Instruction: Generate impression based on findings.

Input: 61 year old female referred for cardiovascular MRI to evaluate etiology of heart failure. Left VentricleThe left ventricle is normal in size with mildly reduced systolic function. Mild concentric left ventricular hypertrophy. The overall LV ejection fraction is 49%, the LV end diastolic volume index is 75 ml/m2 (normal range: 65+/-11), the LVEDV is 155 ml (normal range 109+/-23), the LV end systolic volume index is 38 ml/m2 (normal range 18+/-5), the LVESV is 80 ml (normal range 31+/-10), the LV mass index is 64 g/m2 (normal range 67+/-11), and the LV mass is 132 g (normal range 114+/-24). There are no regional wall motion abnormalities present. There is a borderline region of increased signal on the late gadolinium enhancement images along the basal anterolateral wall of unclear significance which could represent a small amount of mild underlying fibrosing, infiltrative, or inflammatory process; however, I suspect it is more likely an imaging artifact.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 55%, the RV end diastolic volume index is 66 ml/m2 (normal range 69+/-14), the RVEDV is 136 ml (normal range 110+/-24), the RV end systolic volume index is 29 ml/m2 (normal range 22+/-8), and the RVESV is 60 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is trivial pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is trace tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC drain normally into the right atrium. PericardiumThere is a trace pericardial effusion.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Left ventricle is normal in size with mild left ventricular hypertrophy and mildly reduced systolic function (LVEF 49%). There is probably no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.2. Right ventricle is normal in size with normal systolic function RVEF 55%)I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 10-year-old female with history of Crohn's disease and elevated inflammatory markers. Evaluate for small bowel/colon wall thickening.EXAMINATION: MR enterography without and with IV contrast 5/4/2015 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: kidneys and uretersRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Multiple loops of proximal/mid jejunum are noted to have thickened bowel wall (601/9), with corresponding increased enhancement. Restricted diffusion in this area is also noted, suggesting active inflammation. No significant free fluid is seen, and there is no small bowel obstruction.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Multiple loops of proximal/mid jejunum are noted to have thickened bowel wall (601/9), with corresponding increased enhancement. Restricted diffusion in this area is also noted, suggesting active inflammation. No significant free fluid is seen, and there is no small bowel obstruction.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Multiple loops of jejunum with findings of active inflammation/enteritis, as above.


Instruction: Generate impression based on findings.

Input: Breast density study, exam for research purposes only. Research scanning of both breasts was performed with the research protocol. The images are stored for research analysis. Formal interpretation was not performed, existing data are not to be used for clinical purposes.

Output: This study was completed for research purposes only. Formal interpretation was not performed, existing data are not to be used for clinical purposes.


Instruction: Generate impression based on findings.

Input: Known breast cancer patient with metastasis workup. There are multifocal vertebral body lesions likely represent metastasis, specifically, posterior and right side T2 body, T11, L1 body superior endplate, and L2 vertebral body.Nodular and patchy enhancement of conus medullaris, as well as filum terminale on Gad enhanced sagittal scan indicate intra thecal metastasis (series 1501, image 8/15).There is about 10% of chronic vertebral body compression fracture at T7.Spinal cord signal intensity is normal.There is no evidence of spinal canal stenosis or spinal cord compression. There is normal thoracic kyphosis and lumbar lordosis. The spine alignment is anatomic. The signal of the visualized cord is normal. The epidural space, thecal sac, and spinal cord are preserved with no evidence of spinal canal/neural foraminal narrowing, cord compression, or myelopathy. The conus medullaris terminates at the T12-L1 level. There is a small vertebral body hemangioma at T2 vertebral body.There is about 10mm sized right renal cyst.Degenerative changes are specified by the intervertebral level as follows: T12-L1: no neuroforaminal narrowing or spinal stenosis. L1-L2: no neuroforaminal narrowing or spinal stenosis. L2-L3: no neuroforaminal narrowing or spinal stenosis. L3-L4: minimal bulging of disc, no neuroforaminal narrowing or spinal stenosis. L4-L5: diffuse bulging of disc, no neuroforaminal narrowing or spinal stenosis. L5-S1: minimal bulging of disc, no neuroforaminal narrowing or spinal stenosis.

Output: 1. No evidence of cord compression.2. Multiple vertebral body metastatic lesions as described above (T2, T11, L1 and L2), no change since prior exam.3. Nodular and patchy enhancement of conus medullaris and filum terminale indicate intra thecal metastasis.4. Old compression fracture, T7


Instruction: Generate impression based on findings.

Input: 73-year-old female with seizure history presenting with seizure activity and an abnormal EEG with sharp waves noted over the left fronto-temporal area; further evaluation of this area requested. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There has been minimal progression of the mild periventricular and subcortical white matter T2/FLAIR hyperintensity which is nonspecific but likely related to chronic small vessel ischemic changes. This subtle signal intensity within the pons is redemonstrated and unchanged. Again seen is a empty sella with remodeling. There is also some minimal increase in the sulci and ventricle sizes which may be related to global cerebral atrophy. The left hippocampus appears to be smaller than the right side. The signal intensity of the left hippocampus seems to be slightly increased than that of the right side indicating possible hippocampal sclerosis. On prior exam, the left hippocampus appeared to be smaller than that of the right side, however, since that study was not dedicated hippocampus scan, thus, cannot draw any firm conclusion at that point. In addition, it is hard to assess any progression of the left hippocampal signal intensity or size of the left hippocampus comparing to prior scan. There is no abnormal intracranial enhancement. 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: 1.No evidence of acute intracranial hemorrhage, mass, or acute infarct. 2.Smaller left hippocampus compared to the right with subtle higher signal intensity than the right side, indicates possible left hippocampal sclerosis. 3.No additional findings are seen elsewhere to indicate a seizure focus.4.Minimal progression of the likely chronic small vessel ischemic changes.


Instruction: Generate impression based on findings.

Input: 15-year-old male, evaluate for IBD or bowel dilationEXAMINATION: MR enterography without and with IV contrast 2/25/15 ABDOMEN:LIVER, BILIARY TRACT: Small T2 bright focus in the posterior right hepatic lobe without associated enhancement is nonspecific and may in part be artifactual. No biliary ductal dilatation.SPLEEN: No focal lesion.PANCREAS: Normal morphology and enhancement.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: The kidneys enhance symmetrically without hydronephrosis.RETROPERITONEUM, LYMPH NODES: No lymphadenopathy.BOWEL, MESENTERY: There is wall thickening and enhancement of the ileocecal valve and terminal ileum extending approximately 6-8 cm proximal to the ileocecal valve with mildly dilated distal ileum just proximal to the inflamed terminal ileum. Mild wall thickening of the proximal cecum is also noted, which was seen on the prior CT and is improved from the CT dated 1/11/15. No evidence of fistula or abscess. Inflammatory changes in the adjacent mesentery are again noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Moderately distended and otherwise normal.LYMPH NODES: No lymphadenopathy.BOWEL, MESENTERY: There is wall thickening and enhancement of the ileocecal valve and terminal ileum extending approximately 6-8 cm proximal to the ileocecal valve with mildly dilated distal ileum just proximal to the inflamed terminal ileum. Mild wall thickening of the proximal cecum is also noted, which was seen on the prior CT and is improved from the CT dated 1/11/15. No evidence of fistula or abscess. Inflammatory changes in the adjacent mesentery are again noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Wall thickening and enhancement of the terminal ileum, ileocecal valve, and proximal cecum as described above without abscess or fistula.


