Instruction: Generate impression based on findings.

Input: 45-year-old man with history of pancreatic cancer status post Whipple procedure, complicated by abscess formation, status post IR drainage. Please note that this examination was slightly limited as the patient was unable to tolerate the entire examination.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted. There is no significant intrahepatic biliary duct dilatation and the biliary-enteric anastomosis is intact.SPLEEN: The spleen is normal.PANCREAS: The patient is status post Whipple and, adjacent to the biliary-enteric anastomosis, there is a fluid collection with small foci of gas and layering debris now measuring 123 x 67 mm, previously 173 x 122 mm (series 5, image 37). There is no significant enhancement. A drainage catheter is noted within this collection.ADRENAL GLANDS: The adrenal glands are normal.KIDNEYS, URETERS: Kidneys are normal in enhancement symmetrically.RETROPERITONEUM, LYMPH NODES: There are mildly prominent portocaval lymph nodes but no significant lymphadenopathy noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Anterior and lateral abdominal wall soft tissue edema is noted.OTHER: There are additional smaller sites of loculated fluid in the mesentery and right lower quadrant more inferiorly.

Output: Discrete, drained fluid collection adjacent to the biliary enteric anastomosis suspicious for bile leak. If confirmation of biliary leak is clinically warranted, HIDA scan should be considered. Additional smaller mesenteric and right lower quadrant collections seen more inferiorly.


Instruction: Generate impression based on findings.

Input: Reason: Hx of HCC post-resection History: hx of HCC ABDOMEN:LIVER, BILIARY TRACT: Postsurgical changes of a liver transplant. Portal and hepatic veins are patent. The hepatic artery is patent. Small saccular aneurysm at the hepatic artery anastomosis is not significantly changed, measuring 0.7 x 0.5 centimeters (series 11 image 48). No intrahepatic or extra hepatic biliary ductal dilatation. No focal hepatic lesion.SPLEEN: Mild splenomegaly, measuring 14.2 cm (series 9 image 21), unchanged. No focal splenic lesion.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Postsurgical changes of a liver transplant.2.Stable focal hepatic artery secondary aneurysm at the arterial anastomosis.3.No new or suspicious focal hepatic lesions.


Instruction: Generate impression based on findings.

Input: Reason: history of R shoulder dislocation x2, assess for labral pathology Posterior indentation of the right humeral head represents a Hill-Sachs deformity. No fracture or malalignment.ROTATOR CUFF: No significant abnormality noted.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is a fracture of the anteroinferior glenoid with detachment of the labrum, representing an osseous Bankart lesion, with loss of approximately 1.5 cm of bone in the craniocaudal dimension. Intra-articular loose bodies are seen within the axillary recess.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: Findings consistent with osseous Bankart lesion and Hill-Sachs deformity, including a fracture of the anteroinferior glenoid with detachment and intra-articular loose bodies.


Instruction: Generate impression based on findings.

Input: Male, 57 years old, with brain metastases, on new therapy, surveillance exam. Numerous supratentorial and infratentorial enhancing lesions are redemonstrated. Since the prior exam, most of these lesions have decreased in size by several millimeters. For example, a left insular lesion now measures up to 6 mm, previously 8 mm. The large right parietal-occipital lesion has changed in shape, which may reflect collapse of the necrotic components, and despite appearing more elongated in the axial plane, has probably also decreased in size. The edema surrounding this lesion, and several others, has significantly increased, however. The right ventricular atrium is progressively effaced. There is a mild leftward midline shift, but no brain herniation. No new or growing lesions are seen. Evidence of prior right frontal instrumentation is seen. A small scalp lipoma is unchanged.

Output: Interval decrease in size of most of the numerous brain metastases is seen. A few lesions are unchanged in size, but there are no new or growing lesions. Several lesions, including the dominant right parieto-occipital lesion, show progressive edema which is favored to be a treatment effect.


Instruction: Generate impression based on findings.

Input: Metastatic cervical cancer on systemic therapy, evaluate for persistent disease, history of bilateral hydronephrosis status post ureteral stent placement ABDOMEN:LUNG BASES: Bilateral breast prostheses.LIVER, BILIARY TRACT: Gallbladder sludge.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable asymmetrically atrophic right kidney. Moderate left-sided and mild right sided hydronephroureter, increased from earlier study. Left-sided nephroureteral stent and right sided nephroureteral stent, left-sided stent located at level of ureteropelvic junction. Ureteral wall thickening seen bilaterally.RETROPERITONEUM, LYMPH NODES: No pathologically enlarged adenopathy. BOWEL, MESENTERY: Mild to moderate circumferential rectal wall thickening. PELVIS:UTERUS, ADNEXA: Status post hysterectomy. No enhancing soft tissue signal seen at level of postoperative bed. Stable lobulated right adnexal T2 hyperintense lesion encasing the right ureter. Structure essentially unchanged accounting for differences in technique, structure measures approximately 2.6 x 2.4 cm, image 39 series 1301, may represent a lymphocele related to prior nodal dissection.BLADDER: Bilateral nephroureteral stents seen extending into underdistended bladder. BONES, SOFT TISSUES: Scattered foci of susceptibility artifact in pelvis and ventral abdomen, likely postprocedural in etiology.

Output: 1. Mild to moderate rectal wall thickening, may be posttreatment related but correlation with patient's clinical history recommended to exclude proctitis.2. Moderate left-sided and mild right sided hydronephroureter, increased from earlier study. Bilateral ureteral stents present, ureteral wall thickening seen bilaterally.3. Stable lobulated right adnexal T2 hyperintense lesion encasing the right ureter. Structure essentially unchanged accounting for differences in technique, structure measures approximately 2.6 x 2.4 cm, may represent a lymphocele related to prior nodal dissection.


Instruction: Generate impression based on findings.

Input: Possible aneurysm, cavernous malformation or tumor. The patient has ataxia, falls, headaches and MRI abnormality at OSH. Right sided weakness. MRI of the brainNo diffusion weighted abnormalities are appreciated.There is a 42x34x34 mm premedullary and prepontine mass (partially thrombosed aneurysm) with heterogenous signal on T1 and T2 associated with flow voids. Much of the signal is hyperintense on T1WI.The brainstem is displaced and compressed posteriorly by the mass and drapes over the mass. The inferior aspect of the 4th ventricle is narrowed and the foramina of Luschka are distorted. There is mixed signal along the periphery of the mass on SWI phase imaging with some bright signal and some dark signal some of which is opposite in signal on the corresponding magnitude SWI images (suggesting peripheral calcification). The vertebral arteries and basilar artery are contiguous with this mass.A similar signal characteristic well-circumscribe mass is present in the left upper carotid space measuring 16x21x24mm.The temporal horns of the lateral ventricles are dilated. Overall there is mild enlargement of the third ventricle (10 mm width) and lateral ventricles (41mm biventricular diameter at the level of foramina of Monro).There are several supratentorial periventricular and subcortical white matter T2 and FLAIR hyperintense lesions.Normal vascular flow voids are present in 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.MRA brain:There is a partially thrombosed 42x34x34 mm giant aneurysm at the distal left vertebral artery and vertebrobasilar junction. The LVA ends in the aneurysm. The RVA is contiguous with the aneurysm distally and at the V-B junction.There is extracranial origin of the right and left PICAs.There is a 16x21x24mm pseudoaneurysm along the left cervical internal carotid artery at the C1 vertebral body level along the lateral aspect of the left ICAAntegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.The anterior communicating artery is identified and is small in size. The posterior communicating arteries are intact and small.

Output: 1.Partially and subacutely thrombosed giant vertebrobasilar aneurysm with calcified wall associated with mass effect on the brain stem and 4th ventricle and mild ventriculomegaly. This aneurysm primarily involves the left vertebral artery but also involves the medial aspect of the distal right vertebral artery. The PICAs have extracranial origin and are well proximal to the aneurysm. PCOMAs appear to be small. Origin of medullary perforators and anterior spinal arteries are not readily appreciated. Conventional angiography may help further assess for these vessel origins.2.Large pseudoaneurysm along the distal left cervical ICA.3.Findings were discussed with Dr Awad.


Instruction: Generate impression based on findings.

Input: Pseudotumor evaluation The evaluation of the pelvis/hips is limited by the presence of bilateral hip arthroplasties.Within the limits of the exam, there is no abnormal mass or signal surrounding the hip arthroplasties to suggest the presence of pseudotumor. There is a mild amount of signal along the right greater trochanter which may reflect mild bursitis or may be clinically insignificant. Otherwise there is no abnormal fluid collection surrounding the the hip arthroplasties. The bone marrow and muscle signal within the femoral neck and proximal femur is normal.

Output: Bilateral total hip arthroplasties without evidence of surrounding abnormal signal, mass, or fluid collection.


Instruction: Generate impression based on findings.

Input: Possible left submandibular gland sialadenitis. Per EPIC: enlarged left submandibular gland x 6 months. The gland increases in size with eating and then goes down in about 15 minutes. He states that there is a feeling of pressure when the gland enlarges but not much pain. There is some tenderness related to increase in pressure when the gland enlarges. The left submandibular gland is not particularly enlarged and does not appear to be inflamed. There is no evidence of salivary ductal dilatation. The right submandibular and bilateral parotid glands are unremarkable. There is no evidence of measurable mass lesions or significant cervical lymphadenopathy based on size criteria. The thyroid gland appears to be unremarkable. There are small bilateral maxillary sinus retention cysts. The orbits are unremarkable. There is a nonspecific partially empty sella. There is multilevel degenerative cervical spondylosis with mild indentation of the spinal cord by disc-osteophyte complexes at C4 through C7.

