the anterior and posterior horn of the meniscus. No fluid-filled tear is evident.ARTICULAR CARTILAGE AND BONE: Note is made of full-thickness articular cartilage degeneration along the weightbearing portion of the lateral femoral condyle and lateral tibial plateau with underlying subchondral cyst formation within the lateral tibial plateau. There is a full-thickness articular cartilage cleft along the posterior aspect of the lateral tibial plateau (image 11; series 4). There is near full-thickness to full-thickness articular cartilage degeneration along the weightbearing surface of the medial femoral condyle and medial tibial plateau. There is near full-thickness to full-thickness articular cartilage degeneration affecting the patellofemoral articulation. There are tricompartmental osteophytes.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Osteoarthritis of the right knee including tricompartmental full-thickness articular cartilage degeneration as well as an articular cartilage cleft as described above.2. Blunting of the medial and lateral meniscus which likely represents a combination of degeneration, tearing and postsurgical change from prior partial meniscectomy. No fluid-filled tear is evident to confirm a new tear.


Instruction: Generate impression based on findings.

Input: 9-year-old female with swelling of the left calf to muscle and history of AVM. Limited examination with MRA only images of the left lower extremity performed in the region of interest, which demonstrate normal appearance of the distal SFA with normal trifurcation and runoff into the leg. Lesion within the left calf musculature seen on prior exam not as well evaluated due to limited sequences.

Output: Limited examination of left calf musculature lesion on these MRA only images. As discussed, the patient is expected to return free of charge for additional imaging. MRI protocol should be procured from musculoskeletal radiology attending when the patient returns.


Instruction: Generate impression based on findings.

Input: Female, 61 years old, left hip pain. Assess for new herniated disk. Since the prior examination, further compression of the L1 vertebral body has occurred. There is now at least 30% loss of vertebral body height, previously about 15%. Elevated STIR signal within the vertebral body is compatible with edema. The vertebral body is retropulsed to a greater degree than before, and this retropulsion does cause a moderate spinal stenosis and mild impingement of the conus.The remaining vertebral bodies demonstrate preservation of height. There is evidence of degenerative endplate signal change at several levels, but no other areas of concern in marrow replacement or marrow edema are seen. The normal lumbar lordosis is straightened.Except where impinged by the retropulsed vertebral body, the conus and cauda equina are unremarkable.T12-L1: Facet hypertrophy. No significant spinal canal or neuroforaminal stenosis. The L1 vertebral body is retropulsed as above which contributes to a moderate spinal canal stenosis below the level of the T12-L1 disk.L1-2: Facet hypertrophy. No significant spinal canal stenosis. Mild/moderate bilateral foraminal narrowing secondary to L1 compression. No significant interval changes. L2-3: Facet hypertrophy and ligamentum flavum thickening. No significant spinal canal or neuroforaminal stenosis. No significant interval changes. L3-4: Facet hypertrophy and ligamentum flavum thickening. No significant spinal canal or neuroforaminal stenosis. No significant interval changes. L4-5: Facet hypertrophy and ligamentum flavum thickening. Bulging disk asymmetric to the right with a right subarticular zone annular fissure. Effacement of the right lateral recess. Moderate bilateral foraminal narrowing. No significant interval changes. L5-S1: Facet hypertrophy and ligamentum flavum thickening. Mild bulging disk with a right foraminal/far lateral disk osteophyte complex. No significant spinal canal stenosis. Severe right and mild left neuroforaminal narrowing. No significant interval changes.

Output: 1. Progressive collapse of the L1 vertebral body which now shows at least 30% loss of height, previously 15%. There is a greater degree of bony retropulsion which does results in a new mild impingement of the conus.2. Degenerative findings at other levels are not appreciably changed from the prior exam.


Instruction: Generate impression based on findings.

Input: The risks (including, but not limited to, those of bleeding, infection, allergic reaction, temporary nerve block, pain, and inability to access the joint) and benefits of the procedure were explained to the patient, and informed written consent was obtained. A pre-procedural “time-out” form was completed.The patient was placed supine on the fluoroscopy table. The right hip was localized fluoroscopically, and a spot radiograph was obtained. The course of the femoral artery was noted on the patient's skin using an ink marker. The skin was cleansed and covered with a sterile drape. The skin and subcutaneous tissues were anesthetized with 1% lidocaine using 25-gauge and 22-gauge needles.Under fluoroscopic guidance, a 20-gauge spinal needle was advanced into the joint. Attempted aspiration yielded no fluid. Next, 12 ml of a 50/50 mixture of Omnipaque 240 (to confirm the intra-articular position of the needle) and dilute Multihance (0.1 cc in a 10 cc vial of saline, for subsequent MR imaging) were injected into the joint. Contrast opacified the joint in the expected manner. A spot radiograph was obtained for documentation. The needle was withdrawn. Blood loss was negligible (<1cc), and patient tolerated the procedure well without immediate complication. An adhesive bandage was placed on the patient’s skin. Routine post procedure instructions were communicated to the patient. The patient was escorted to the MRI suite for further imaging in stable condition. Please refer to the subsequent MRI report for further information.Exposure time: 41 seconds.

Output: Fluoroscopic guided injection of dilute gadolinium into the right hip for subsequent MRI arthrogram examination.


Instruction: Generate impression based on findings.