Instruction: Generate impression based on findings.

Input: Patellar instability MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: The articular cartilage of the medial and lateral compartments is preserved. There is slight depression of the lateral femoral condyle which may relate to prior injury. A small amount of marrow signal is seen along the lateral femoral condyle presumably from prior patellar subluxation.There is a obliquely oriented linear defect involving the medial portion of the patella representing a nondisplaced fracture. Marrow edema is seen along the fracture site although the underlying articular cartilage of the patellofemoral compartment is intact. The femoral trochlea appears slightly shallow and dysplastic. The MPFL is torn.LIGAMENTS: The ACL is absent. The PCL and remaining collateral ligaments are intact.EXTENSOR MECHANISM: There is patella alta although the patellar tendon is intact. A mild amount of edema-type signal surrounds the anterior soft tissues of the knee.ADDITIONAL

Output: 1. Ruptured ACL.2. Oblique, nondisplaced fracture of the patella.3. Findings consistent with prior patellar subluxation including bony contusions of the patella and lateral femoral condyle, shallow appearance of the femoral trochlea, and tearing of the MPFL.


Instruction: Generate impression based on findings.

Input: Head and neck cancer with acute altered mental status. Evaluate for etiology of the altered mental status. There are post-surgical findings partially visualized related to interval resection of a left parotid mass. There is redemonstration of an 8 mm lesion in the left inferior frontal gyrus with intrinsic T1 shortening, complete hypointense T2 rim and associated blooming susceptibility artifact. There is no associated developmental venous anomaly. There are multiple other scattered punctate foci of susceptibility artifact within the supra- and infratentorial compartments, consistent with hemosiderin deposition from chronic microhemorrhages.The ventricles and sulci are prominent, consistent with mild age-related volume loss. The basal cisterns remain patent. There is no midline shift or mass effect. There are scattered punctate foci and confluent areas of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, which is nonspecific, but most likely represent minimal small vessel ischemic changes. There is an area of abnormal T2/FLAIR hyperintensity in the left temporal lobe, which may represent gliosis/encephalomalacia. There is no acute infarct. 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. There is minimal mucosal thickening of the right maxillary sinus and mild mucosal thickening of the left maxillary sinus. Fluid is incidentally noted in the right C1-C2 joint, presumably degenerative in nature.

Output: 1. Partially visualized post-surgical findings related to resection of a mass in the posterior left parotid space.2. No significant interval change in an 8 mm T1 hyperintense lesion with blooming artifact in the left inferior frontal gyrus, most likely representing a cavernoma. No other evidence of abnormal intracranial enhancement to suggest intracranial metastases.


Instruction: Generate impression based on findings.

Input: Status post liver transplant, evaluate for incisional hernia ABDOMEN:LUNG BASES: UnremarkableLIVER, BILIARY TRACT: Status post liver transplant. No focal lesions on this noncontrast CT.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Large left-sided anterior abdominal wall hernia containing nonobstructing small bowel segments and mesenteric fat is not significantly changed from previous MRI.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Extensive degenerative changes involving bilateral hip joints.OTHER: No significant abnormality noted

Output: No significant change in the large anterior wall hernia containing nonobstructive bowel segments on the left side of the abdomen.


Instruction: Generate impression based on findings.

Input: Syringomyelia and syringobulbia [G95.0] / Other intervertebral disc displacement, lumbar region [M51.26] / Low back pain [M54.5], Reason for Study: ^Reason: syrinx, herniated discs, scoliosis, stenosis, back pain, evaluate of changes History: back pain Redemonstration of thoracic syrinx from the level of T3 to the level of T8.Measured maximum diameter of thoracic syrinx is about 5 mm, unchanged since prior scan. Focal spinal cord deformity at the level of T6 is again seen, unchanged. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The conus medullaris terminates at the T12-L1 level. There is broad based disc protrusion central to left which abuts thecal sac at the level of T6-7.Minimal focal eccentric bulging of disc toward left side at the level T78 is also seen.

Output: 1. Thoracic syrinx seen from T34 to T78 level, unchanged in its size and extent since prior scan.2. Disc protrusion at the level of T67 and eccentric bulging at the level of T78, unchanged since prior scan.


Instruction: Generate impression based on findings.

Input: Diagnosis: Epilepsy, unspecified, not intractable, without status epilepticusClinical question: seizuresSigns and Symptoms: seizures The CSF spaces are appropriate for the patient's stated age with no midline shift. A previously noted T2 hyperintense lesion in the splenium of the corpus callosum is significantly less conspicuous on the current exam.There are burr holes present along the left temporal bone and the left parietal bone. Since the prior exam depth electrodes have been removed. There are tracts of T2 signal hyperintensity within the parenchyma of the left temporal and parietal lobe where the depth electrode was placed. Tracts associated with the previously placed electrodes along the left insular cortex are not as readily appreciated.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 right vertebral artery appears hypoplastic distally.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.Status post removal of the electrodes with posttreatment change.2.Please note that this is a limited exam performed for guidance during treatment.3.There has been interval partial resolution of a splenium of corpus callosum lesion.


Instruction: Generate impression based on findings.

Input: Clinical question: Based on the study. Signs and symptoms: Metastatic melanoma. Please measure. Enhanced CT of brain:The examination demonstrates no evidence of metastatic disease to the brain or leptomeninges.There is no evidence of intracranial hemorrhage, edema, mass-effect, midline shift or hydrocephalus. No abnormal enhancement. Calvarium is intact, limited view of the orbits are unremarkable, mastoid air cells and middle ear cavities are unremarkable.There is complete opacification of the left chamber of the splenic sinus. This is associated with subtle thinning of the bone at the level of planum sphenoidale on the left. This finding is best appreciated on axial bone density (series 5) image 10, coronal reformatted bone density (series 8036) image 46, sagittal reformatted bone density image 28 through 30. There are also minimal increased density of the contents of the left chamber of the sphenoid sinus. Although all of the above findings could represent long-standing chronic sinus disease the associated bony changes are concerning and further follow-up or dedicated MRI exam is recommended to exclude the less likely possibility of a small metastatic bony lesion.120 cc of Omnipaque 350 was administered for the study.

Output: 1.Negative enhanced CT of brain parenchyma and the leptomeninges.2.Complete opacification of the left chamber of the sphenoid sinus with some subtle bony thinning of planum sphenoidale which remotely could represent a bony metastatic disease considering provided clinical data. The findings could also represent changes related to long-standing chronic sinus disease or even a small fibrous dysplasia. Please see above comments for exact location of the lesion. Follow-up with an MRI is recommended.


Instruction: Generate impression based on findings.