Output: No evidence of left submandibular gland sialadenitis.


Instruction: Generate impression based on findings.

Input: Decreased smell and taste; UPSIT showed severe microsmia. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The olfactory bulbs and olfactory sulci appear to be unremarkable. There are bilateral paradoxical middle turbinates, but the nasal cavity and paranasal sinuses are otherwise intact. There are mild scattered foci of T2 hyperintensity in the cerebral 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 orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: The olfactory bulbs, olfactory sulci, and nasal cavity appear to be intact, without evidence of intracranial hemorrhage, mass, or acute infarct. Mild scattered foci of T2 hyperintensity in the cerebral white matter are nonspecific, but may represent chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: Mid-back pain, with question of a dural AV fistula found incidentally after CT abdomen for diarrhea and abdominal pain. Dural AVF seen on outside MRI in May, 2015. Please compare to outside MRI and evaluate. MRI C-spine:Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained. Bone marrow signal is within normal limits. The cervical spinal cord has normal signal characteristics and overall morphology.Degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: No significant compromise to the spinal canal or neural foramina.C4-5: No significant compromise to the spinal canal or neural foramina.C5-6: Disc osteophyte complex and uncovertebral hypertrophy causes mild right neuroforaminal stenosis. There is no significant left neuroforaminal or central canal stenosis.C6-7: Mild disc osteophyte complex and uncovertebral hypertrophy with mild left neuroforaminal stenosis. There is no significant right neuroforaminal or central canal stenosis.C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.MRI T-spine:Coursing along the anterior and posterior aspect of the lower thoracic spine spinal cord mostly between the T10-11 and T11-12 levels is a enhancing vascular structure partially surrounds the left hemicord at the T10-11 level. This vascular structure appears to enter the spinal canal at the right L1-L2 neural foramen and is suspicious for an AV fistula.The thoracic spine is in normal alignment. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber. There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the thoracic spine.

Output: 1.Findings are suspicious for an AV fistula involving the lower thoracic cord, predominately at T10-11 and T11-12 levels. There are no significant cord signal changes appreciated to suggest cord edema. Spinal arteriogram may be of benefit if clinically appropriate.2.There are mild degenerative changes in the cervical spine.


Instruction: Generate impression based on findings.

Input: The ventricles and sulci are within normal limits. The basal cisterns remain patent. There is no midline shift or mass effect. There are no areas of abnormal signal. There is no diffusion abnormality. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. Prominent mucosal thickening of the maxillary sinuses is demonstrated.

Output: 1. Unremarkable noncontrast MRI of the head. Of note, the postcontrast portion of the examination was inadvertently not performed. If post contrast images remain clinically warranted as leptomeningeal enhancement cannot be excluded on this exam, postcontrast imaging can be rescheduled.2. Maxillary sinus mucosal thickening. Please correlate clinically.


Instruction: Generate impression based on findings.

Input: 57-year-old male kidney donor. Evaluate cystic lesion described on CT scan dated 6/2014. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Simple exophytic cyst along the inferior pole of the left kidney, appearing similar to the prior study when allowing for differences in technique. A subcentimeter focus of fluid signal intensity in the inferior pole of the left kidney is too small to characterize, but likely represents a simple cyst. No other focal mass lesions are identified.RETROPERITONEUM, LYMPH NODES: No evidence of lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Simple cyst in the left kidney, without evidence of suspicious mass lesion.


Instruction: Generate impression based on findings.

Input: T1N0M0 polymorphous low grade adenocarcinoma of the soft palate s/p excision with positive margins in May 2016. There are postoperative findings in the soft palate region, but no evidence of gross measurable mass lesions or significant cervical lymphadenopathy based on size criteria. The thyroid and major salivary glands are unremarkable. There is multilevel degenerative spondylosis of the imaged portions of the cervical spine. The imaged intracranial structures are unremarkable.

Output: Postoperative findings in the soft palate region, but no evidence of gross measurable mass lesions or significant cervical lymphadenopathy.


Instruction: Generate impression based on findings.

Input: 31-year-old with severe headache and dizziness. Please evaluate for intracranial hemorrhage. There is no evidence of intracranial hemorrhage, mass, or edema. Subtle periventricular white matter hypoattenuation most prominent in the posterior parietal lobes that is of uncertain significance.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. Small left sphenoid retention cyst, otherwise the visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1.No acute intracranial abnormality.2.Subtle periventricular white matter hypoattenuation most prominent in the posterior parietal lobes. This is of uncertain significance and is still within normal limits, however if patient symptoms persist, MR can be obtained to rule out white matter disease.


Instruction: Generate impression based on findings.

Input: Female 53 years old Reason: eval cord pathology including myelitis, demyelination, mass lesions, etc History: weakness, neurogenic bladder Postsurgical change lower lumbar spine with pedicle screws and lumbar fusion. The right S1 pedicle screw traverses close to the right S1 foramina. Postsurgical changes from bilateral total hip arthroplasties. There is mild red marrow recruitment involving the osseous structures of the pelvis. No suspicious sclerotic or lytic lesions. Imaged thecal sac within the pelvis is unremarkable.Mild age-related muscle atrophy. No pelvic lymphadenopathy.Urinary bladder is decompressed by Foley catheter.

Output: Etiology for the patient's urinary incontinence is not evident on the current exam of the pelvis.


Instruction: Generate impression based on findings.

Input: 80-year-old male with pain and weakness. Evaluate rotator cuff. ROTATOR CUFF: There is a full-thickness complete (or near-complete) tear of the supraspinatus tendon with retraction of the tendon to the top of the humeral head. The retracted tendon is thickened which may reflect tendinosis and delamination. There is mild fatty atrophy along the myotendinous junction, otherwise the supraspinatus muscle is within normal limits. There is increased signal intensity within the infraspinatus tendon at its insertion on the greater tuberosity suggesting tendinosis and perhaps mild concealed interstitial tearing with cyst formation in the underlying humeral head. There is fatty infiltration along the myotendinous junction of the infraspinatus muscle which otherwise appears normal. The teres minor tendon and muscle are normal in appearance. There is insertional tearing of the superior fibers of the subscapularis tendon with mild retraction. There is thickening and increased signal intensity of the remaining subscapularis tendon indicating tendinosis and additional undersurface tearing. There is mild fatty atrophy of the subscapularis muscle along the myotendinous junction.SUPRASPINATUS OUTLET: Mild osteoarthritis affects the acromioclavicular joint. There is a small amount of fluid within the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Mild to moderate osteoarthritis affects the glenohumeral joint. Blunting and heterogeneous signal of the glenoid labrum is consistent with degeneration and chronic tearing. There is a small glenohumeral joint effusion and perhaps a small amount of fluid within the subcoracoid bursa as well. The glenohumeral joint alignment is within normal limits.BICEPS TENDON: There is medial subluxation/dislocation of the tendon of the long head of the biceps from the bicipital groove. The tendon itself is abnormally thinned with irregular margins, indicating extensive partial thickness tearing. There is distention of the biceps tendon sheath with fluid which may representing tenosynovitis or extension of fluid from the glenohumeral joint.ADDITIONAL

Output: 1. Complete retracted tear of the supraspinatus tendon.2. Insertional tear of the superior fibers of the subscapularis tendon with medial subluxation/dislocation and tearing of the long head of the biceps tendon.3. Osteoarthritis of the glenohumeral and acromioclavicular joints.


Instruction: Generate impression based on findings.

Input: Female 17 years old Reason: concern for ACL tear History: effusion, instability in knee MENISCI: The menisci are intact.ARTICULAR CARTILAGE AND BONE: There is edema within the lateral tibial plateau posteriorly as well as within the lateral femoral condyle anteriorly above the anterior horn of the lateral meniscus. There is slight depression of the anterior surface of the lateral femoral condyle above the anterior horn of the lateral meniscus, likely representing impaction fracture sustained at the time of injury. There is edema in the far medial femoral condyle. The cartilage is intact.LIGAMENTS: There is rupture of the anterior cruciate ligament through its mid to proximal fibers. The PCL, MCL, and LCL complex are intact. No edema is present within the posterior lateral corner. EXTENSOR MECHANISM: Extensor mechanism is intact.ADDITIONAL

Output: 1.Anterior cruciate ligament tear.2.Edema in Hoffa's fat pad superolaterally may reflect patellofemoral tracking abnormality.


Instruction: Generate impression based on findings.

Input: Pilocytic astrocytoma, increased seizure frequency. There are postoperative findings relate to prior right transparietal biopsy. There is no significant change in the non-enhancing T2 hyperintense mass that measures up to 22 mm involving the right medial temporal lobe. There is associated mild mass effect upon the right anterior midbrain and basal vein of Rosenthal. The ventricles are normal in size. There is no evidence of intracranial hemorrhage or acute infarct. The flow-voids of the major cerebral arteries appear to be intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are unchanged.