Input: 52 year old male with history of ischemic heart disease, hypertension, dyslipidemia and smoking history presenting for cardiac evaluation. MEDICATIONS: enteric coated aspirin, rosuvastatin, carvedilol, prasugrel, ranolazine, lisinopril, fenofibrate First Pass PerfusionDuring hyperemia, there is a large perfusion defect involving the entire inferior and inferolateral walls. Additional the perfusion defect involves the basal inferoseptum. The vast majority of the perfusion defect (except the basal inferoseptum) is also seen during resting conditions and is associated with the below described large transmural myocardial infarction. Viability/ Myocardial ScarThere is a large amount of transmural late gadolinium enhancement noted suggesting prior myocardial infarction with scar in most of the the inferior and inferolateral walls. There is a non-transmural myocardial infarction involving the basal anterolateral wall. All of the territories with transmural myocardial infarction are not likely to be viable. The basal anterolateral wall has an intermediate probability of viability. The remainder of the myocardium is free of myocardial infarction and is likely to be viable.Left VentricleThe left ventricle is normal in size with moderately reduced systolic function. The overall LV ejection fraction is 38%, the LV end diastolic volume index is 98 ml/m2 (normal range: 74+/-15), the LVEDV is 199 ml (normal range 142+/-34), the LV end systolic volume index is 60 ml/m2 (normal range 25+/-9), the LVESV is 123 ml (normal range 47+/-19), the LV mass index is 60 g/m2, and the LV mass is 123 g. There is akinesis of most of the inferior and inferolateral walls. The basal anterolateral wall is mildly hypokinetic.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 56%, the RV end diastolic volume index is 71 ml/m2 (normal range 82+/-16), the RVEDV is 143 ml (normal range 142+/-31), the RV end systolic volume index is 31 ml/m2 (normal range 31+/-9), and the RVESV is 62 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. There is a very large transmural myocardial infarction involving most of the inferior and inferolateral wall and is associated with akinesis. Although there is a corresponding perfusion defect during stress in this territory, it is also present during resting conditions and the territory is unlikely to be viable.2. There is a small perfusion defect during stress noted in the basal infero-septum. There is no associated myocardial infarction in this small segment and it is likely to be viable.3. There is a non-transmural infarction limited to the basal anterolateral wall, this small segment has an intermediate probability of viability. 4. The LAD territory has normal resting wall motion, is free of myocardial infarction and ischemia, and is viable.5. Normal LV size with overall moderately reduced systolic function (LVEF 38%).6. Normal RV size and systolic function (RVEF 56%).


Instruction: Generate impression based on findings.

Input: Male 60 years old Reason: r/o internal derangement History: pain and swelling in the knees, worse on the left. Hx of left Baker's cyst on the left MENISCI: There is extensive intermediate to high signal within the posterior horn of the medial meniscus, which extends to the articular surface consistent with complex/degenerative tearing. The lateral meniscus appears intact, although there are several parameniscal cysts at the origin of the anterior horn of the lateral meniscus, as well as mild fraying along its medial surface.ARTICULAR CARTILAGE AND BONE: There is focal full-thickness cartilage loss along the weightbearing surface of the medial femoral condyle, with adjacent irregular cartilage thinning anterior and posterior to this focal full-thickness defect. There is mild irregularity of the patellar articular cartilage.LIGAMENTS: The anterior cruciate and posterior cruciate ligaments are intact. The medial and lateral collateral ligament complexes are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1.Extensive complex/degenerative tearing of the posterior horn of the medial meniscus.2.Focal full-thickness cartilage loss as well as adjacent cartilage thinning of the weightbearing surface of the medial femoral condyle.3.Small joint effusion and large Baker's cyst.


Instruction: Generate impression based on findings.

Input: Abdominal pain. Evaluate for cholelithiasis. Also follow-up previous pancreatic cystic lesions. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in signal and morphology. No intrahepatic or extrahepatic ductal dilatation. Cholelithiasis without evidence of choledocholithiasis.SPLEEN: No significant abnormality noted.PANCREAS: The pancreas is normal in signal and morphology. There is a nonenhancing simple cyst measuring 11 x 7 mm in the mid pancreatic body, previously 10 x 6 mm, compatible with a sidebranch IPMN.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right renal simple cyst. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: Prominent periportal lymphadenopathy appears similar to prior.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Stable pancreatic cyst compatible with a side branch IPMN.2.Cholelithiasis without evidence of choledocholithiasis or cholecystitis.


Instruction: Generate impression based on findings.

Input: Male, 41 years old, with history of grade II oligodendroglioma, follow-up examination . Sequelae of prior resection are seen with cavities involving the right anterior temporal lobe and the inferior right frontal lobe. Findings related to more recent right frontal approach stereotactic biopsy are also seen.Since the prior examination, significant progression of irregularly marginated enhancement is seen within the right frontal lobe. The lesion now measuring up to 48 x 35 mm in the axial plane, whereas enhancement in this location on the prior examination was subcentimeter in size. This enhancement extends superiorly along the prior frontal lobe biopsy tract.Internally, this lesion demonstrates smudgy susceptibility compatible with blood product along with patchy restricted diffusion. On rCBV mapping, there are scattered patches of elevated blood volume within this large enhancing lesion, though there is an equal proportion of tissue which shows relatively low blood volume. Patchy enhancement is also seen within the right genu of the corpus callosum, within the right insula and inferior frontal gyrus, and along the ependyma of the right ventricular atrium.Along with progressive enhancement, there has been a significant increase in the degree of surrounding FLAIR hyperintensity and generalized regional mass effect. The right lateral ventricle is partially effaced, as are the regional sulci, and there is a new midline shift to the left of approximately 5 mm.No lesions are seen in the left cerebral hemisphere. Likewise, the brainstem and cerebellum are relatively spared. No evidence of brain herniation is seen. No acute intracranial hemorrhage is suspected.