Input: There are unchanged postoperative findings related to right occipital craniotomy and occipital mass resection. The previously seen focus of enhancement along the superior margin of the postoperative bed is no longer appreciated on today's exam. There is no other evidence of recurrence or residual tumor. Again seen is extensive confluent subcortical and periventricular white matter T2 signal abnormality which likely represents therapy related change. No evidence of acute intracranial hemorrhage, mass, mass effect or midline shift. There is an unchanged right transfrontal ventricular catheter terminating in the third ventricle/level of the foramen of Monro. Mild diffuse volume loss is again noted with stable ventricles. There is mild bilateral maxillary and scattered ethmoid sinus mucosal thickening.

Output: Stable postsurgical findings within the right occipital region without evidence of residual/recurrent tumor.


Instruction: Generate impression based on findings.

Input: Reason: rule out lumbar radiculopathy. hx of prostate cancer with radiation Rx History: L sciatica but sensory problems in both legs and pain in L paraspinal region Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is loss of lumbar lordosis as well as grade 1 anterolisthesis of L2 on L3 and mild retrolisthesis of L3 on L4. There is also grade 2 anterolisthesis of L5 on S1. The conus medullaris is normal in position. No suspicious lesions are seen in the spine to suggest metastatic disease. No abnormal enhancement in the epidural space or of the cauda equina nerve roots. Perineural cysts noted in the sacrum at the S2 level. There is T1 shortening involving the lower lumbar spine and sacral bone marrow consistent with history of prior radiation.There is osseous fusion involving the L4-L5 disc space. There is multilevel disc height loss, particularly the L3-L4 and L5-S1 levels and to a lesser degree L2-L3 level. There are degenerative endplate marrow signal changes as well as vacuum phenomena at these disc spaces. Small Schmorl's nodes are also evident.Multilevel degenerative changes are seen, as described below:T12-L1: Mild disc bulge, ligamentum flavum thickening, and bilateral facet arthropathy. There is no significant spinal canal stenosis. There is mild left neural foraminal stenosis.L1-L2: Mild disc bulge, ligamentum flavum thickening, and bilateral facet arthropathy. No significant spinal canal stenosis. No significant neural foraminal stenosis.L2-L3: Mild disc bulge, ligamentum flavum thickening, and moderate facet arthropathy. Grade 1 anterolisthesis as mentioned above. There is mild to moderate spinal canal stenosis. There is mild bilateral neural foraminal narrowing.L3-L4: Disc bulge, facet arthropathy, ligamentum flavum thickening result in effacement of the lateral recesses as well as mild central canal stenosis. There is mild to moderate right and mild left neural foraminal stenosis.L4-L5: Fusion across the disc space as mentioned above. There is effacement of the lateral recesses without significant central canal stenosis. There is mild right greater than left neural foraminal stenosis. L5-S1: Grade 2 anterolisthesis with advanced bilateral facet arthropathy. There is disc uncovering and mild bulge extending to the neural foramina. There is no significant central canal stenosis. There is effacement of the bilateral lateral recesses. There is moderate to severe right and severe left neural foraminal stenosis where there may be impingement of the exiting L5 nerve roots.Paraspinous soft tissues are within normal limits. Bilateral renal cysts are seen, including a relatively larger one on the right measuring approximately 5 cm in diameter.

Output: 1. Multilevel degenerative changes in the lumbar spine as detailed above. There is mild to moderate L2-L3 and mild L3-L4 central canal stenosis. There is also multilevel neural foraminal narrowing, which is severe at the L5-S1 level where there may be impingement of the L5 nerve roots, particularly on the left. There is also grade 2 anterolisthesis at this level. Additional levels as above.2. No findings to suggest metastatic disease in the lumbar spine.


Instruction: Generate impression based on findings.

Input: There is redemonstration of a large bilobed heterogeneously enhancing lesion centered in the right caudate head and anterior basal ganglia region, that measures 3.4 x 2.4 cm in greatest axial dimensions, compared to previous 3.3 x 2.5 cm, respectively. Please note that remeasurement were obtained, as one of the previous measurements was obtained through the narrow waist of the bilobed lesion, resulting in under measurement. T2 signal remains heterogeneous, with a peripheral T2 hypointense rim of hemosiderin. Small air-fluid levels are again seen, with prominent blooming artifact on susceptibility. A tiny exophytic lobular component of the mass extends just beyond the midline with slight mass effect on the anterior aspect of the third ventricle. There is also mild localized mass effect on the right frontal horn. There appear margin the lesion abuts the right A1 segment. There is no surrounding FLAIR hyperintensity to suggest recent hemorrhage.The ventricles and sulci are otherwise within normal limits. The cisterns remain patent. There is no midline shift. Other scattered punctate foci of T2/FLAIR hyperintensity are seen within the cerebral white matter bilaterally which are nonspecific. No new foci of susceptibility are appreciated. There is no diffusion abnormality. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits.

Output: 1. Redemonstration of right caudate/basal ganglia cavernoma without significant interval change in size or overall configuration. No evidence of surrounding FLAIR abnormality to suggest recent hemorrhage.2. Stable appearance of minimal scattered punctate foci of nonenhancing T2/FLAIR hyperintensity within the cerebral white matter bilaterally, which are nonspecific.


Instruction: Generate impression based on findings.

Input: Female, 65 years old, with known pituitary mass, receiving periodic follow-up at outside hospital, transitional care to CMC. Marked cystic expansion of the sella is demonstrated with bony remodeling suggestive of chronicity. The fluid resembles CSF on all sequences. The native pituitary gland is displaced and flattened along the floor and left lateral aspect of the sella. The pituitary gland appears to enhance normally. No evidence of any solid nodular or enhancing mass is seen. The pituitary infundibulum enhances normally and deviates towards the left. On limited views of the brain, scattered nonspecific T2 hyperintense lesions are seen within the parenchyma. A cavum vellum interpositum is also noted incidentally.

Output: Cystic expansion of the sella is demonstrated with mass effect upon the pituitary gland but no obvious solid or enhancing masses. This finding may simply represent the effects of chronically elevated intracranial pressure such as might be seen with idiopathic intracranial hypertension. Other possibilities would include a Rathke cleft cyst or intrasellar arachnoid cyst though these are considered less likely.


Instruction: Generate impression based on findings.

Input: Craniopharyngioma surveillance. There has been interval evolution of postoperative findings related to right frontal craniotomy, with resolution of extra-axial fluid deep to the craniotomy flap. There is interval increase in size of the heterogeneously enhancing suprasellar mass, attributable to enlargement of a cystic component posteriorly. The signal characteristic of other cystic components have also changed and some of the cysts are slightly smaller. Overall, the tumor measures up to 42 mm in the anteroposterior dimension, previously 39 mm. There is increased mass effect upon the surrounding brain parenchyma and interval increase in size of the bilateral lateral ventricles and superior portion of the third ventricle. There is persistent marked mass effect upon the optic apparatus and circle of Willis vessels, as well as high T2 signal along the left optic tract. There is no evidence of acute infarct. There is no midline shift or herniation. The orbits are grossly unremarkable.

Output: Interval increase in size of the suprasellar craniopharyngioma, attributable to enlargement of a cystic component posteriorly, with resultant aggravation of obstructive hydrocephalus.