Output: No significant interval change in the right medial temporal lobe low-grade glioma.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, 75 years old, with right foot drop and previous right L5-S1 microdiscectomy. Assess for stenosis. Sagittal alignment is anatomic. Vertebral body height and morphology are unremarkable. No worrisome marrow signal replacement or marrow edema is seen.The visualized spinal cord and conus are unremarkable. The cauda equina as discussed below.T12-L1: Right paracentral annular fissure. No significant disc herniation, spinal canal stenosis or neuroforaminal narrowing. No interval changes.L1-2: Mild facet hypertrophy and ligamentum flavum thickening. Mild bulging disc, stable to slightly improved. No significant spinal canal stenosis or neuroforaminal narrowing. No other interval changes. L2-3: Moderate facet hypertrophy and ligamentum flavum thickening. Bulging disc with a new right paracentral protrusion. Findings contribute to produce a new moderate spinal canal stenosis with crowding of the cauda equina nerve roots. No significant foraminal narrowing. L3-4: Severe facet hypertrophy and ligamentum flavum thickening. Bulging disc with central protrusion, progressed from prior. Findings contribute to produce a worsened moderate to severe spinal canal stenosis with crowding of the cauda equina. No significant foraminal narrowing. L4-5: Severe facet hypertrophy and ligamentum flavum thickening. Mild bulging disc with central and left far lateral annular fissuring. A central disc protrusion seen on the prior examination has improved. A moderate spinal canal stenosis is seen with minimal crowding of the cauda equina, improved from prior. Mild bilateral foraminal narrowing, unchanged. L5-S1: Moderate facet hypertrophy. Minimal bulging disc. No significant spinal canal stenosis. Mild bilateral foraminal narrowing. No interval changes. Linear T1 hyperintensity along the endplates may reflect sequelae of prior microdiscectomy, though no other definite surgical findings are seen at this level.

Output: 1.New right paracentral disc protrusion at L2-3, along with posterior element hypertrophy, contribute to interval worsening of a moderate spinal canal stenosis.2.Progressive disc bulge and central disc protrusion at L3-4, along with posterior element hypertrophy, contribute to interval worsening of a moderate to severe spinal canal stenosis.3.Interval resolution of a central disc protrusion seen previously at L4-5 with improvement of moderate spinal canal stenosis.


Instruction: Generate impression based on findings.

Input: 58-year-old male with right shoulder pain for 2 weeks. ROTATOR CUFF: There is increased signal intensity within the supraspinatus at its insertion, indicating a tear that disrupts the bursal surface fibers and results in minimal retraction of these fibers. The tear appears to involve just over 50% of the tendon width, but the articular surface fibers appear intact. This tear appears to extend posteriorly to involve the anterior fibers of the infraspinatus and measures approximately 1.5 cm in the AP dimension. There is intermediate signal intensity within the supraspinatus indicating mild tendinosis. The supraspinatus and infraspinatus muscles appear intact. There is moderate fatty atrophy of the teres minor muscle although the tendon appears intact. There is focal fatty atrophy along the myotendinous junction of the subscapularis, but the tendon appears intact. The subscapularis muscle otherwise appears normal.SUPRASPINATUS OUTLET: Mild osteoarthritis affects the acromioclavicular joint. No frank fluid is identified within the subacromial subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is anatomic. We see no fluid-filled labral tear, although there is mild increased signal within the superior labrum which may reflect degeneration.BICEPS TENDON: The tendon of the long head of the biceps appears intact.

Output: 1. Insertional tear of the distal supraspinatus/infraspinatus tendons involving the bursal surface fibers as described above.2. Fatty atrophy of the teres minor with a normal-appearing tendon.3. Acromioclavicular joint osteoarthritis and other findings as described above.


Instruction: Generate impression based on findings.

Input: 57-year-old male with history of adenocarcinoma, evaluate for metastatic lesions There is a 2.4 x 1.7 cm T2 bright enhancing lesion in left ilium, consistent with a metastatic focus. The overlying cortex is intact and there is no evidence of fracture. Additional small enhancing foci are noted within the right ilium and right femoral head consistent with additional metastatic lesions. Alignment is anatomic. The prostate is enlarged.

Output: Left iliac lesion as described above, consistent with metastatic disease, as well as additional subcentimeter foci of metastatic disease. No fracture is evident.


Instruction: Generate impression based on findings.

Input: 55 year-old female with flank pain. RIGHT KIDNEY: The right kidney measures 9 cm in length without hydronephrosis, or shadowing nephrolithiasis. There is a 2.1 x 1.6 x 2.0 cm lobulated cyst with a possible thin septation compatible with a minimally complex cyst, stable in size since the 2012 MRI at which point there were no discrete solid components. More inferiorly is a 1.5 x 1.6 x 1.4 cm simple cyst.LEFT KIDNEY: The left kidney measures 10.4 cm without hydronephrosis, shadowing nephrolithiasis, or discrete lesion evident.URINARY BLADDER: No significant abnormalities noted.OTHER: No significant abnormalities noted.

Output: No hydronephrosis or shadowing nephrolithiasis. Simple and minimally complex right renal cysts, stable since 2012 MRI.


Instruction: Generate impression based on findings.

Input: History of heart transplant in 2007. Multiple pancreatic cysts. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology, size and signal intensity without a focal lesion. No intrahepatic biliary ductal dilatation.Normally distended gallbladder with multiple small gallstones without evidence of acute inflammation.SPLEEN: No significant abnormality noted.PANCREAS: The uncinate process cystic lesion measures approximately 2.6 x 2.1 cm (series 4/35) compared to 2.3 x 2.2 cm previously. No mural nodularity or definite communication with the main pancreatic duct.The previously referenced cystic lesion in the pancreatic head measures approximately 1.5 x 1.1 cm (series 3/112), compared to 1.4 x 1.1 cm previously.The previously referenced pancreatic body cystic lesion measures 1.0 x 1.0 cm (series 3/88) compared to 1.1 x 0.8 cm previously. Additional smaller cystic lesions are not significantly changed in size or number.The main pancreatic duct is normal caliber. No pancreatic parenchymal atrophy.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Unchanged minimal symmetric perinephric fluid is nonspecific.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Post sternotomy changes.OTHER: No significant abnormality noted.

Output: 1.Minimal change in the reference pancreatic cystic lesions. No suspicious imaging features although evaluation is limited by lack of intravenous contrast.2.Cholelithiasis without evidence of cholecystitis.


Instruction: Generate impression based on findings.

Input: Skull base lesion There is a lytic lesion affecting the occipital bone with an associated suboccipital soft tissue component that is better evaluated on the comparison MRI.There is multilevel degenerative disc disease of the cervical spine particularly of C3-C4, C4-C5, and C6-C7. There is grade 1 retrolisthesis of C3 but we see no gross instability between the flexion, neutral, or extension positions. There is mild multilevel facet joint osteoarthritis and the neural foramina are not well evaluated secondary to suboptimal patient positioning.

Output: 1. Multilevel degenerative disc disease and facet joint osteoarthritis of the cervical spine without evidence of frank instability.2. Lytic lesion of the occipital bone which is better appreciated on the comparison MRI imaging.


Instruction: Generate impression based on findings.

Input: Reason: evaluate for crohn's disease activity and distribution, identify strictures / inflammation History: abdominal pain, bloating ABDOMEN:LIVER, BILIARY TRACT: Visualized portions demonstrate no significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Status post small bowel resection and ileocecectomy with neoterminal ileum. The neoterminal ileum is felt to be best seen on series 3 image 24 in the right upper quadrant. Given the thicker sections of MRI, it is very difficult to localize which portion of the small bowel with disease is involved, however it is not the duodenum or proximal jejunum. The loops involved are likely distal jejunum and ileum. Given this, there is long segment narrowing with interspersed bowel dilatation throughout the abdomen and pelvis, along with fibrofatty proliferation and increased vascularity. UPPER ABDOMEN:An approximately 8 cm segment of fixed narrowing (3:17) may correlate with prior inflammation and narrowing seen on CT from 2014 (10:50). The small bowel proximal to this measures up to 5.7 cm in diameter (11:35). Another segment of narrowing is seen anteriorly (3:22) which is approximately 12 cm (also seen on series 11:36). Both of these segments appear to have an active component of inflammation (14:68) and (14:48) and are actually very close to each other. Another 2.5 cm segment of active inflammation narrowing is seen (14:43) that is slightly more distal or proximal to the lesions described above. Numerous prominent mesenteric lymph nodes are also noted.LOWER ABDOMEN AND PELVIS: Numerous dilated small bowel loops are seen with areas of interspersed narrowing similar to the upper abdomen. The postcontrast images are difficult to assess for active disease. However, the T2 signal and appearance of the bowel appears narrowed with dilated small bowel on either side. For example, a segment measuring approximately 2.8 cm (4:15).BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Acute on chronic/fibrostenosing Crohn's disease as described above with several strictured small bowel segments with intervening bowel dilatation.


Instruction: Generate impression based on findings.

Input: Male, 72 years old, neurogenic claudication in the bilateral legs, history of prior surgery, questionable report of "cannot rule out infection". Image quality is degraded by motion artifact. Within this limitation the following observations are made.Again seen are findings related to posterior decompression from L3 through L5. STIR hyperintense edema persists within the posterior paraspinal musculature at the L5 level and below.Loss of vertebral body height is seen at L4, and particularly at L5 which shows anterior wedging. The L4-5 endplates are irregular and the disk space shows T2 hyperintense signal similar to prior exam. Substantial edema is noted within the marrow adjacent to the endplates. There is corresponding enhancement within the vertebral body marrow but not within the disk space. Edema is evident along the L4-5 facets. The ventral epidural space posterior to L5, and continuing down into the sacrum, is expanded and enhancings, but without evidence discrete fluid collection. Allowing for substantial artifact on both examinations, there has been no significant interval change in the noncontrast portion of the exam.L1-2: No spinal canal stenosis or neuroforaminal narrowing. L2-3: No spinal canal stenosis or neuroforaminal narrowing. L3-4: Facet hypertrophy. Bulging disk toward the foramina. Mild bilateral foraminal narrowing. No significant spinal canal stenosis. No changes. L4-5: Moderate facet hypertrophy. Bulging disk. Mild spinal canal narrowing. Severe bilateral foraminal narrowing. No changes.L5-S1: Moderate facet hypertrophy. Bulging disk with osteophytic ridging. Thickening of the ventral epidural space. Mild/moderate spinal canal narrowing. Moderate bilateral foraminal narrowing. No interval changes.