Output: Extensive progressive enhancement, FLAIR signal abnormality and mass effect is seen within the right frontal lobe, above the level of prior resections. Progressive enhancement is also seen within the genu of the corpus callosum, the right insula and inferior frontal lobe, and along the ependyma of the right ventricular atrium. Morphologically, these findings are highly suggestive of progressive tumor. In particular, the discontiguous involvement of the corpus callosum and the progressive ependymal enhancement would be atypical for a treatment related effect. The finding of low blood volume in portions of the dominant frontal lobe lesion would be somewhat at odds with pure progressive tumor, though it could be seen in the context of mixed tumor and treatment effect.


Instruction: Generate impression based on findings.

Input: 48-year-old female with hepatic encephalopathy with decreased level of consciousness. Evaluate for cerebral edema. There is no evidence of intracranial hemorrhage. Bilateral, lateral temporal lobe decreased attenuation consistent with edema which is unchanged when compared with previous brain MRI , 10/7/08.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Stable examination.


Instruction: Generate impression based on findings.

Input: Reason: rule out ligamentous/meniscal injury History: pain after twisting injury MENISCI: The medial and lateral meniscus appear intactARTICULAR CARTILAGE AND BONE: There is increased bone marrow signal abnormality within the medial aspect of the patella and lateral femoral condyle indicating prior transient lateral dislocation of the patella. The medial facet of the femoral trochlea is small relative to the lateral facet. Additionally the femoral trochlea appears shallow superiorly, indicating femoral trochlear dysplasia.LIGAMENTS: The cruciate and collateral ligaments appear intact EXTENSOR MECHANISM: The quadriceps and patellar tendons appear intact. The posterior and mid substance fibers of the MPFL are indistinct with associated increased signal abnormality on fluid sensitive sequences, indicating partial thickness tearing/sprain. Some of the fibers of the MPFL appear intact.ADDITIONAL

Output: 1. Findings consistent with prior transient patellar dislocation and partial thickness tearing/sprain of the MPFL.2. Patella alta, borderline tibial tubercle to trochlear groove distance, femoral trochlear dysplasia, and edema within the superolateral aspect of Hoffa's fat pad can be seen in patellofemoral instability.


Instruction: Generate impression based on findings.

Input: 64-year-old male with cirrhosis, portal hypertension, chronic pancreatitis, autoimmune pancreatitis, evaluate for primary sclerosing cholangitis ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology. No focal liver lesions. Mild hepatic steatosis. The hepatic vasculature are patent. Status post cholecystectomy. Mild prominence of the CBD without stricturing or beading. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple T2 hyperintense renal cysts. No hydronephrosis. T2 hypointense, T1 hyperintense cysts in the interpolar right kidney may represent a hemorrhagic 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.Cirrhotic liver morphology without focal liver lesions. 2.Mild prominence of the CBD without specific findings to raise concern for primary sclerosing cholangitis.


Instruction: Generate impression based on findings.

Input: 71-year-old female with a history of metastatic breast cancer with extensive bony involvement, presenting with severe left shoulder and cervical spine pain. Please evaluate for disease and compression. Exam is limited given an incomplete exam and motion degradation. There is slight reversal of the upper cervical curvature centered at C4-5. There is diffusely abnormal bone marrow signal with relative sparing of the lower half of the C2 vertebral body as well as the C3 and C5 vertebral bodies. In comparison to the counting sequence on the previous thoracic spine MRI, the overall appearance of the cervical marrow appears grossly unchanged likely reflecting treated areas of metastatic disease. There is mild loss of vertebral body height involving the T3 vertebral body but which is unchanged compared to that seen on the T-Spine MRI from 7/6/2016.There is multilevel disc dessication and loss of disc height involving many of the discs, which most prominently involve the C4-5 and C6-7 levels. There are multi-level small disc osteophyte complexes but no high grade spinal canal stenosis. There are multiple areas of neuroforaminal narrowing, with up to bilateral left greater than right moderate to severe C4-5 neural foraminal narrowing and bilateral moderate to severe C6-7 neural foraminal narrowing. There is facet and uncovertebral hypertrophy at multiple levels in the cervical spine, for instance involving the left C4-5 level. Within the limitations of motion degradation, the cervical spinal cord has normal signal characteristics and overall morphology. The vertebral artery flow voids appear to be intact. Again seen is a large lobulated T2 hyperintense cystic structure in the posterior nasopharynx compatible with a mucous retention cyst, which is better seen on the prior head CT. The paraspinous soft tissue structures appear within normal limits.

Output: 1.Full evaluation is complicated by an incomplete exam and motion degradation. Within these limitations, there is a combination of treated metastatic disease in the cervical spine which appears grossly similar to the counting sequence on the prior thoracic MRI. 2.No change in the mild chronic compression fracture involving the T3 vertebral body compared to the recent prior MRI of the thoracic spine from 7/6/2016.3.Multilevel spondylotic changes of the cervical spine without high grade spinal canal stenosis and up to moderate to severe neuroforaminal narrowing involving C4-5 and C6-7 levels as described above.


Instruction: Generate impression based on findings.