Instruction: Generate impression based on findings.

Input: Multiple sclerosis with paresthesias. Brain: There are multiple foci of T2 hyperintensity in the cerebral white matter, mainly in a periventricular distribution, as well as in the brainstem and cerebellum, similar to the prior MRI. Many of the lesions demonstrate low T1 signal. There is no evidence of intracranial hemorrhage, mass, or acute infarct. 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.Cervical Spine: There are multiple foci of high T2 signal within the imaged portions of the spinal cord, most notably at the C2-3 and C4 levels, similar to the prior MRI. 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: The demyelinating lesions in the brain and imaged portions of the spinal cord appear to be similar in extent as on the prior MRI.


Instruction: Generate impression based on findings.

Input: Diagnosis: WeaknessClinical question: assess for expanding old infarction or new infarctionSigns and Symptoms: gait instability The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a T2 and FLAIR hyperintense lesion present along the right posterior lateral aspect of the medulla measuring approximately 5 x 4 mm in axial dimensions which demonstrated diffusion restriction in the October exam. The diffusion restriction has resolvedNormal 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. In general there appears to be bilateral fetal origins of the posterior cerebral arteries with a small basilar artery.The visualized portions of the paranasal sinuses demonstrate mucosal thickening in the right maxillary sinus associated with a asymmetrically smaller right maxillary sinus compared to the left maxillary sinus and thick walls of the right maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Findings are compatible with an old lacunar infarct in the right medulla. This was in the acute phase in October.2.Findings are compatible with silent sinus syndrome involving the right maxillary sinus


Instruction: Generate impression based on findings.

Input: The risks (including, but not limited to, those of bleeding, infection, allergic reaction, temporary nerve block, pain, and inability to access the joint) and benefits of the procedure were explained to the patient, and informed written consent was obtained. A pre-procedural “time-out” form was completed.The patient was placed supine on the fluoroscopy table. The left hip was localized fluoroscopically, and a spot radiograph was obtained. The course of the femoral artery was noted on the patient's skin using an ink marker. The skin was cleansed and covered with a sterile drape. The skin and subcutaneous tissues were anesthetized with 1% lidocaine using 25-gauge and 22-gauge needles.Under fluoroscopic guidance, a 20-gauge spinal needle was advanced into the joint. Attempted aspiration yielded no fluid. Next, 10 ml of a 50/50 mixture of Omnipaque 240 (to confirm the intra-articular position of the needle) and dilute Multihance (0.1 cc in a 10 cc vial of saline, for subsequent MR imaging) were injected into the joint. Contrast opacified the joint in the expected manner. A spot radiograph was obtained for documentation. The needle was withdrawn. Blood loss was negligible (<1cc), and patient tolerated the procedure well without immediate complication. An adhesive bandage was placed on the patient’s skin. Routine post procedure instructions were communicated to the patient. The patient was escorted to the MRI suite for further imaging in stable condition. Please refer to the subsequent MRI report for further information.Exposure time: 46 seconds.

Output: Successful left hip arthrogram injection.


Instruction: Generate impression based on findings.

Input: History of elevated PSA. Evaluate for disease. 15 minutes of direct patient contact was spent counseling the patient about the improved image quality when using an endorectal coil. The patient declined coil placement.PELVIS:PROSTATE:Prostate Size: 5.4 x 4.7 x 4.1 cm (transverse by AP by cc)Peripheral Zone: There is typical heterogeneous appearance of the peripheral zone gland parenchyma. Within the mid to lower aspect of the left apex there is a geographic area of lower T2 signal which abuts the lateral aspect of the capsule and cranially towards the mid gland. This measures 1.1 x 1.3 x 1.0 cm (series 1001 image 16). This is associated with slightly asymmetric early arterial enhancement relative to the rest of the peripheral zone (series 2101 image 1216). There is associated restricted diffusion (series 804 image 284). Appearance is compatible with tumor.Slightly more cranial to this lesion there is an additional small focus of signal abnormality in the mid gland which measures 5 x 5 mm (series 1001 image 18). This may represent an additional small focus of tumor.There is a nonenhancing cystic focus in the posterior aspect of the right peripheral zone which measures 7 mm in maximum diameter and likely represents a retention cyst.Central Gland: Expected nodular appearance of benign prostatic hypertrophy.Seminal Vesicles: Mild dilatation of the seminal vesicles. No evidence of tumor involvement.Extracapsular Extension: No evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic or abdominal lymphadenopathy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Focus of abnormal signal in the left peripheral zone apex measuring 1.3 cm in maximum dimension compatible with tumor. There is an additional small focus of abnormal signal in the mid gland superior to the dominant lesion which measures 5 mm in maximum dimension. No specific evidence of extracapsular extension or metastatic disease.


Instruction: Generate impression based on findings.

Input: Reason: Retroperitoneal Sarcoma. S/p XRT, needs restaging MRI. Some question of IVC involvement ABDOMEN:LIVER, BILIARY TRACT: Right hepatic T2 hyperintensity, likely a cyst.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:Retroperitoneal mass centered within the IVC is compatible with a leiomyosarcoma and has significantly decreased in size from the prior exam with decreased enhancement. There is a rim enhancing infrarenal component which measures 3.1 x 2.5 cm (12/33), previously 4.4 x 4.3 cm. There may be some extension to the right psoas musculature, similar to the prior exam. And nonenhancing intraluminal component extending superiorly, expanding IVC, is similar in size. There is a rim of nonenhancing thrombus extending inferiorly, similar in distribution to the prior exam.BOWEL, MESENTERY: No significant abnormality noted.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: Diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: Scoliosis and degenerative changes.OTHER: No significant abnormality noted.

Output: 1.Leiomyosarcoma within the IVC has significantly decreased in size from the prior exam with decreased enhancement also seen.2.No evidence of metastatic disease.


Instruction: Generate impression based on findings.

Input: There is transitional anatomy with either 11 thoracic and 5 lumbar vertebrae or 12 thoracic and 4 lumbar vertebrae. For the purposes of this exam, the last fully formed disc space will be termed L4-S1. There are postoperative findings related to suboccipital craniotomy for Chiari decompression. There is expected biphasic CSF flow anteriorly and posteriorly across the neo-foramen magnum. There is minimal retroflexion of the dens. The cerebellar tonsils lie at the level of C1. At the C1-C2 level, there is focal syringohydromyelia which measures 6 x 5 x 12 mm, previously 7 x 7 x 12 mm. There is an approximately 58 x 41 mm fluid collection within the left abdomen and pelvis, as well as smaller amount of fluid within the right abdomen that is likely related to the patient's lumboperitoneal shunt. The vertebral column alignment is unchanged, with straightening of the cervicothoracic alignment. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The conus terminates at T12-L1, using the chosen nomenclature for this exam.

Output: 1.Transitional vertebral anatomy, as detailed above. Close attention and correlation during any future spine surgery is recommended. 2.Postoperative findings related to Chiari decompression surgery with patent neo-foramen magnum. 3.A focal syringohydromyelia at the C1-C2 level has minimally decreased in size. 4.Persistent intraperitoneal fluid collections may represent a pseudocyst related to the lumboperitoneal shunt. An ultrasound of this region may be useful for further evaluation.