Output: Allowing for substantial artifact on the present and prior exam, no significant interval change is demonstrated in the precontrast appearance of the L4 and L5 vertebral bodies and intervening disk space. There is enhancement which corresponds to marrow edema along the L4-5 endplates, and the disk space is hyperintense, but the disk space does not enhance. No definite evidence of any epidural or paraspinal fluid collection is seen. Given the relative stability of the findings and the lack of disk enhancement, findings may simply represent severe degeneration. Infection is considered less likely, particularly if there are no supportive clinical or laboratory findings.Postoperative findings are redemonstrated in the lower lumbar spine. Stable degenerative disease is demonstrated resulting in spinal canal stenosis at L4-5 and L5-S1. Severe foraminal narrowing is demonstrated bilaterally at L4-5, with moderate foraminal narrowing at L5-S1.


Instruction: Generate impression based on findings.

Input: Female, 13 years old, with partial complex seizures, assess for structural brain lesion. The cerebral and cerebellar hemispheres and brainstem show normal signal intensity and morphology. No restricted diffusion is seen.No evidence of parenchymal edema, mass, or mass effect is seen. There is no evidence of intracranial hemorrhage or abnormal extra-axial fluid. The ventricular system is normal in caliber and morphology. No evidence of cortical dysplasia or migrational anomaly is seen.Signal intensity of the bone marrow is unremarkable. No significant abnormalities of the paranasal sinuses are detected.

Output: Unremarkable evaluation with no specific findings to account for the patient's seizures.


Instruction: Generate impression based on findings.

Input: Pain in right knee. Evaluate for meniscal injury. Motor vehicle accident 11/3/2015. Limited range of motion with flexion. MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: Degenerative changes of the articular cartilage of the patella along the medial facet and eminence, with near-full-thickness to full-thickness fissuring. A tiny full-thickness defect of the articular cartilage of the medial facet of the femoral trochlea is identified. Mild bone marrow edema is identified at the medial aspect of the medial femoral condyle.LIGAMENTS: There is a tear of the proximal fibers of the anterior cruciate ligament. Interestingly, we do not see the typical accompanying bone contusion pattern. Proximal fibers of the superficial band of the medial collateral ligament are indistinct with adjacent edema, indicating a high-grade partial thickness tear. There is bandlike low signal posterior to the proximal fibers of the medial collateral ligament, likely representing the posterior oblique ligament, which also appears thickened and poorly defined, suggesting at least a partial tear.EXTENSOR MECHANISM: The extensor mechanism is intact, without significant abnormality.ADDITIONAL

Output: 1. Anterior cruciate ligament tear, which may be acute, although lack of the typical associated bone contusion pattern raises the possibly of a subacute injury.2. High-grade partial-thickness tear of the superficial band of the medial collateral ligament at its femoral attachment and probable tear of the posterior oblique ligament and medial retinaculum.3. Patellofemoral cartilage degeneration as described above.


Instruction: Generate impression based on findings.

Input: Clinical question:? Bleed or mass effect. Signs and symptoms: Seizure Nonenhanced CT of brain:The images through the anterior aspect of the temporal lobes demonstrate a subtle area of low attenuation in the left anterior temporal lobe. This is within the white matter and mid no distinct involvement of cortex. There is also extensive beam hardening artifact secondary to bone. Recommend follow-up exam with an MRI for better evaluation. The finding could represent edema from an inflammatory process (viral encephalitis), masse, venous thrombosis or other causes. I cannot be entirely certain if this finding is not an artifact or represent a focal area of encephalomalacia of unknown etiology. Considering provided clinical history of seizure further MR is recommended.The density and morphology of brain is otherwise entirely within normal limits. The cortical sulci, ventricular system and all CSF cisterns as well as gray -- white matter differentiation is preserved. The density of intracranial venous sinuses show no definitive abnormality.Calvarium, limited real paranasal sinuses, orbits and mastoid air cells are unremarkable.

Output: 1.Subtle suspected area of edema in the white matter of the left anterior temporal lobe as detailed above. Follow-up wirth and MRI is recommended if patient's symptoms persist. Please see above comments as for etiology.2.this examination is otherwise unremarkable.


Instruction: Generate impression based on findings.

Input: Hepatic failure and encephalopathy with hyperammonemia and hyperbilirubinemia. There are large areas of restricted diffusion and faint T2 hyperintensity, predominantly in a cortical and subcortical distribution involving the right posterior and medial temporal, anterior occipital, and parietal lobes, as well as the left temporal lobe and insula. There also appears to be mildly restricted diffusion in the bilateral posterior thalami. There are scattered areas of deep and periventricular white matter T2 hyperintensity without corresponding restricted diffusion. The brainstem and cerebellum are unremarkable. There is suggestion of a punctate lesion in the roof of the third ventricle that corresponds to the hyperattenuating lesion demonstrated on CT. There is no evidence of intracranial hemorrhage. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is a small right maxillary sinus retention cyst.

Output: 1. Extensive scattered areas of restricted diffusion in the periphery of the bilateral cerebral hemispheres likely represents acute hepatic encephalopathy.2. Background of mild chronic white matter ischemic disease.3. A probable tiny colloid cyst of the third ventricle is more conspicuous on the prior CT.


Instruction: Generate impression based on findings.

Input: Male 64 years old Reason: 64-year-old male with a history of multiple myeloma now with worsening low back and right hip pain There is diffuse signal abnormality and enhancement within the bone marrow of the pelvis, proximal femora, and lower lumbar spine. Although this is nonspecific, it is compatible with given history of myeloma, and new from prior MRI in 2014. There are several more focal and discrete lesions on T2 and STIR images.There is enlargement of the right gluteus medius muscle with increased signal intensity on T2 imaging and enhancement following gadolinium administration. There is also suggestion of increased vascularity on the coronal STIR sequence. Findings are compatible with myositis or tumor infiltration of the muscle. Tendons are intact. The right hip joint itself appears normal. There is generalized subcutaneous and intermuscular edema without enhancement. Hydroceles bilaterally. There is a small amount of free fluid in the pelvis.

Output: 1.Diffuse marrow abnormality which is nonspecific but compatible with given history of myeloma.2.Enlargement and abnormal signal intensity of the right gluteus medius muscle is nonspecific and suggestive of myositis, but we cannot exclude tumor infiltration of muscle.


Instruction: Generate impression based on findings.

Input: Male 52 years old Reason: patient with hepatic lesion, known cancer and suspected abscess need to eval for infectious component of lesion that may be amenable to biopsy for cultures History: fever, abdominal pain ABDOMEN:LIVER, BILIARY TRACT: The dominant right hepatic lobe lesion measures 11.2 x 9.5 cm (image 11/series 11) previously, 11.2 x 9.7 cm. The lesion indicates the portal vein including the right and left branches and main portal vein and extends up to the level of the SMV. The lesion also invades the right hepatic and possibly the middle hepatic veins.No discrete fluid collection to suggest an abscess.The gallbladder is mildly distended but there is no pericholecystic fluid or gallbladder wall thickening.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: Periesophageal lymph node measures 1.5 x 1.5 cm (image 12/series 11) previously, 1.6 x 1.3 cm.Cardiophrenic angle lymph node measures 1.7 x 1.0 cm (image 12/series 11) previously, 1.9 x 1.2 cm.There is portacaval lymphadenopathy.BOWEL, MESENTERY: Postsurgical changes with a right lower abdominal ostomy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.INDEX LESION MEASUREMENTS (Current exam date/time: 11/5/2015 17:00:00)LIVER LESION: 11.2 x 9.5 cm (Image 11, Series 11); 9.7 x 11.2 cm on prior (11/4/2015) (Image 37, Series 3).PERIESOPHAGEAL LN: 1.5 x 1.5 cm (Image 12, Series 11); 1.3 x 1.6 cm on prior (11/4/2015) (Image 32, Series 3).COSTOPHRENIC ANGLE LN: 1.7 x 1.0 cm (Image 12, Series 11); 1.9 x 1.2 cm on prior (11/4/2015) (Image 29, Series 3).

Output: 1.Redemonstration of the dominant right hepatic lobe mass which is previously biopsied and shown to represent a hepatic malignancy.2.No MR evidence of abscess.


Instruction: Generate impression based on findings.

Input: Foot pain There is metallic susceptibility artifact adjacent to the navicular tuberosity representing a partially dislodged suture anchor as seen on prior radiographs. The adjacent spring ligament appears slightly distorted which may be the result of artifact or mild mass effect but there is no evidence of frank disruption. Although evaluation of the distal posterior tibialis tendon is limited due to the metal artifact, there is no abnormal signal or disruption of the tendon itself and there is also no evidence of navicular edema. The marrow signal of the remaining bones of the foot is also normal. The anterior talofibular ligament appears thinned which may be the result of prior injury but the calcaneofibular and posterior talofibular ligaments appear normal. The distal tibiofibular syndesmotic complex is intact. The visualized components of the deltoid ligament are unremarkable. The anterior tendons, flexor digitorum and flexor hallucis longus tendons, the Achilles tendon, and the peroneal tendons all appear normal. A small amount of fluid is noted within the tibiotalar and subtalar joints which is within normal limits.