Input: Female, 79 years old. Reason: thyroid Ca? History: non-specific L thyroid nodule RIGHT LOBE MEASUREMENTS: 4.4 x 1.7 x 1.8 cmLEFT LOBE MEASUREMENTS: 4.4 x 1.7 x 1.7 cmISTHMUS MEASUREMENTS: 0.2 cmRIGHT LOBE: Heterogeneous echotexture. A nodule in the lower pole measures 1.0 x 0.7 x 1 .0 cm, solid and heterogeneous, well marginated, code, noncalcified, nonvascular.LEFT LOBE: Heterogeneous echotexture. A nodule in the lower pole measures 1.6 x 1.2 x 1 .8 cm, predominantly solid with small cystic component and small echogenic foci, with peripheral vascularity.ISTHMUS: Heterogeneous echotexture. A nodule toward the right aspect of the Isthmus measures 0.8 by 0.9 x 0 .6 cm, heterogeneous and hypoechoic, with mild internal vascularity.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: A right level 3 lymph node measures 1.1 x 0.5 x 0.7 cm, with a fatty hilum. An additional right level 2 a node measures 2.1 x 0.4 x 1 .3 cm, with a fatty hilum. A left cervical lymph node measures 1.2 x 1.8 by 0.4 cm, with a fatty hilum. An additional left cervical lymph node measures 1.2 x 0.6 x 0.8 cm, with a fatty hilum.OTHER: No significant abnormality noted.

Output: Multiple thyroid nodules as detailed above. A left lower pole predominantly solid nodule is amenable to biopsy if clinically warranted.


Instruction: Generate impression based on findings.

Input: Reason: evaluate for ligament injury History: L knee pain Severely limited examination secondary to patient motion artifact. The examination was terminated early due to the patient's inability to tolerate the examination. Due to the patient's body habitus, the dedicated knee coil could not be utilized. A flex coil was utilized instead resulting in suboptimal image quality.MENISCI: Limited evaluation of the menisci due to the aforementioned motion artifact. The lateral meniscus is grossly intact. There is deformity, blunting and increased signal abnormality affecting the posterior horn and body of the medial meniscus indicating complex degenerative tearing.ARTICULAR CARTILAGE AND BONE: There is increased bone marrow signal abnormality within the medial femoral condyle and medial aspect of the tibial plateau which may be degenerative in etiology. There is full-thickness articular cartilage degeneration along the medial tibiofemoral compartment with large areas completely devoid of articular cartilage. There are tricompartmental osteophytes. There is subjective thinning of the lateral compartment articular cartilage. Evaluation of the patellofemoral articulation is limited due to the lack of axial imaging.LIGAMENTS: The cruciate and collateral ligaments appear grossly intact within the limitations of this examination. There is increased signal abnormality within the proximal fibers of the superficial band of the MCL which may represent a mild sprain injury in the correct clinical context.EXTENSOR MECHANISM: The extensor mechanism appears intact. There is thickening and intermediate signal intensity within the distal fibers of the patellar tendon indicating moderate tendinosis.ADDITIONAL

Output: 1. Limited examination. Osteoarthritis of the knee including full-thickness articular cartilage degeneration most pronounced along the medial tibiofemoral compartment. There is degeneration and complex degenerative tearing of the medial meniscus.2. Bone marrow signal abnormality within the medial femoral condyle and medial tibial plateau is likely degenerative in etiology although bone contusions could be considered in the correct clinical context.3. Findings indicating a mild sprain of the superficial band of the MCL as described above.4. Large joint effusion.


Instruction: Generate impression based on findings.

Input: Clinical question: Patient with new symptoms onset of lower extremity weakness; reevaluate for disease progression. Signs and symptoms: Stage IV Melanoma. Pre and post enhanced lumbar MRI:There is normal anatomical alignment of the vertebral column.There is however significant diffuse marrow signal abnormality of the entire visualized osseous structures of the study. On post enhanced images there are numerous varying size foci of enhancement involving the vertebral bodies, pedicles and the posterior elements of the lumbosacral spine corresponding to regions of T2/T2 STIR hyperintensity and consistent with diffuse tumor involvement.There is no evidence of fracture or malalignment. There is also no detectable extraosseous spread of tumor into the dural space or the paravertebral soft tissues.The signal intensity of the lower most visualized cord, conus and the cauda equina is within normal and without abnormal enhancement.There is also small well-demarcated enhancing mass in the pelvis on the left anterior to the left iliac wing measuring 12 x 12.5 mm (axial T2 and axial post enhanced series on image 8).

Output: 1.Diffuse marrow signal abnormality of the entire visualized bony structures of the lumbosacral spine and pelvis with numerous internal varying size foci of enhancement consistent with diffuse metastatic disease. No definitive extraosseous spread of tumor.2.No evidence of leptomeningeal enhancement.3.No evidence of fracture or malalignment.4.Small enhancing mass in the left pelvis anterior to the left iliac wing as mentioned/measured above.


Instruction: Generate impression based on findings.

Input: 20-year-old male with history of testicular cancer. Evaluate retroperitoneal lymph nodes. ABDOMEN:LIVER, BILIARY TRACT: No focal enhancing hepatic lesions. 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: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Nonspecific subcentimeter left periaortic lymph nodes. Reference left periaortic lymph node just inferior to the left renal vein measures 9 x 6 mm, unchanged. Nonspecific subcentimeter gastrohepatic ligament and mesenteric lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Bilateral subcentimeter nonspecific inguinal lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Nonspecific subcentimeter left periaortic lymph node located just inferior to the left renal vein is unchanged.


Instruction: Generate impression based on findings.