Instruction: Generate impression based on findings.

Input: 67 years, Female, headache after age 40, nausea. There is a 7 x 8 mm enhancing lesion along the surface of the left inferior frontal lobe, which is favored to be extra-axial in location and demonstrates a broad base compatible with meningioma. No associated edema or mass effect. There is confluent as well as scattered foci of T2/FLAIR hyperintensity involving the bilateral periventricular and subcortical white matter which are nonspecific but compatible with moderate chronic small vessel ischemic disease. No evidence of acute infarct or hemorrhage. There is prominence of the perivascular spaces in the basal ganglia. T2/FLAIR hyperintensity involving the pons is also nonspecific but compatible with small vessel ischemic disease. No hydrocephalus. No extra-axial collections. There is a nonenhancing 5 x 6 mm T1 hyperintense and T2 hypointense lesion involving the posterior aspect of the pituitary gland which may represent a Rathke's cleft cyst. No suprasellar extension or evidence of mass effect.There is opacification involving the lateral recess of the left sphenoid sinus. There is also mild mucosal thickening involving the inferior aspect of the bilateral maxillary sinuses. Calvarium and remainder of the extra cranial soft tissues are unremarkable.

Output: 1. 7 x 8 mm enhancing lesion along the surface of the left inferior frontal lobe likely represents a small meningioma. Would suggest comparison with prior studies if available or short-term follow-up to exclude more aggressive etiologies. No associated edema. No other enhancing lesions within the brain or evidence of intracranial mass effect.2. Subcentimeter nonenhancing lesion involving the posterior aspect of the sella can be better assessed with a dedicated pituitary MRI study but may represent a Rathke's cleft cyst. No associated mass effect.3. Multiple foci of T2/FLAIR hyperintensity in the periventricular and subcortical white matter as well as in the pons are nonspecific but compatible with moderate chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: SAH due to aneurysm in need of embolization.OPERATORS: Greg Christoforidis, Sophia ShakurFLUOROSCOPY TIME: 45.2 minutesFrontal: 1609.8 mGyLateral: 1182.2 mGyPROCEDURES: 1) cerebral angiogram 2) Intracranial cerebral aneurysm coil embolization with balloon assistance. 3) 3-D reconstructions of intracranial right internal carotid artery Left common carotid artery: No evidence for carotid stenosis on the basis of NASCET criteria. There is no evidence for carotid dissection.Left internal carotid artery: There is opacification of the left anterior, middle and posterior cerebral arteries. Venous and parenchymal phases were within normal limits. No evidence for aneurysm, AVM or AV fistula. There is inflow of unopacified blood entering the left ACA from the ACOMA.Left subclavian artery: No evidence for arteriovenous fistula. No evidence for vertebral dissection.Left vertebral artery: No evidence for aneurysm AVM or arteriovenous fistula. There is opacification of the basilar artery and both posterior cerebral arteries. There in inflow of unopacified blood entering the basilar artery and left PCA via the RVA.Right subclavian artery: No evidence for arteriovenous fistula. No evidence for vertebral dissection.Right vertebral artery studied via the right subclavian injection: No evidence for aneurysm AVM or arteriovenous fistula. There is opacification of the PICA and partial opacification of the basilar artery.Right common carotid artery: No stenosis at the carotid bifurcation on the basis of NASCET criteria. There is no evidence for carotid dissection.Right internal carotid artery: There is a 6mmx4mm right PCOMA aneurysm present. The right PCOMA originates from the base of the aneurysm. The right PCOMA is very small an appears to supply perforating arteries. There is opacification of the right anterior, middle and posterior cerebral arteries. Venous and parenchymal phases were within normal limits. There was partial opacification of the ACOMA which was intact. The ACOMA was moderate size. The left A2 segment mildly opacified on this injection. Intraprocedural angiograms:Serial arteriograms performed during aneurysm coiling demonstrate serial occlusion of the aneurysm using balloon remodeling. The balloon remained across the neck of the aneurysm throughout the procedure.Final RICA arteriogram :At the end of the procedure there is pacification of the base of the aneurysm with preservation of the PCOMA and anterior choroidal artery and no thromboembolic events.Right common iliac artery: No contraindications to closure device.

Output: 1.Right PCOMA aneurysm2.Embolization of right PCOMA aneurysm with residual based. The PCOMA originates from the base of the aneurysm and did not depict opacification of the p1 segment. Rather is supplies the thalamotuberal artery and possibly additional perforating arteries.3.Findings were reported to Dr Awad at the end of the procedure.


Instruction: Generate impression based on findings.

Input: Diagnosis: Unqualified visual loss, right eye, normal vision left eyeClinical question: vision loss both eyesSigns and Symptoms: optic nerve pallor, bilateral MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal enhancing mass lesions are appreciated within the brain parenchyma. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate some mucosal thickening in the left maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI orbits:The eyeballs are intact. No intraconal or extraconal space mass is identified. The extraocular muscles are intact. The lacrimal glands are symmetric and within normal limits in size and configuration. There is no optic nerve enhancement appreciated. The suprasellar cistern is intact .Some minor thickening of the superior aspect of the infundibulum of the pituitary gland is nonspecific, however, it extends into the center of the optic high as in.

Output: 1.There is minimal thickening of the superior aspect of the infundibulum of the pituitary gland extending to the optic chiasm. This a nonspecific finding but may represent some minor or early inflammatory effect (such as granulomatous lesion or other infiltrating lesion). Please correlate with clinical history and findings.2.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. They are most likely vascular related.


Instruction: Generate impression based on findings.

Input: Altered mental status in a 55-year-old female. No evidence of hemorrhage, edema, mass effect or midline shift or hydrocephalus is detected. This examination is essentially normal limits for patient of stated age of 55. If clinical symptoms persist an MRI would be helpful. Calvarium, paranasal sinuses and mastoid air cells also unremarkable.

Output: Normal CT brain.


Instruction: Generate impression based on findings.

Input: 40 year-old female with left foot pain over fifth metatarsal shaft Alignment is anatomic. Bone marrow signal is normal throughout the visualized foot. Normal muscle bulk. The extensor and flexor tendons appear unremarkable. The previously noted edema signal along the lateral soft tissues adjacent to the fifth metatarsal has resolved.

Output: No specific findings to account for the patient's pain.


Instruction: Generate impression based on findings.

Input: Ms. Hamilton is a 61 year old female with a personal history of benign left breast MR-guided biopsy in 08/2010 for atypical lobular hyperplasia. She has a strong family history of breast cancer in her sister (diagnosed at the age of 59), paternal grandmother (diagnosed in her 70s), and a paternal first cousin (diagnosis at the age of 53). She has no current breast related complaints. There is scattered fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally. A few cysts are again seen on T2 images.No suspicious enhancement is seen in either breast. Stable benign intramammary lymph node is seen in the left breast upper outer quadrant. Artifact from the benign MR guided biopsy in the left central breast. Scattered areas of enhancement bilaterally do not appear significantly changed, including the area in the right 9:00 breast. No abnormal axillary lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Right upper extremity weakness. The images are degraded by patient motion. There is high T2 signal and mild swelling of the left medial temporal lobe and basal ganglia without restricted diffusion. There are otherwise multiple scattered areas of cerebral and pontine white matter T2 hyperintensity. There are bilateral cerebral convexity subdural effusions, which measures up to 4 mm in thickness. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. Sequelae of maxillofacial trauma are better delineated on the prior CTs.