Output: Metallic susceptibility artifact adjacent to the navicular tuberosity representing a partially dislodged suture anchor which perhaps causes mild mass effect upon the spring ligament. There is no evidence of additional tendinous or bony abnormality or other specific findings to account for the patient's pain.


Instruction: Generate impression based on findings.

Input: 79-year-old female with pain over the posterolateral aspect of the knee. Evaluate for meniscal tear versus Baker's cyst. MENISCI: There is globular increased signal abnormality within the medial meniscus consistent with intrasubstance degeneration. There is increased signal abnormality which extends to the tibial and femoral articular surfaces with associated deformity/maceration of the posterior horn and body of the medial meniscus consistent with degenerative tearing. There is medial extrusion of the body of the meniscus. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is full-thickness articular cartilage degeneration along the weightbearing surface of the medial femoral condyle and medial aspect of the tibial plateau with bone marrow edema type signal abnormality, likely degenerative in etiology. There is tricompartmental osteophyte formation. There is near full-thickness articular cartilage degeneration along the lateral facet of the patella. There is near full-thickness to full-thickness articular cartilage degeneration along the medial facet of the patella.LIGAMENTS: The cruciate and collateral ligaments appear intact.EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: Osteoarthritic changes including articular cartilage degeneration and degenerative tearing of the medial meniscus as described above.


Instruction: Generate impression based on findings.

Input: Cervical root lesions, not elsewhere classified [353.2], Reason for Study: ^Reason: Cervical syrinx, persistent shoulder and back pain History: Shoulder and back pain Extensive syrinx cavity from the cervical cord to the thoracic cord is again demonstrated.The syrinx cavity started from the C2 level and extends toward the T10-11 disc level. No change since prior scan.The largest diameter of the syrinx cavity is about 9.8 mm x 6.9 mm which does not show any significant interval change since prior scan.Small signal void at the T1 level syrinx cavity which may indicate hemosiderin deposition, is again demonstrated, no change since prior scan.C-SpineCranial cervical junction is crowded as described before. No change since prior scan.There is normal cervical lordosis. The cervical spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance.Subtle desiccation of intervertebral disc was from C2-C3 to C5-6, however, there is no evidence of spinal canal stenosis. At the level of C67, there is ligamentum flavum thickening with the minimal bulging of disc, again no change since prior scan.T-Spine:Thoracic spine alignment is normal, with the normal kyphotic angulation. The vertebral body heights are maintained. Marrow signal intensity is benign throughout.There is no evidence of spinal canal stenosis or neural foraminal stenosis.There is no evidence of intervertebral disc bulge of protrusion.

Output: 1. No change of expanded syrinx from C2 to T10 11 level.2. No evidence of significant spinal canal stenosis or neuroforaminal stenosis on the scan. No change since prior scan.


Instruction: Generate impression based on findings.

Input: Female 34 years old Reason: Change in nodules, please compare to outside study History: History of Graves', diffuse goiter with nodules RIGHT LOBE MEASUREMENTS: 5.6 x 2 x 1.8 cmLEFT LOBE MEASUREMENTS: 5.9 x 2.3 x 1.5 cmISTHMUS MEASUREMENTS: 2 mmRIGHT LOBE: The echogenicity of the entire thyroid is heterogeneous with geographic areas of hypo-and hyperechogenicity. No definite nodules are seen in the right thyroid lobe.LEFT LOBE: The echogenicity of the entire thyroid is heterogeneous with geographic areas of hypo-and hyperechogenicity. There is a 7 x 6 mm, well-defined hypoechoic benign-appearing, cystic nodule in the left thyroid lobe.ISTHMUS: There is a 8 x 5 mm hypoechoic, well-defined nodule on the right side of the isthmus.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Diffusely heterogeneous echotexture of the thyroid gland with subcentimeter benign-appearing nodules in the left lobe and isthmus. Etiology for heterogeneous echotexture is not known, however, thyroiditis may be considered in the differential diagnosis. Clinical correlation is recommended.


Instruction: Generate impression based on findings.

Input: 75-year-old female with elevated liver function enzymes who presents for evaluation for any obstructive lesion or hepatic parenchymal disease. ABDOMEN:LIVER, BILIARY TRACT: Noted is a subcentimeter segment 7 T2 intermediate intensity, T1 hypointense lesion without contrast enhancement; this is most likely benign.The common bile duct is slightly irregular without obvious obstructing lesion. There is mild intrahepatic biliary ductal dilatation, most obvious on the left. No definite connection between the left intrahepatic biliary duct and the common bile duct is identified. However, there is no obvious mass.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: T2 hyperintense subcentimeter left renal foci without evidence of enhancement compatible with cysts. Additionally, there is a T1 hyperintense, T2 hypointense nonenhancing subcentimeter left renal focus, most compatible with a proteinaceous cyst. No suspicious renal lesions.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is a peripherally calcified, T1 and T2 isointense focus anterior to the left inferior renal pole measuring 2.1 x 1.9 cm (series 12, image 78). This lesion does not demonstrate dropout on in and out of phase. There is additionally no evidence of enhancement.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Slightly irregular common bile duct with mild intrahepatic biliary ductal dilatation. No definite connection between the left intrahepatic biliary duct and the common bile duct is identified. However, there is no obvious mass is noted. If there is clinical concern, further evaluation with ERCP to evaluate for inflammatory etiology may be considered.2.Subcentimeter segment 7 nonenhancing lesion as detailed is most likely benign.3.Left upper quadrant mesenteric peripheral calcified nonenhancing focus is most likely benign in etiology.


Instruction: Generate impression based on findings.

Input: 73-year-old female with right lower inner quadrant mass, suspicious, family history of breast and ovarian cancer, MRI for screening There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.In the right breast 4:00 position there is an irregularly shaped heterogeneously enhancing spiculated mass measuring 20 x 28 x 18 mm (AP X ML X CC). Medial component of the mass demonstrates more intense homogeneous enhancement with rapid uptake and washout kinetics.No abnormal enhancement is seen in left breast. No abnormal lymph nodes are identified in either axillary region.Septated high signal intensity T2 lesion in segment 4A of the liver most likely represents a cyst or less likely hemangioma.

Output: 28 mm enhancing highly suspicious mass right breast 4:00 position corresponding to the mammographic and sonographic findings. Patient will undergo ultrasound-guided core biopsy subsequently.No abnormality in the left breast or bilateral axillary region.BIRADS: 5 - Highly suggestive of malignancy.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Low back pain radiating to right thigh Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign. There is edema involving the L5 pedicles likely related to facet arthropathy. The conus medullaris is normal in position. Small Schmorl's node is noted involving the superior endplate of L2.Lumbar spinal canal appears mildly narrowed on a congenital basis with superimposed prominence of the epidural fat and degenerative changes as described below: L1-L2: Mild disc bulge and facet arthropathy. No significant spinal canal or neural foraminal stenosis.L2-L3: Mild disc bulge and bilateral facet arthropathy. There is minimal spinal canal narrowing. No significant neural foraminal narrowing.L3-L4: There is disc bulge, ligamentum flavum thickening, facet arthropathy, and prominence of the epidural fat which results in mild spinal canal stenosis. There is mild to moderate right and mild left neural foraminal stenosis.L4-L5: There is disc bulge eccentric to the right, with ligamentum flavum thickening and advanced bilateral facet arthropathy. There is effacement of the lateral recesses as well as mild to moderate central spinal canal stenosis. There is moderate right neural foraminal stenosis and possible impingement of the exiting right L4 nerve root. Mild left neural foraminal stenosis.L5-S1: There is disc bulge and advanced bilateral facet arthropathy. There is partial effacement of the lateral recesses without significant central spinal canal stenosis. There is mild right and mild to moderate left neural foraminal stenosis.Paraspinous soft tissues are within normal limits.

Output: 1. Degenerative changes throughout the lumbar spine as detailed above, worst at the L4-L5 level. There is mild to moderate spinal canal stenosis at this level and moderate right neural foraminal stenosis, which may be impinging on the exiting right L4 nerve root.2. Advanced bilateral facet arthropathy at L4-L5 and L5-S1 which may be contributing to patient's low back pain.


Instruction: Generate impression based on findings.

Input: 30-year-old female with BRCA1 mutation as well as BRCA2 variant of uncertain significance. Breast MRI for surveillance There is heterogeneous amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.High signal intensity round lesion on T2 W sequence in segment 8 of liver has minimally increased in size from 9 mm to 13 mm; could represent a hemangioma; however liver MRI is recommended for confirmation. Also noted is an irregular high signal intensity lesion along the falciform ligament which suppresses on the T1 dynamic fat-suppressed sequence and most likely represents fat along the falciform ligament however not definitely visualized on prior MRI.

Output: No MRI evidence for malignancy in the breast. Interval increase in size of high signal intensity round lesion and irregular high signal intensity along falciform ligament which could represent fat . Further evaluation with liver MRI can be performed.BIRADS: 1 - Negative.RECOMMENDATION: NS - Routine Screening Mammogram.


Instruction: Generate impression based on findings.

Input: 58-year-old female with history of gallbladder carcinoma. Evaluate for obstruction. ABDOMEN:LIVER, BILIARY TRACT: The gallbladder is distended with soft tissue consistent with tumor and calcified stones. There is additionally a calcified stone in the neck of the gallbladder. There is trace pericholecystic fluid.There are innumerable hepatic heterogeneous peripherally T2 hyperintense, diffusion restricting, hypovascular lesions replacing nearly the entire hepatic parenchyma; findings compatible with extensive metastatic disease.The proximal to mid common bile duct is compressed extrinsically from metastatic disease (series 901, image 72). There is mild right and left intrahepatic biliary prominence.Although, the portal venous system is patent, there is mild to moderate attenuation of the left and right portal veins by the metastatic disease.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: There is mildly enhancing, extensive retroperitoneal lymphadenopathy with index lymph node measuring 4.0 x 3.0 cm (series 1301, image 30).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small bilateral pleural effusions.