Input: Neck pain and bilateral hand burning Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. There is loss of cervical lordosis. There is minimal retrolisthesis of C6 on C7 and minimal anterolisthesis of C7 on T1. Bone marrow signal is within normal limits. There is mild flattening of the cord at the C5-C6 level related to extrinsic mass effect without definite cord signal abnormality. No abnormal enhancement.There is moderate degree of facet arthropathy throughout the cervical spine bilaterally. Additional details regarding cervical spine degenerative changes as below: C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: Small disc osteophyte complex with uncovertebral hypertrophy and bilateral facet arthropathy contribute to mild spinal canal stenosis and moderate bilateral neural foraminal stenosis. C4-5: Small disc osteophyte complex with uncovertebral hypertrophy and bilateral facet arthropathy contribute to mild narrowing of the spinal canal. There is mild to moderate bilateral neural foraminal stenosis.C5-6: There is a disc osteophyte complex, ligamentum flavum thickening, and bilateral facet arthropathy contributing to moderate degree of spinal canal stenosis at this level with mild deformity of the cord, but without definite cord signal abnormality. The disc bulge component primarily contributes to the spinal canal stenosis. There is also mild to moderate bilateral neural foraminal stenosis.C6-7: Small disc osteophyte complex, bilateral uncovertebral hypertrophy, and facet arthropathy. There is mild narrowing of the spinal canal. There is moderate left neural foraminal stenosis and mild to moderate right neural foraminal narrowing.C7-T1: No significant compromise to the spinal canal or right neural foraminal narrowing. Mild left neural foraminal narrowing. There is bilateral facet arthropathy.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: 1. Degenerative changes throughout the cervical spine with moderate spinal canal stenosis at the C5-C6 level. There is no definite cord signal abnormality. 2. There is mild degree of spinal canal stenosis as well as multilevel neural foraminal stenoses as detailed above.


Instruction: Generate impression based on findings.

Input: Clinical question: Presence of intracranial abnormality. Signs and symptoms:somnolent, change in mental status. Unenhanced head CT:Nonspecific periventricular and subcortical foci of low-attenuation is highly suspected of small vessel ischemic disease of indeterminate age. Prior MRI also reveals presence of small muscle ischemic strokes.No evidence of acute intracranial hemorrhage, edema, mass-effect, midline shift or hydrocephalus.CT is insensitive for detection of early acute ischemic strokes.

Output: Small ischemic disease of indeterminate age.


Instruction: Generate impression based on findings.

Input: 49 years Male (DOB:6/9/1966)Reason: stroke evaluation History: L hemisensory / hemiplegiaPROVIDER/ATTENDING NAME: DAVID G BEISER ADIL JAVED The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: Periventricular and subcortical white matter signal changes of a mild degree are present which are nonspecific. They could be vascular related, related to demyelination, trauma, vasculitis, sarcoid. They are nonspecific.


Instruction: Generate impression based on findings.

Input: Ms. Jones-Hansbrough submitted outside mammogram dated 6/30/2014, from Regenstein Breast Imaging Center. She was recently diagnosed with right breast IDC in March 2015. Submitted outside study was compared to multiple recent examinations spanning from 02/18/2015 to 03/18/2015. The breast parenchyma is composed of scattered fibroglandular elements. No suspicious masses, microcalcifications or areas of architectural distortion are present on the submitted prior mammogram dated 06/30/2014.  However, there is development of a new ill-defined mass in the right retroareolar breast on mammogram dated 02/18/2015, which was eventually biopsied with pathology of IDC. Patient has since also had an MRI dated 03/18/2015 that demonstrated unifocal malignancy.

Output: Patient has a known unifocal malignancy in the right breast. She is being followed by surgery. No additional imaging is warranted at this time.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Right knee instability MENISCI: There is complex tearing involving the entirety of the lateral meniscus with only a remnant of the posterior horn noted. There is subluxation into the lateral gutter. The medial meniscus is intact.ARTICULAR CARTILAGE AND BONE: Increased marrow signal is noted in the lateral tibial plateau without evidence of depression. There is associated marrow edema within the anterior aspect of the lateral tibial plateau as well as a portion of the medial femoral condyle. Similar increased marrow signal is noted in the anterior aspect of the medial femoral condyle also without evidence of depression. There is severe articular cartilage loss of the lateral tibial plateau with moderate changes also noted in the femoral condyle. Additionally, there is mild cartilaginous fraying of the patellofemoral compartment (particularly the lateral facet) with associated cystic changes within the patellar articulation.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1.Complex tearing of the lateral meniscus with subluxation into the lateral gutter. The medial meniscus is intact.2.Severe articular cartilage loss of the lateral compartment with milder changes noted in the patellofemoral compartment. There is associated degenerative marrow within the lateral compartment as well as anterior aspect of the tibial plateau.3.Moderate joint effusion.


Instruction: Generate impression based on findings.

Input: 55 years Female (DOB: 5/3/1960)Reason: myelopathy cord signal change? History: R hand numbness, neck painPROVIDER/ATTENDING NAME: JAMES M MOK JAMES M MOK The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is mild reversal of the normal cervical curvature. There is multilevel disc desiccation present. There is a 7 mm extra-axial and intradural nodule present adjacent to the spinal cord at the right lateral aspect of the spinal canal at the C2-3 level.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is a broad-based central disc protrusion which impresses on the ventral aspect of the thecal sac and partially effaces spinal fluid ventral to the spinal cord. Overall there is a mild degree of spinal stenosis resulting at this level. There is no compromise of the exiting nerve roots at this level.At C4-5 there is no significant compromise to the spinal canal. There are some uncovertebral osteophytes and disc material at the lateral recesses which mildly encroach on the exiting nerve roots.At C5-6 there is a disc bulge at this level associated with bilateral uncovertebral osteophytes resulting in effacement of spinal fluid ventral and posterior the spinal cord and overall a mild to moderate degree of spinal stenosis as well as encroachment of the exiting nerve roots.At C6-7 there is a central disc extrusion at this level associated with bilateral uncovertebral osteophytes resulting in effacement of spinal fluid ventral and posterior the spinal cord and overall a moderate degree of spinal stenosis. There is no significant compromise to the exiting nerve roots within the neural foramina at this level.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.There are multilevel degenerative changes present in the cervical spine worse at C5-6 and C6-7 where there is mild to moderate spinal stenosis at C5-6 and moderate spinal stenosis at C6-7 as well as encroachment of the exiting nerve roots within the neural foramina at C5-6. There are degenerative changes present at other levels as well with milder degrees of neural foraminal encroachment.2.There is an extra-axial and intradural well-circumscribed nodule present within the spinal cana at C2-3l. Differential considerations include a schwannoma and less likely meningioma as well as in the appropriate clinical setting metastatic disease. An MRI with contrast would help further evaluate this.3.An email was sent to Dr Mok regarding the above findings.