Output: 1. High T2 signal and mild swelling of the left medial temporal lobe and basal ganglia without restricted diffusion may represent traumatic brain injury, subacute infarction superimposed upon a background of chronic small vessel ischemic disease, and less likely neoplasm, although the assessment is limited by patient motion and the lack of intravenous contrast. Otherwise, no evidence of acute infarction. Nevertheless, follow up with a brain MRI with contrast is recommended.2. Small bilateral cerebral convexity subdural hygromas.3. Sequelae of maxillofacial trauma are better delineated on the prior CTs.


Instruction: Generate impression based on findings.

Input: 31 year old with strong family history of breast cancer. There is extreme amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: NS - Routine Screening Mammogram.


Instruction: Generate impression based on findings.

Input: Neoplasm of unspecified nature of brainh/o brain tumor; preop planning for biopsy There is redemonstration of a mass centered in the left thalamus measuring 46 x 33 mm axial dimensions. There is associated signal abnormality involving the right thalamus, the left caudate nucleus, the left lentiform nuclei and the midbrain. There is greater involvement of the left cerebral peduncle compared to the right cerebral peduncle. This appearance is stable when compared to the previous exam from 6/2/2015Normal 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 minor opacities. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.There are defects present along the skin surface along the right occipital and right parietal scalp.Fiducial markers are in place.

Output: 1.A mass is centered in the left thalamus associated with signal changes in the left basal ganglia and infiltration into the right thalamus. It is stable compared to the prior exam. Examination was performed for the purpose of stereotactic surgical guidance2.There are defects present along the skin surface along the right occipital and right parietal scalp. Please correlate with physical findings on clinical exam


Instruction: Generate impression based on findings.

Input: BAckache Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: No compromise to lumbar spinal canal or neural foramina.


Instruction: Generate impression based on findings.

Input: Several sequences, particularly the axial T2-weighted sequences, are motion degraded.CERVICAL SPINE

Output: 1. Examination slightly motion degraded however there is no spinal cord signal abnormality or abnormal enhancement involving the cord or cauda equina nerve roots.2. At C5-C6 there there is a left paracentral disc protrusion causing effacement of the ventral thecal sac and minimal impression on the left ventral aspect of the spinal cord without neural foraminal or significant spinal canal stenosis overall. 3. There are minimal diffuse disc bulges at L4-L5 and L5-S1 with minimal bilateral neural foraminal narrowing at L4-L5 as described above.


Instruction: Generate impression based on findings.

Input: Clinical question: Altered mental status for one week, blunt head trauma. Signs and symptoms: Same Unenhanced head CT:There is no evidence of intracranial hemorrhage, edema, mass-effect, midline shift or hydrocephalus. The cortical sulci, ventricular system, CSF cisterns and gray -- white matter differentiation remains within normal. Limited view of the orbits are unremarkable. Calvarium and visualized paranasal sinuses and mastoid air cells as well as middle ear cavities are also unremarkable. There is no evidence of any soft tissue abnormality of scalp. If clinical concern persists recommend an MRI examination.

Output: Negative nonenhanced head CT.


Instruction: Generate impression based on findings.

Input: Female, 39 years old, history of lung cancer with metastases. No convincing evidence of any residual enhancing lesions are seen within the brain or cerebellum.Progression of ill-defined periventricular and somewhat linear external capsule T2 hyperintensity is seen, most likely related to therapy. No mass effect or midline shift is detected. No abnormal extra-axial collections are seen. The ventricles are stable and normal in size. A subcentimeter nonspecific focus of enhancement within the left occipital bone is unchanged.

Output: Continued interval improvement with resolution of all residual enhancing parenchymal lesions.


Instruction: Generate impression based on findings.

Input: 56-year-old female with facial droop; evaluate for CVA There is no evidence of acute intracranial hemorrhage, mass or edema. Multiple foci of hypoattenuation are seen in the periventricular and subcortical white matter which may represent small vessel ischemic disease of indeterminate age. Mild asymmetry is seen in the temporal lobes which may be artifactual. Right posterior cerebellar wedge shaped hypodensity is seen which may represent acute / subacute infarct versus artifact. Recommend MRI of the brain for further evaluation. The gray-white matter differentiation is grossly preserved. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses, mastoid air cells and middle ear cavities are normally pneumatized.

Output: No acute intracranial hemorrhage. Wedge-shaped right cerebellar hypodensity which may represent acute or subacute infarct versus artifact. Small vessel ischemic disease of indeterminate age. Given the absence of prior study for comparison, acute infarcts cannot be excluded. Recommend MRI of the brain for further evaluation.


Instruction: Generate impression based on findings.

Input: T2N1 left lateral tongue squamous cell carcinoma status post partial glossectomy. There are postoperative findings related to left partial glossectomy and left neck dissection. There is no evidence of measurable tumor in the oral cavity region. The cervical lymph nodes are not enlarged by size criteria. The thyroid and remaining salivary glands are unremarkable. There are persistent bilateral otomastoid effusions. The orbits are unremarkable. There is mild degenerative cervical spondylosis. There are scattered foci of nonspecific cerebral white matter T2 hyperintensity.

Output: 1. Interval resection of the left oral tongue tumor, without evidence of measurable residual tumor. 2. No evidence of lymphadenopathy in the neck.


Instruction: Generate impression based on findings.

Input: There is a redemonstration of expansile infiltrative high T2 signal in the right insula, right basal ganglia and infiltrates into the right parietal, temporal, and frontal lobes without enhancement. Gray white differentiation has been lost and overlying gyri appear to be effaced.There is no evidence of abnormal contrast enhancement.There is minimal effacement of the right lateral ventricle and the minimal midline shift to the left, no changes in the previous study.

Output: Preoperative planning MRI demonstrates infiltrative intra axial lesion involving multiple lobes of the right cerebral hemisphere, which is suggestive of gliomatosis cerebri.


Instruction: Generate impression based on findings.

Input: Reason: rule out cord compression History: Weakness of all 4 extremities status post fall, difficulty walking Abnormal T2 hyperintensity of the cord from C3-4 to C5-6 levels. Prevertebral edema throughout the cervical spine. There is edema involving the C6-7 disc space with asymmetric anterior widening and suggestion of anterior longitudinal ligament disruption compatible with hyperextension injury. Air is seen within this space on recent CT. Advanced degenerative changes throughout the cervical spine.C1/2: No evidence of foraminal narrowing or spinal canal stenosis.C2/3: Mild to moderate posterior bulging of the central disc with effacement of the thecal sac and mild spinal canal stenosis. No significant foraminal narrowing.C3/4: Posterior bulging of the disc with moderate to severe spinal canal stenosis. Moderate right and mild left foraminal narrowing. C4/5: Posterior bulging of the disc with moderate to severe spinal canal stenosis. Moderate bilateral foraminal narrowing. C5/6: Posterior bulging of the disc with moderate spinal canal stenosis. Mild bilateral foraminal narrowing. C6/7: Posterior bulging of disc with moderate spinal canal stenosis. Mild to moderate bilateral foraminal narrowing. C7/T1: Minimal grade 1 anterolisthesis of C7 over T1. No significant spinal canal or neural foraminal stenosis.