Output: 1.Mass and calcified cholelithiasis within the gallbladder fossa compatible with patient's history of gallbladder carcinoma. Calcified stone in the gallbladder neck.2.Extensive diffuse hepatic metastatic disease replacing nearly the entire normal hepatic parenchyma. Mild to moderate portal venous attenuation from metastatic disease.3.Proximal to mid common bile duct is compressed extrinsically from metastatic disease resulting in mild intrahepatic biliary prominence.4.Extensive retroperitoneal lymphadenopathy.


Instruction: Generate impression based on findings.

Input: 49 year old female with biopsy proven cancer in right breast presents for staging. There is heterogeneous amount of fibroglandular tissue in both breasts.Moderate nodular parenchymal enhancement is noted bilaterally.RIGHT BREAST:Irregular, heterogeneously enhancing mass with spiculated margins noted in the right breast 10:00 position that measures 1.8 x 1.4 x 1.6 cm (AP x ML x CC) and a clip artifact is identified within it. Located 1 cm, anterior and medial to this lesion is a second irregular enhancing mass with spiculated margin at 12:30 position that measures 1 x 0.8 x 0.8 cm. The total extent is 2.5 x 4.1 cm. Located anterior to the biopsy proven mass is a lobulated, circumscribed, hematoma that measures 2.6 x 1.3 centimeters. LEFT BREAST: Oval enhancing mass left breast two o'clock position measures 0.7 x 0.6 x 0.6 cm that needs further evaluation with MR directed ultrasound.No abnormal lymph nodes are identified in either axillary region.

Output: 1. Biopsy proven cancer in the right breast 10 o'clock position with a second suspicious mass at 12:30 o'clock position, located 1 cm anterior and slightly medial to it. MR directed ultrasound and biopsy is recommended for this mass. If lesion not seen on ultrasound, MR guided biopsy is recommended.2. Oval 7-mm enhancing mass left breast two o'clock position, needs further evaluation with MR directed ultrasound. If lesion not seen on ultrasound, MR guided biopsy is recommended3. Normal axillary lymph nodes noted bilaterally. BIRADS: 6 - Known cancer.RECOMMENDATION: E - Additional Mammo/Ultrasound Workup Required.


Instruction: Generate impression based on findings.

Input: Ms. Roy is a 38 year old female with a personal history of right breast lumpectomy in October 2015 for DCIS. She has no current breast related complaints. There is heterogeneous amount of fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. Multiple cysts are present bilaterally, the largest one of which measures approximately 1.2 cm in the left superior breast. Stable benign morphology enhancing mass in the left lower inner breast.No abnormal lymph nodes are identified in either axillary or internal mammary region.

Output: No MRI evidence for malignancy. Of note, no recent mammogram is present in our system. If patient has had a recent mammogram performed at an outside institution, than this should be submitted for future comparison purposes. Otherwise, patient is due for a bilateral diagnostic mammogram. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: Male, 69 years old, with progressive altered mental status, assess for metastatic disease. No evidence of edema, mass effect or pathologic enhancement is seen to suggest intracranial metastatic disease.Moderate confluent T2 hyperintensity is seen along the lateral ventricular margins bilaterally with a few additional scattered patchy foci including in the brain stem. These findings are nonspecific.No evidence of restricted diffusion is seen. No findings to suggest intracranial hemorrhage or any abnormal extra-axial fluid are detected. The ventricles are slightly prominent but not out of proportion to the degree of sulcal widening.

Output: 1. No evidence of intracranial metastatic disease.2. No definite acute intracranial abnormalities.3. White matter signal abnormality primarily in the periventricular regions is a nonspecific finding which may represent the sequelae of chronic microvascular ischemia or an effect of therapy among other etiologies.


Instruction: Generate impression based on findings.

Input: 46-year-old female with increased ICP and history of SAH status post right craniotomy with PCOM aneurysm clipping. Increased ICP? Postoperative changes status post right frontal craniotomy for clipping of an aneurysm is again noted without interval changes. Right-sided ventricular catheter with no interval change in its course and position with its tip located in the frontal horn of the right lateral ventricle. Small amount of hemorrhage is again noted in the dependent portion of the occipital horn of the right lateral ventricle, unchanged.Ventricular system and basal cisterns appear unchanged. No evidence of acute hemorrhage, edema or mass effect.Multiple prior studies were reviewed and demonstrate persistent low positioned cerebellar tonsils with crowding of the foramen magnum, raising a question of Chiari malformation. If clinically indicated, MRI with flow study may be considered.

Output: 1. Stable postoperative changes.2. Persistently low positioned cerebellar tonsils with crowding of the foramen magnum are noted raising a question of Chiari malformation. If clinically indicated, MRI with flow study may be considered.


Instruction: Generate impression based on findings.

Input: 15-year-old male with recurrent abdominal pain and weight loss status post appendectomy. Evaluate for Crohn's disease or any other abnormalities.EXAMINATION: MR enterography without and with IV contrast 5/20/2015 ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesions. No biliary ductal dilation.SPLEEN: No focal splenic lesions.PANCREAS: No focal pancreatic lesions. No pancreatic ductal dilation.ADRENAL GLANDS: No adrenal masses.KIDNEYS, URETERS: No focal renal lesions. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No lymphadenopathy.BOWEL, MESENTERY:No significant bowel wall thickening or enhancement. Greater than average amount of stool in the distal colon and rectum.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No lymphadenopathy.BOWEL, MESENTERY: No significant bowel wall thickening or enhancement. Greater than average amount of stool in the distal colon and rectum.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Trace amount of nonspecific pelvic ascites.

Output: 1. No significant bowel wall thickening or enhancement to suggest inflammatory bowel disease.2. Trace amount of nonspecific pelvic ascites.


Instruction: Generate impression based on findings.

Input: History of large posterior fossa ependymoma WHO grade 2 s/p resection x2 with VP shunt placement and adjuvant proton radiotherapy who presents for post-operative management following stereotactic cyst puncture and insertion of Rickham catheter. Following radiation therapy, the patient formed a large cystic structure in the former resection cavity in the right cerebellopontine angle. Subsequently, the patient developed a 7th nerve palsy and compression of the brainstem with right side weakness. Interval surveillance MRI. There are postsurgical changes of right occipital craniotomy. The right occipital approach catheter traversing the right CP angle cystic lesion is unchanged in position. There has been interval increase in size of one of the cystic components at the right CP angle. For example, a component just lateral to the catheter tip measures up to 23 mm (series 501, image 10), previously 12 mm. The enhancing posterior fossa mass appears slightly larger when compared to prior measuring approximately 49 x 44 mm (series 1301, image 9). Comparable measurements on the prior MRI are difficult given differences in mass effect and surrounding parenchymal morphology. Mass effect on the brainstem with leftward deviation is unchanged. Left frontal approach ventriculostomy catheter terminates at the foramen of Monro, unchanged. The ventricle size has decreased in size compared to the prior exam. The right frontal horn measures 2 mm, previously 5 mm. Additional prior bilateral catheter tracts are noted. Flow voids are present within the major vessels indicating patency. Partial opacification of the bilateral mastoid air cells.

Output: 1. Slight interval increase in size of posterior fossa enhancing mass. 2. Reaccumulation of fluid in the cystic lesional components at the right cerebellopontine angle.


Instruction: Generate impression based on findings.

Input: Convulsions, seizures. The left amygdala appears slightly prominent without associated abnormal signal. The bilateral hippocampi appear symmetric in signal and morphology.The gray-white matter interface is preserved. The ventricles appear slitlike. There is no associated empty sella. There is no diffusion abnormality to suggest acute ischemia. There is no midline shift or mass effect appreciated. There is no evidence for acute intracranial hemorrhage. No abnormal susceptibility is appreciated.

Output: There is mild nonspecific prominence of the left amygdala without abnormal signal. The bilateral hippocampi appear symmetric in signal and morphology. Please correlate with EEG findings, and imaging follow-up may be obtained as clinically indicated.


Instruction: Generate impression based on findings.

Input: 63-year-old male with knee giving way and knee pain. Evaluate for loose body/meniscus tear. MENISCI: There is increased signal abnormality within the posterior horn and body of the medial meniscus indicating intrasubstance degeneration, but we see no discrete tear. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: Moderate osteoarthritis affects the patellofemoral joint with articular cartilage thinning and subchondral cysts. There are focal areas of full-thickness cartilage loss and subchondral cysts. There are small tricompartmental osteophytes. There are multiple loose bodies within the suprapatellar pouch, most of which are under 5 mm, although one within the anteromedial aspect of the joint measures just over 1 cm in its greatest dimension.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Loose bodies as described above.2. Meniscal degeneration without evidence of a tear.3. Osteoarthritis of the patellofemoral joint.4. Borderline tibial tubercle to trochlear groove distance. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate disk herniation. Signs and symptoms: LBP for months; cannot run. Also has tailbone pain. Nonenhanced lumbar MRI:Examination extends from T9 -- T10 disk level inferiorly through mid S3 and does not include the distal sacral spine.There is normal anatomical development, signal intensity and alignment of vertebral column.There is no evidence of any appreciable degenerative disk disease, no evidence of spinal canal compromise or stenosis at any level and no evidence of neural foraminal compromise. The alignment of the vertebral column is within normal and there is no evidence of marrow space T2/T2 stir hyperintensity to suggest edema in particular in the lower lumbar spine to suggest presence of pars defect.Lowermost visualized thoracic spine and thoracic cord is unremarkable. The signal intensity of conus and cauda equina is within normal and with normal termination of the cord at mid L1 level.No detectable perispinal soft tissue/musculature abnormalities. Visualized kidneys are unremarkable. Visualized SI joints are unremarkable.