Instruction: Generate impression based on findings.

Input: history of possible testicular mass on CT. RIGHT TESTIS: The testicular echotexture is homogenous. Blood flow is normal. Right testicle measures 3.4 x 2.6 x 4.2 cm.LEFT TESTIS: The testicular echotexture is homogeneous. Blood flow is normal. The left testicle measures 3.2 x 2.0 x 4.7 cmRIGHT EPIDIDYMIS: The right epididymis measures 0.9 x 0.6 cm.LEFT EPIDIDYMIS: The left epididymis measures 0.6 x 1.2 cm. A left epididymal cyst measuring 0.3 x 0.5 cm is visualized.OTHER: Bilateral small varicoceles.

Output: Bilateral small varicoceles are present. Left-sided epididymal cyst.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Reason: meniscal tear History: knee instability with periodic locking or giving way with minimal activity. MENISCI: Branching signal abnormality within the posterior horn of the lateral meniscus extending to the body of the meniscus indicating a complex tear. This tear consists of a vertical-longitudinal component that extends to the periphery of the posterior horn, contacting the tibial articular surface on multiple consecutive sagittal images. The anterior horn of the lateral meniscus is intact without discrete tear. The medial meniscus is intact without discrete tear.ARTICULAR CARTILAGE AND BONE: We see no articular cartilage defect. Bone marrow signal intensity is within normal limits.LIGAMENTS: The proximal fibers of the anterior cruciate ligament are indistinct, likely representing a full-thickness tear, presumably chronic given the lack of bone contusions. The posterior cruciate ligament is intact. The medial collateral ligament is intact. The lateral collateral ligament complex is intact.EXTENSOR MECHANISM: The extensor mechanism is intact. ADDITIONAL

Output: Chronic ACL tear and complex tear of the lateral meniscus as described above.


Instruction: Generate impression based on findings.

Input: Male, 45 years old, with history of metastatic renal cell cancer and new thoracic spine collapse with neuropathic right chest pain. Assess for cord compression. Complete marrow replacement of the T8 vertebral body is seen with compression resulting in up to 50% loss of vertebral body height anteriorly. There may be minimal retropulsion along with nearly circumferential extraosseous enhancing tumor involvement of the ventral and lateral epidural space, resulting in moderate to severe spinal canal compromise at this level. The spinal cord is mildly deformed by this process but shows minimal if any T2 hyperintensity. The bilateral T8-9 neural foramina are also significantly narrowed secondary to extraosseous tumor spread.The T10 vertebral body is also compressed with approximately 80% loss of vertebral body height. The remaining vertebral bodies show relative preservation of height.Numerous additional marrow replacing lesions are seen throughout the thoracic spine including within T4, T7, T9, minimally at T11 and T12, and within L1. None of these additional lesions is associated with any significant epidural extension or spinal canal compromise.Spinal alignment is otherwise anatomic. Minimal degenerative disc disease is seen. Apart from findings at T8, no additional areas of significant spinal canal or neuroforaminal stenosis are seen.Multiple lung nodules are poorly visualized. Small pleural effusions are noted. A large right renal mass is also visualized.

Output: 1. Diffuse metastatic involvement of the T8 vertebral body with loss of vertebral body height and fairly extensive extraosseous tumor spread into the epidural space. This results in a moderate to severe spinal canal stenosis with deformation of the cord but minimal if any associated cord edema. The T8-9 neural foramina are also compromised by tumor spread. Discussed with Dr. Szmulewitz at 2:00 PM on 8/4/2015.2. A severe compression deformity of T10 is also seen. The remaining vertebral bodies demonstrate relatively preserved heights.3. Multiple additional sites of osseous metastatic disease are seen in the thoracic spine, but none of these is associated with any significant epidural disease spread or spinal canal stenosis.


Instruction: Generate impression based on findings.

Input: Left upper extremity numbness. There is lack of the normal cervical lordosis. No evidence of acute fracture or subluxation. There is an intravertebral disc herniation in the inferior C4 endplate. The vertebral body heights are otherwise preserved. There is indentation upon the anterior spinal cord at C5-6 and C6-7 by posterior disc-osteophyte complexes. However, streaky increased T2 signal within the cord likely represents artifact. The imaged intracranial and paraspinal contents are unremarkable. However, there is a left thyroid nodule that measures up to 20 mm. C2-3: Disc osteophyte complex and uncovertebral joint hypertrophy without spinal canal stenosis or neural foraminal narrowing.C3-4: Disc osteophyte complex and uncovertebral joint hypertrophy without spinal canal stenosis or neuroforaminal narrowing.C4-5: Disc osteophyte complex without spinal canal stenosis or neural foraminal narrowing.C5-6: Disc osteophyte complex and uncovertebral joint hypertrophy with moderate spinal canal stenosis and right neural foraminal narrowing.C6-7: Disc osteophyte complex and uncovertebral joint hypertrophy with moderate spinal canal stenosis and left neural foraminal narrowing.C7-T1: No significant spinal canal stenosis or neural foraminal narrowing.