Output: Advanced degenerative changes throughout the cervical spine with moderate to severe spinal canal stenosis at C3-C4 and C4-C5 and to a lesser degree at the additional levels. There is edema involving the C6-C7 disc with asymmetric widening of the disc space anteriorly, suggestion of disruption of the anterior longitudinal ligament at this level, and mild prevertebral edema. These findings are consistent with recent trauma. There is extensive abnormal cord signal extending from the C3-C4 to the C5-C6 levels which is favored to represent, at least in part edema, although a component of this may reflect myelomalacia.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Thyroid carcinoma, known metastatic disease. Shortness of breath with hemoptysis, query pulmonary embolism. PULMONARY ARTERY: This is a technically adequate examination for the evaluation of pulmonary embolism. No pulmonary embolism is noted to the subsegmental level.LUNGS AND PLEURA: Despite the short term interval, there is evidence of interval progression of metastatic disease. Some of the innumerable pulmonary nodules throughout both lungs have slightly enlarged. For example, on image 47/156, a pulmonary nodule measures 11 mm as compared to 10 mm one month ago. A second nodule in the right upper lobe (image 36/156) currently measures 8 mm as opposed to 6 mm.Progressive thickening of the major fissure with irregular nodularity is noted. There is progressive increased reticulonodular thickening of the interlobular septae raising a question of lymphangitic involvement. Persistent atelectasis at the superior segment of the left lower lobe.MEDIASTINUM AND HILA: The mediastinal and hilar lymphadenopathy has increased in size. The right low pretracheal lymph node now measures 22 x 26 mm, compared to 26 x 19 mm one month ago. The subcarinal lymph node is also enlarged, measuring 26 x 22 mm as compared to 22 x 22 mm.The left paraesophageal lymph node is stable, measuring 20 x 20 millimeters.CHEST WALL: A right breast nodule inferior at the nipple line on image 168/313 has slightly enlarged, measuring 10 x 10 mm, as opposed to 9 x 6 mm. A second nodule in the inferomedial left breast currently measures 8 mm AP dimension as opposed to 6 mm.UPPER ABDOMEN: The enhancing left adrenal nodule has increased in size, measuring 27 x 20 mm on image 290/313 as opposed to 18 x 24 mm. The right adrenal mass with central low density is not significantly changed in size. However, there is a new enhancing nodule anterior to the right adrenal gland measuring approximately 9 mm in its transverse dimension.Although this is not optimized for evaluation of the hepatic parenchyma, there are new foci of hyperdensity throughout the right hepatic lobe suspicious for hypervascular metastases. Further evaluation may be performed with either triphasic CT or dedicated hepatic MRI. Incidentally, there is a replaced right hepatic artery.A hiatal hernia is present. BONES: There are multiple osseous lesions in the mid and lower thoracic and upper lumbar vertebral bodies compatible with metastases.

Output: 1. No evidence of pulmonary embolism to the subsegmental level2. Progression of pulmonary metastases with enlarging pulmonary nodules and mediastinal lymphadenopathy.3. Interval appearance of hypervascular lesions throughout the right hepatic lobe suspicious for metastatic disease. Further investigation with a triphasic CT or dedicated hepatic MRI recommended.,


Instruction: Generate impression based on findings.

Input: Hydrocephalus, unspecified [G91.9] / Other complicated headache syndrome [G44.59] / Cerebral cysts [G93.0], Reason for Study: ^Reason: 27 year old female with, cerebral palsy, encephalitis, post hemispherectomy as child, hydrocephalus with VP shunt and mul Right hemispherectomy status, unchanged.There is no evidence of acute ischemic or hemorrhagic lesion on this scan.Multiloculated fluid collections appear to be unchanged in terms of maximum diameter since prior scan.The periventricular white matter T2/FLAIR high signal intensities are again seen, unchanged. Collapsed left lateral ventricle, unchanged.Extradural lenticular shaped fluid collection on the right side is again seen, unchanged in its maximum diameter.There is, however, tubular shaped low signal intensity portion on all sequences on the right frontal area [11.5mm (AP) x 11.2mm (RL) x 23.6mm (CC)] indicating air filled space. On prior scan performed on Dec 28 2015, this lesion was filled with fluid which was filled with air on Sep 23 2015.The paranasal sinuses and mastoid air cells are clear.

Output: No evidence of acute ischemic or hemorrhagic lesion on this scan.Filing of air at the right extra dural space which was filled with fluid on prior scan as described above.Otherwise no interval change of post right hemispherectomy status since prior scan.


Instruction: Generate impression based on findings.

Input: Male, 65 years old, with history of grade 2 astrocytoma status post RT + TMZ several years ago. Evaluate for growth. Patchy, non-masslike T2/FLAIR hyperintensity is again seen within the pons and medulla showing no significant interval change in morphology or geographic extent. No associated enhancement is seen.A focus of susceptibility within the right posterior medulla, and a very small additional focus along the left posterior medulla, are unchanged, possibly representing foci of microhemorrhage or small cavernous malformations.Subcortical T2 hyperintensity within the right cuneus and in the right inferior frontal gyrus is unchanged. Likewise, scattered small foci of periventricular and subcortical white matter T2 hyperintensity are unchanged and nonspecific. No evidence of mass effect is seen. The ventricular system is stable in size and morphology. Prominence of the CSF space along the right cerebellar hemisphere is unchanged.

Output: Stable examination with no findings to suggest recurrent or progressive disease.


Instruction: Generate impression based on findings.

Input: 60 years, Female, with a history of syncope versus seizure. Brain parenchyma appears within normal limits for age. No intracranial mass or mass effect. No abnormal parenchymal or meningeal enhancement. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. Minimal nonspecific foci of T2/FLAIR hyperintensity in the supratentorial white matter. Bilateral hippocampi are symmetric in size and signal characteristics with preserved internal architecture. The ventricles are within normal limits in size and configuration. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. Bone marrow signal and extracranial soft tissues are within normal limits. Incidentally seen are enlarged bilateral parietal foramina, a normal variant.