Output: Unremarkable nonenhanced lumbar MRI.


Instruction: Generate impression based on findings.

Input: 55 years Male (DOB:10/31/1960)Reason: Eval for structura lesions History: foot drop, leg weaknessPROVIDER/ATTENDING NAME: ADIL JAVED ADIL JAVED 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.There are several punctate subcortical white matter lesions present which are high signal on T2 and FLAIR MRI.There is a 25 x 16 mm sagittal dimension mass high signal on T1 which is just below the subcutaneous fat. Most likely it represents a lipomaNormal 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 few subcortical white matter lesions present which are nonspecific. They are very common in most likely of little clinical significance.2.Lipoma the left upper neck adjacent to the occiput.3.There is no intracranial mass lesion or cerebral infarction to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: 81-year-old male status post Whipple (8/24/2016) for ampullary cancer now with episodes of pancreatitis and questionable liver metastases. ABDOMEN:LIVER, BILIARY TRACT: The previously described segment 4A lesion is not identified on the current study. The previously described segment 6 lesion is again seen demonstrating low T1 signal and hypoenhancement best seen on portal venous phase (series 1104, image 378) relatively stable in size, measuring 12 x 10 mm. There is mild intrahepatic biliary ductal dilation.SPLEEN: No significant abnormality noted.PANCREAS: Postsurgical changes of the multiple are again seen. There is interval placement of a gastrojejunostomy tube causing artifact near the tail of the pancreas.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple renal cysts are again noted, unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Colonic diverticulosis is partially imaged. There is mild mucosal enhancement at the hepaticojejunostomy anastomosis which may be inflammatory. Segmental mucosal enhancement is also noted in the left lower quadrant, partially imaged. Improvement in ascites.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Previously described segment 4A lesion is not identified on the current study. The previously described segment six lesion is again seen and relatively stable in size when compared to the prior exam. Findings may represent a focus of resolving infection. Provided the lesions persistence in the interim, a small early metastatic focus still cannot be entirely excluded.2.Small bowel mucosal enhancement at the hepaticojejunostomy anastomosis and in the left lower quadrant (partially imaged) is nonspecific.


Instruction: Generate impression based on findings.

Input: 15-year-old female with history of sickle cell disease and with sports related left hip pain for 2 to 3 days. Evaluate for labral tear. Bilateral femoral heads are well directed within the acetabula without evidence of abnormal signal within the femoral heads or femoral head collapse to suggest avascular necrosis. No evidence of acute fracture or malalignment. No labral abnormalities noted bilaterally. Sacroiliac joints appear normal. No evidence of an avulsion injury. The visualized tendons are normal.No evidence of increased T2 signal within the musculature to suggest strain or sprain.Physiologic cysts in bilateral adnexa are noted. Small amount of free fluid, likely physiologic in etiology. No additional abnormality within the visualized pelvis and abdomen is noted.

Output: No evidence of labral tear or other findings to account for patient's left hip pain. If there is continued concern for a left hip labral tear, further evaluation with a left hip arthrogram MRI may be considered as clinically indicated.


Instruction: Generate impression based on findings.

Input: There are postoperative findings related to left frontoparietal craniotomy with a residual extra-axial fluid collection deep to the craniotomy that measures up to 15 mm in thickness. There is a subcentimeter focus of extra-axial nodular enhancement in the surgical bed overlying the left posterior frontal convexity. There is also persistent confluent T2 hyperintensity in the underlying brain parenchyma. In addition, there is susceptibility effect within posterior frontal lobe sulci, which is suggestive of prior subarachnoid hemorrhage or superficial siderosis. There is no evidence of acute infarct. The ventricles are unchanged in size and configuration. There is a partially-empty sella. The adenoids are prominent and contain several retention cysts.

Output: Postoperative findings with a subcentimeter focus of extra-axial nodular enhancement in the surgical bed overlying the left posterior frontal convexity, which may represent residual tumor versus treatment effects.


Instruction: Generate impression based on findings.

Input: 62-year-old male with gallstone and wall thickening on recent CT examination. Presents with abdominal pain. ABDOMEN:LIVER, BILIARY TRACT: Note is made of a large gallstone at the level of the neck of a distended gallbladder. No gallbladder wall thickening, pericholecystic fluid, or increased T2 signal abnormality is identified in the surrounding liver parenchyma to suggest acute cholecystitis. No common duct stones are identified. There is no evidence of intra-or extrahepatic biliary ductal dilation.Subcentimeter foci of fluid signal intensity are too small to characterize but likely represent simple cysts versus biliary hamartomas.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Simple cyst in the interpolar region of the left kidney. Subcentimeter focus of fluid signal intensity in the inferior pole of the right kidney is too small to characterize, but likely represents a simple 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: Gallstone without evidence of common duct stone or acute cholecystitis.


Instruction: Generate impression based on findings.

Input: 61-year-old male who presents for evaluation of liver lesion. ABDOMEN:LIVER, BILIARY TRACT: There are two T1 hypointense and T2 intermediate signal lesions in the liver. Segment 2/3 measures 3.4 x 2.3 cm (series 401, image 8) and segment 5 lesion measures 1.7 x 1.6 cm (series 401, image 26). These lesions do not demonstrate signal loss on the in and out of phase sequences to suggest fat within the lesions. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Indeterminate solid hepatic masses. Further evaluation with biopsy may be considered.


Instruction: Generate impression based on findings.

Input: 67-year-old female with pain after fall. History of 2 previous rotator cuff repairs. Evaluation of the rotator cuff is slightly limited by metallic susceptibility artifact within the anterior humeral head, presumably related to prior rotator cuff repair.ROTATOR CUFF: There is a full-thickness defect of the supraspinatus tendon situated approximately 1.5 cm proximal to its insertion on the greater tuberosity resulting in a gap measuring approximately 6 mm in the longitudinal and in the AP dimension. The remainder of the supraspinatus tendon appears intact. The supraspinatus muscle is within normal limits. The infraspinatus muscle and tendon appear intact. The teres minor and subscapularis muscles and tendons appear intact.SUPRASPINATUS OUTLET: There is widening of the acromioclavicular joint likely postoperative in etiology. Fluid within the acromioclavicular joint communicates with the subacromial bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is within normal limits. No glenohumeral joint effusion is evident. Mild osteoarthritis affects the glenohumeral joint. Given the limitations of a non-arthrogram study, the glenoid labrum appears intact.BICEPS TENDON: The tendon of the long head of the biceps appears intact. ADDITIONAL

Output: 1. Postoperative changes as described above.2. Full-thickness defect of the supraspinatus tendon as described above.3. Mild osteoarthritis of the glenohumeral joint.


Instruction: Generate impression based on findings.

Input: Secondary malignant neoplasm of brain [C79.31] / Secondary malignant neoplasm of other parts of nervous system [C79.49], Reason for Study: ^Reason: metastatic lung cancer to brain s/p SRS History: surveillance There are multifocal minimally enhancing intra axial lesions including left frontal lobe, left cerebellar hemisphere, right superior parietal lobule, left intraparietal sulcus and right occipital cortex, no change in terms of size and enhancement pattern and other MR imaging findings.The left frontal lobe and left cerebellar hemisphere lesions show susceptibility artifacts indicating internal development of hemorrhage, unchanged.The ventricles, sulci and cisterns are unremarkable. The gray-white matter differentiation is normal. There is no restricted diffusion/acute ischemia. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.Minimal tonsilar downward displacement is again seen.

Output: 1. Multiple minimally enhancing intra axial lesions consistent with metastatic lesions, unchanged in terms of size, number and MR findings since prior scan.2. No new enhancing lesion is seen.3. No evidence of new acute ischemic or hemorrhagic lesion.


Instruction: Generate impression based on findings.

Input: 56 year-old male. Left hip pain. Assess for abnormality. Please see hip xray (4/2015) density noted on femoral neck. There is a irregular focus of low signal intensity within the the femoral neck along the posterior cortex associated with a tiny central focus of relatively high signal intensity. The etiology of this finding is uncertain but it is not associated with any significant edema and does not have a typical appearance of a metastatic focus. We suspect it is benign in etiology, perhaps a focus of corticotrabecular thickening. This likely corresponds to the focus of sclerosis seen on recent radiographs. Degenerative disk disease affects the lower lumbar spine, most severely at L5-S1. Mild osteoarthritis affects both hips. There is increased signal intensity within the anterosuperior acetabular labrum on the left suggesting degeneration or degenerative tearing. There is slight prominence of the anterior aspect of the left femoral head/neck junction with an alpha angle of 55 degrees suggesting a borderline CAM deformity. Mild heterogeneity of the bone marrow on T1-weighted images likely represents residual red marrow. The musculature is unremarkable. On the large field of view T2 weighted images, there are small elongated foci of high signal intensity within the left sciatic nerve, which may represent prominent fascicles or perhaps tiny benign nerve sheath tumors, but these not necessarily of any clinical significance.

Output: 1. Cortically based focus of low signal intensity within the posterior aspect of the left femoral neck likely corresponds to the sclerosis seen on the recent radiographs. While its etiology is uncertain, we suspect that it is benign and of doubtful clinical significance.2. Degenerative arthritic changes and other findings as described above.