Output: 1. Degenerative spondylosis of the cervical spine with spinal canal stenosis that is most pronounced at C5-6 and C6-7 and neural foraminal narrowing worst at left C6-7.2. A nonspecific left thyroid nodule that measures up to 20 mm. A thyroid ultrasound may be useful for further evaluation.


Instruction: Generate impression based on findings.

Input: 50-year-old female with abdominal distention, hypoxia, pleural effusion. Please mark area for paracentesis and thoracentesis. LIVER: The IVC and hepatic veins are distended. Mild perihepatic ascites. Stable central cystic lesion as seen on the 9/16/2016 MRI abdomen exam.BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. OTHER: Small right pleural effusion. Mild ascites in the right lower quadrant and left lower quadrant. Trace perihepatic ascites.

Output: Small right pleural effusion and mild ascites.


Instruction: Generate impression based on findings.

Input: Diagnosis: Secondary malignant neoplasm of brainClinical question: eval for intracranial cause for AMS, metastatic esophageal SCCSigns and Symptoms: non-participatory with exam, obtunded stateComments: Stereotactic radiosurgery 2014, but many previous MRI brain as early as this year Foci of diffusion restriction are present along the globus pallidus bilaterally as well as in the periventricular and subcortical white matter as well as the left cerebellar hemisphere. There is a new focus of diffusion restriction present adjacent ot the deep gray nuclei of the right cerebellar hemisphere. It is located immediately anterior to the location of a previously treated ring-enhancing lesion associated with some susceptibility effect. The appearance of the previously treated lesion remains stableThere is a focus of abnormal heterogeneous signal present along the left cuneus and precuneus associated with susceptibility effect and an adjacent burr hole where there is previously a metastatic lesion. There are associated T2 and FLAIR signal hyperintensity in the adjacent white matter. There is no associated asymmetric ex vacuo effect present. Compared to the prior exam from 9/11/2015 there is not appear to be a substantial change.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.There are multiple subcentimeter infarcts present in the globus pallidus bilaterally and right cerebellar hemisphere associated with punctate periventricular and subcutaneous cortical microinfarcts and microinfarction the left cerebellar hemisphere.2.A hemorrhagic lesion is present in the left cuneus and precuneus. The possibility that there is recurrent tumor cannot be excluded. Another possibility is that this could represent radiation necrosis. Please note that no post contrast imaging was performed.3.A right cerebellar hemisphere lesion is unchanged since the prior exam and also likely represents previously treated metastasis.


Instruction: Generate impression based on findings.

Input: Diagnosis: Type 2 diabetes mellitus with unspecified diabetic retinopathy without macular edema Other symptoms and signs involving the musculoskeletal systemClinical question: r/o lumbosacral disc diseaseSigns and Symptoms: right leg weakness 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 disc desiccation and diffuse disc bulge at this level associated with bilateral facet and ligamentum flavum hypertrophy. Fluid is identified within the facet joints. There is partial effacement of the fat at the lateral recess bilaterally at this level with mild encroachment of the nerve roots of the lateral recess. There is narrowing of the neural foramina bilaterally with effacement of the fat surrounding the left-sided exiting nerve roots and partial effacement of the fat surrounding the right-sided exiting nerve roots.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is loss of disc space height this desiccation and diffuse disc bulge at this level associated with ligamentum flavum hypertrophy and partial effacement of the fat at the lateral recess bilaterally. The exiting nerve roots of the neural foramina are surrounded by fat.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is disc desiccation, diffuse disc bulge and endplate reactive change at this level associated with mild ligamentum flavum hypertrophy. There is mild narrowing of the neural foramina at this level. The endplate reactive changes are predominantly high signal on T1 with a mixture of T2 signal hyperintensity.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: There are multilevel degenerative changes present lumbar spine with encroachment of the nerve roots within the left neural foramen at L5-S1.


Instruction: Generate impression based on findings.

Input: 42-year-old female with history of immature teratoma with new ascites and pelvic cystic mass suspicious for inclusion cyst versus ovarian neoplasm. PELVIS:UTERUS, ADNEXA: Multiple uterine fibroids. Intermediate signal T2 lesion protruding into the left endometrial canal in the lower uterine segment (series 801/34) has signal characteristics that would be atypical for a fibroid, and as a result, endometrial polyp or neoplasm cannot be excluded.Small amount of endometrial fluid, most likely physiologic.The left ovary is not well-visualized, most likely due to surgical removal. In the expected location of the left ovary there is a tubular cystic structure similar in appearance and size to both prior CT exams, most compatible with residual hydrosalpinx.The right ovary is not well visualized. In the expected location of the right ovary, there is a multiloculated cystic lesion with thin wall without significant enhancement, mural nodularity, or solid components. The largest component posterior to the uterus measures up to 5.7 x 10.1 cm.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small amount of pelvic ascites.