Instruction: Generate impression based on findings.

Input: 40-year-old male with history of a pancreatic head cyst. Evaluate for interval change. ABDOMEN:LIVER, BILIARY TRACT: Hepatic steatosis. Stable segment 6/7 hemangioma measuring 2.9 x 2.6 centimeters.No intra or extra hepatic biliary ductal dilatation. Common bile duct tapers smoothly to the level of the ampulla without evidence of a lesion, mass, or stone.SPLEEN: No significant abnormality noted.PANCREAS: There is no corresponding lesion to the previously noted subcentimeter hypoattenuating focus in the pancreatic head. In this location, there is a small area of signal dropout on the out of phase images compatible with focal fat deposition. No suspicious pancreatic lesions or pancreatic ductal dilatation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Focal fat in the pancreatic head corresponding to the hypoattenuating focus seen on CT examination. No further follow-up is required.2.Stable segment 6/7 hemangioma.


Instruction: Generate impression based on findings.

Input: Endocarditis, valve unspecified [I38] / Disorientation, unspecified [R41.0] / Septic arterial embolism [I76] / Occlusion and stenosis of unspecified cerebral artery [I66.9], Reason for Study: ^Reason: Eval for progression of septic emboli, characterization of lesions for risk of bleeding on full dose of anticoagulation. Brain MRIThere are multifocal bihemispheric susceptibility lesions indicating petechial hemorrhages including right frontal large subacute hemorrhages with surrounding edema. Especially both right frontal and left cerebellar ICHs show areas of restricted diffusion indicating hemorrhagic conversion of ischemic stroke. Multiple supra and infra tentorial variable sized susceptibility brain parenchymal lesions can be seen in multiple cavernous malformations, however, given then patient's clinical circumstances, these lesions are likely related to septic emboli and/or anticoagulation related petechial parenchymal hemorrhages or chronic hypertension related.Therefore, Gad enhanced MRI is recommended to evaluate any enhancing lesions which may suggest mycotic aneurysm.Loss of normal fatty marrow T1 high signal intensity on clivus and upper cervical vertebral bodies, diagnostic possibilities include systemic disease such as severe anemia or blood dyscrasia related red marrow conversion or metastasis. There is no evidence of acute ischemic lesion on this scan.The ventricles, sulci and cisterns are symmetric and unremarkable.The midline structures and cranial-cervical junction are normal. The paranasal sinuses are clear.Opacification on the left mastoid air cells.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate about 4.5mm sized luminal ectasia at the top of the basilar artery or could be related to a perforator arising from the fetal PCA indicating possible intracranial arterial aneurysm. Comparing to prior CT angiography performed on Mar 27 2016, there was no evidence of ectatic change of the basilar artery. There is no other aneurysm seen on this scan.There is no evidence of arterial luminal stenosis.Bilateral ICAs, MCAs and ACAs appear to be normal.

Output: 1. Right frontal and left cerebellar hemisphere ICHs most likely due to ischemic infarction with hemorrhagic conversion.2. Both supra and infra tentorial susceptibility lesions indicate possible petechial hemorrhages. Gad enhanced MRI can be helpful for further evaluation regarding possible multiple mycotic aneurysms.3. About 4.5mm sized aneurysmal lesion on the top of the basilar artery or arising from a perforator of the right fetal PCA.Comment: discussed with cardiac unit fellow and suggested either Gad enhanced MRI to evaluate possibility of multifocal septic emboli related mycotic aneurysm or cerebral angiography to evaluate both intracranial arterial system as well as posterior fossa aneurysmal dilatation.


Instruction: Generate impression based on findings.

Input: 73-year-old male patient with hepatitis C cirrhosis. HCC screening. ABDOMEN:LIVER, BILIARY TRACT: The liver is cirrhotic in morphology. There is no intra or extrahepatic biliary ductal dilatation. No suspicious hepatic lesion is identified. The portal vein is patent. Cholelithiasis without evidence of acute cholecystitis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left renal cysts are unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small amount of ascites, decreased from the prior study.

Output: 1. Cirrhotic morphology of the liver without suspicious lesion to suggest HCC.2. Small amount of ascites.


Instruction: Generate impression based on findings.

Input: Diagnosis: Other idiopathic scoliosis, site unspecified Other symptoms and signs involving the musculoskeletal systemClinical question: loss of motor function to right lower extremity when positioned prone for spinal procedure, eval for vascular or other abnormalitySigns and Symptoms: loss of motor function to right lower extremity MRI brain: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 demonstrate only minor opacities.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.Thoracic spine:The thoracic vertebral bodies are appropriate in the overall alignment and height.There is a 4 mm lesion present in the right hemicord at the T8-9 disc space level. It is high signal on T2. There is some suggestion of diffusion restriction.The patient is status post lower thoracic and upper lumbar spine surgery. Pedicle screw tracts are present at L2, L1, T12 and T11. There are postoperative changes identified in the tissues superficial to the lower thoracic and upper lumbar spine.There is a small right pleural effusion present.Lumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. There is a compensatory levocurvature to the lumbar spine. The conus medullaris on sagittal imaging is grossly intact.Pedicle screw tracts are present at L2, L1, T12 and T11. There are postoperative changes identified in the tissues superficial to the lower thoracic and upper lumbar spine.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.The bladder is relatively full. There appears to be a small air bubble in the urinary bladder.

Output: 1.There is a 4 mm lesion present in the right hemicord at the T8-9 disc space level involving gray matter. It is possible that this relates to a small spinal cord infarction based on some questionable evidence for diffusion restriction. The lesion may have been present on the prior exam but not visible on the prior exam due to low signal to noise on that exam.2.There is a small right pleural effusion present.3.There is no compromise to the cervical spinal cord or lumbar spinal cord appreciated.4.Findings were discussed with Dr Sullivan at around 9 am on 11/24/15.5.Scoliosis6.Status post lower thoracic and upper lumbar spine surgery. Pedicle screw tracts are identified in the bilateral pedicles of T11, T12, L1 and L2.7.The bladder is relatively full. This is a nonspecific finding. There appears to be a small air bubble in the urinary bladder.


Instruction: Generate impression based on findings.

Input: There are postoperative findings related to lipomyelomeningocele repair. There is a mass with fat signal characteristics along the conus medullaris that is intimately associated with the cauda equina nerve roots. The mass measures 1.5 x 1.4 x 5.8 cm, previously measures 1.5 x 1.3 x 5.8 cm. The conus medullaris appears to extend to approximately the L3-L4 level and there is no significant ventral translation on prone imaging. The vertebral column alignment is uchanged. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable.

Output: Postoperative findings related to lipomyelomeningocele repair without significant change in the residual intradural lipomatous mass surrounding the low-lying conus and involving the distorted cauda equina roots with suggestion of re-tethering.


Instruction: Generate impression based on findings.

Input: Male, 60 years old, with history of cord contusion status post kyphoplasty with history of T5 fracture due to myeloma. A moderate compression deformity of the T5 vertebral body appears similar to the prior examination. There is no significant retropulsion. T5 vertebral body marrow signal characteristics are similar to that seen on the prior examination.Slight encroachment upon the left dorsal epidural space at T5 seen on the prior examination due to osseous fracturing is improved. A small focus of T2 hyperintensity seen within the left lateral cord at T5 which may represent myelomalacia corresponding to a site of edema on the prior study.Small foci of marrow replacement are seen within the T3-T9 vertebral bodies, most or all of which have progressed when compared to the prior examination. Paraspinal masses along the left aspect of the T9 vertebral body, and along the right aspect of the T11 vertebral body have increased in size. Patchy airspace opacity is seen in the right lung.Mild exaggeration of the thoracic kyphosis is seen centered at the T5 compression deformity. Sagittal alignment is otherwise unremarkable. Scattered small disc protrusions have not significantly changed. No high-grade spinal canal stenosis is seen. Mild bilateral foraminal narrowing at T4-5 and T5-6 is noted .

Output: 1.No significant change in the severity of the T5 compression deformity.2.No significant spinal canal compromise is seen at this location.3.A small focus of signal abnormality within the left lateral cord at T5 may reflect myelomalacia from prior injury.4.No new compression deformities are seen. However, numerous foci of marrow replacement in the midthoracic spine are identified concerning for sites of myelomatous disease, most or all of which have progressed from prior. Paraspinal masses in the lower thoracic region have also progressed.


Instruction: Generate impression based on findings.

Input: Chiari malformation. There is artifact related to a left cochlear implant. The cerebellar tonsils extend below the foramen magnum by approximately 10 mm and have a pointed morphology, consistent with Chiari I malformation. There is narrowing of the column of cerebrospinal fluid flow anteriorly across the foramen magnum and obstruction of the column of cerebrospinal fluid flow posteriorly across the foramen magnum. There is no evidence of a syrinx. 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.

Output: Findings consistent with Chiari I malformation without evidence of a syrinx. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: The cervical spine is in normal alignment, with a normal cervical lordosis. The vertebral body and disk heights are well-maintained. No focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal. There is no pathological enhancement. There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the cervical spine. THORACIC SPINE

Output: 1. Suboptimal examination due to motion degradation with possible mild T2 signal within the cord at the level of T7, as well as mild enhancement along the cord surface which appear less prominent compared to the prior study dated 08/27/2013. Findings are compatible with previously treated spinal AVM. 2. No findings to suggest hematoma within the spinal canal or obvious new cord edema within the limitations of the study. No new flow-voids. If there is significant clinical suspicion for persistent arteriovenous shunting, follow-up conventional angiogram may be considered.