Output: 1. Large multiloculated cystic lesion without features suspicious for malignancy, which could be due to benign etiology such an inclusion cyst, as clinically questioned and particularly given that a normal right ovary was visualized on prior outside ultrasound. However, a normal right ovary is not visualized on the current MRI, and as a result, this examination alone cannot exclude ovarian neoplasm such as serous cystadenoma.2. Multiple uterine fibroids. A lesion protruding into the endometrial canal may be a subendometrial fibroid, but endometrial polyp or neoplasm cannot be excluded, as detailed above. Endometrial sampling and biopsy can be performed as clinically indicated.


Instruction: Generate impression based on findings.

Input: Ms. Cohen is a 45 year old female with a personal history of right breast lumpectomy for IDC and axillary lymph node dissection, status post radiation and chemotherapy in 2002. History of left breast reduction and right breast reconstruction in July 2013 and additional right breast reconstruction surgery in the summer 2015. History of MRI guided biopsy of a central right breast enhancing lesion in 2004 with pathology result of fibrotic breast parenchyma. There is heterogeneous amount of fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.Stable postsurgical changes are identified in the right lower inner breast, at site of prior lumpectomy. There is a stable enhancing 10 x 5 x 8 mm lesion (AP x LR X CC) at 12 o'clock in the right breast, mid depth, with a biopsy clip artifact, corresponding to the previously biopsied benign lesion. There is no abnormal enhancement seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.

Output: Stable postsurgical changes of the right breast. No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: Clinical question: History of ET and Parkinson's. Signs and symptoms: Preop planning for DBS. Pre- and post enhanced brain MRI:Examination is performed utilizing surgical planning protocol which is a limited and not a true diagnostic study.Examination demonstrate a slight generalized prominence of cortical sulci and the lateral ventricles for patient stated age without significant change since prior exam. Patchy foci of periventricular and subcortical low-attenuation white matter and suggestive of small vessel ischemic strokes are noted. Post enhanced images demonstrate previously known a small mental venous anomaly in the left basal ganglia and left insular cortex. No detectable abnormal parenchymal or leptomeningeal enhancement. Unremarkable signal intensity of the calvarium, paranasal sinuses and mastoid air cells and unremarkable images through the orbits.

Output: 1.Findings suggestive of chronic small vessel ischemic strokes.2.Generalized prominence of cortical sulci and supratentorial ventricular system for age.3.Small left basal ganglia/left insular cortex developmental venous anomaly.


Instruction: Generate impression based on findings.

Input: 50 year-old female status post craniotomy for meningioma. Postoperative changes status post bifrontal craniotomy, with pneumocephalus, surgical hardware, and skin staples evident. Previously described partially calcified lesions along the anterior interhemispheric fissure just right of midline and along the high left frontal convexity are unchanged. There is marked low attenuation within the frontal lobes, right greater than left, corresponding to edema seen on MRI. The previously described area of focal low attenuation in the medial left frontal lobe appears increased compared with the prior study, concerning for ischemia. Punctate high attenuation in the medial left frontal lobe may represent a calcification or hemorrhage, though thrombus within the anterior cerebral artery may have this appearance.A small curvilinear focus of high attenuation is seen in the medial right frontal lobe inferior to the partially calcified lesion, which may represent a small focus of hemorrhage, unchanged from the prior study. The degree of leftward midline shift and ventricular volumes are unchanged. The remainder of the cerebral and cerebellar hemispheres and brainstem demonstrate normal morphology and attenuation. Postoperative changes affect the frontal bones, with the remainder of the calvarium and osseous structures appearing intact. There is partial opacification of the left anterior ethmoid air cells, with the remainder the visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. Continued evolution of focal low attenuation in the medial left frontal lobe, suspicious for anterior cerebral artery territory or venous infarction.2. Extensive postoperative changes with residual tumor and mass effect unchanged.


Instruction: Generate impression based on findings.

Input: VHL and history of multiple hemangioblastoma; evaluate for growth and new lesions History: 54 yo female with VHL and history of multiple hemangioblastoma; evaluate for growth and new lesions. There is evidence of posterior element resection at most levels of the cervical spine. There is no evidence of spinal cord lesions. The cervical lordosis is mildly straightened. The vertebral body heights are preserved. Level specific findings are as follows:C2-3: There is no spinal canal stenosis or neural foraminal narrowing. C3-4: There is a small posterior disk osteophyte, but no significant spinal canal stenosis or neural foraminal narrowing.C4-5: There is a small posterior disk osteophyte, but no significant spinal canal stenosis or neural foraminal narrowing.C5-6: There is posterior disk osteophyte formation along with ligamentum flavum thickening, which results in a moderate spinal canal stenosis, as well as severe left and moderate right neural foraminal narrowing. C6-7: There is left facet hypertrophy and a small posterior disk osteophyte, but no significant spinal canal stenosis. However, there is moderate left and mild right neural foraminal narrowing. C7-T1: There is no significant spinal canal stenosis or neural foraminal narrowing. Thoracic spine: The thoracic kyphosis is mildly exaggerated at T12 secondary to mild vertebral body wedging without change. The bone marrow signal is unremarkable. There is no definite evidence of any spinal cord signal abnormality. There is a small central disk protrusion at T8-9 along with a left paracentral protrusion at T11-12. There is no significant spinal canal or neuroforaminal stenosis. There are innumerable bilateral renal and pancreatic cystic lesions, some of which contain heterogeneous material and/or fluid-fluid levels. The findings appear similar to those seen on the prior examination, though this examination is not adequate for assessment of individual lesions.

Output: 1. Degenerative spondylosis at multiple levels of the spine, but bi definite evidence of hemangioblastomas in the imaged spinal cord, although the lack of intravenous contrast limits evaluation.2. Innumerable bilateral renal and pancreatic cystic lesions are compatible with stigmata of VHL.