Output: Brain parenchyma appears within normal limits. No evidence of infarct, intracranial mass, or abnormal enhancement. No findings to suggest seizure focus.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for lower back pain. Signs and symptoms: Back pain, sciatic pain. Nonenhanced lumbar MRI:The lower most visualized thoracic spine and thoracic cord is unremarkable.T12-L1 and L1-L2 level was demonstrate mild degenerative changes and unremarkable otherwise.L2-L3 demonstrate moderate disc disease and loss of disc height and mild bilateral facet and ligamentum flavum hypertrophy. There is a central and leftward broad-based disc protrusion resulting gain significant left lateral recess compromise. Degenerative changes also result in mild central spinal stenosis at this level.L3-L4 demonstrate advanced disc disease and loss of disc height, mild bilateral (right greater than left) ligamentum flavum hypertrophy and to a lesser degree facet hypertrophic changes are noted. Constellation of changes results in mild central spinal stenosis and lateral recesses compromise (right greater than left) as well as mild to moderate right neural foraminal compromise.L4-5 demonstrate advanced disc disease and loss of disc height, moderate bilateral facet and ligamentum flavum hypertrophy and trace anterolisthesis. Although there is mild compromise of the transverse diameter of the thecal sac is no spinal stenosis in AP axis. Degenerative changes however results in moderate left neural foraminal compromise, mild bilateral recess compromise and moderate left neural foraminal compromise.L5-S1 demonstrate advanced disc disease and loss of disc height, mild bilateral facet and ligamentum flavum hypertrophy without central spinal stenosis. There is a central and left lateral broad-based disc protrusion with mass effect and posterior displacement of left S1 nerve root in the lateral recess. Moderate left neural foraminal compromise secondary to degenerative disease is also noted.Postcontrast images demonstrate expected enhancement of degenerative changes in particular of the facets and ligamentum flavum and unremarkable otherwise.

Output: 1.Degenerative changes of lumbar spine with resultant central spinal stenosis at L2-L3 and L3-L4 levels. Mild decreased transverse diameter of the thecal sac at L4/L5 however without central spinal stenosis and AP axis.2.A central and leftward protrusion at L2-L3 level and a central and leftward disc protrusion at L5-S1 levels as detailed above.3.Mild to moderate neural foraminal compromise at multiple levels as detailed per level.4.Unremarkable postcontrast images.5.Please see detailed report per level above.


Instruction: Generate impression based on findings.

Input: 40-year-old female with history of left knee pain and structural damage to representing with worsening knee pain and swelling MENISCI: The anterior and posterior horns of the lateral meniscus are markedly small, deformed, and have abnormal signal intensity consistent with complex tears and degeneration, progressed since the prior study. The anterior horn of the medial meniscus is macerated. The posterior horns of the medial meniscus is also small and deformed and has abnormal signal intensity consistent with complex tears and degeneration. There is medial extrusion of the body of the medial meniscus and lateral extrusion of the body of the lateral meniscus.ARTICULAR CARTILAGE AND BONE: Greater than 50% thinning of the articular cartilage of the medial femoral condyle. Thinning and irregularity of the articular cartilage of the lateral femoral condyle. Near-complete thinning of the articular cartilage of the medial facet of the patella. Severe tricompartmental osteoarthritis most pronounced along the medial tibiofemoral compartment. There is increased bone marrow signal abnormality along the proximal aspect of the medial tibial plateau and medial femoral condyle which like represents bone marrow reactive change or contusions. New bone marrow edema type signal along the posterior aspect of the tibial condyle beneath the tibial spine.Confluent residual red marrow is noted in the distal femoral metaphysis as well as patchy areas within the proximal tibial metaphysis. LIGAMENTS: Posterior cruciate ligament is intact. New intermediate signal within the ACL is suspicious for at least a partial tear. Some fibers can be followed along the course of the ligament. The medial collateral ligament is intact. The lateral collateral ligament complex is intact. EXTENSOR MECHANISM: The extensor mechanism is intact. Susceptibility artifact from metal and fibrosis in the fat pad of Hoffa compatible with prior surgery.ADDITIONAL

Output: 1.Progression of bilateral complex tears and degeneration involving both menisci.2.At least a partial tear of the ACL.3.Marked osteoarthritis affects the knee with near full-thickness to full-thickness articular cartilage defects as described above.


Instruction: Generate impression based on findings.

Input: This exam is degraded by motion artifact and inability to complete the exam. No susceptibility weighted imaging was performed. There is no evidence of acute infarct. There are patchy foci of T2 hyperintensity throughout the supratentorial and infratentorial white matter that are most compatible with chronic small vessel ischemic disease. There are additional small chronic lacunar infarcts of the brainstem and cerebellum. There is mild global volume loss. 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. There is mild vermian hypoplasia. There is a chronic deformity of the right medial orbital wall. There is minimal paranasal sinus mucosal thickening.

Output: 1.Motion degraded and incomplete exam without susceptibility weighted imaging.2.No evidence of acute infarct.3.Supratentorial and infratentorial chronic small vessel ischemic disease and chronic lacunar infarcts.


Instruction: Generate impression based on findings.

Input: 17-year-old male pitcher with medial elbow pain. Evaluate ulnar collateral ligament. LIGAMENTS: Intra-articular contrast material traverses a linear defect traversing the entire ulnar collateral ligament, consistent with complete rupture (image 13; series 501).TENDONS: No significant abnormality noted.ARTICULAR SURFACES AND BONE: Incidental note is made of a benign bone island within the distal humerus. No evidence of articular cartilage degeneration. No bone marrow signal abnormality is identified.SURROUNDING STRUCTURES: No significant abnormality noted.ADDITIONAL

Output: Findings consistent with complete rupture of the ulnar collateral ligament.


Instruction: Generate impression based on findings.

Input: 80 years Female (DOB:8/17/1935)Reason: history of lumbar fusion History: history of lumbar fusionPROVIDER/ATTENDING NAME: BEN-ZION ROITBERG BEN-ZION ROITBERG The patient is status post laminectomies at L1, L2, L3 and L4 and fusion using pedicle screws and interconnecting rods from L1 through L5. There is approximately 13 mm anterior subluxation of L4 and L5. There is T2 signal hyperintensity present along the perivertebral musculature. There is fatty replacement of the paraspinous musculature at L5 and at the level of the sacrum.The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is disc desiccation present at this level associated with a diffuse disc bulge, significant loss of disc space height and endplate reactive change which is high signal on T1. There is mild facet hypertrophy at this level.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is loss of disc space heights disc desiccation and anterior subluxation of L4 and L5 at this level. At L3-4 there is no significant compromise to spinal canal or neural foramina. There is loss of disc space height at this level. There is a fluid collection behind the thecal sac at this level measuring 11 x 26 mm axial dimensions and 27 x 14 mm sagittal dimensions. It is well-circumscribed. At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina. There is mild posterior subluxation of L1 on L2. There is loss of disc space height and some endplate reactive changes which are hyperintense on T1.At T12-L1 there is loss of disc space height and disc desiccation and some mild compression along the anterior-inferior aspect of T12.There is a 56 mm cystic lesion along the superior pole of the left kidney. There is a 8 mm cyst along the upper portion of the right kidney. There is a 15 mm cyst along the inferior portion of the right kidney. There is a 28 mm cyst along the inferior aspect of the left kidney. There is a 15 mm cyst along the midportion of the left kidney.

Output: 1.The patient is status post lumbar spine surgery with multilevel laminectomies and posterior fusion using pedicle screws and interconnecting rods. There is no significant compromise to the spinal canal or exiting nerve roots on the current exam. 2.There are multilevel degenerative changes present in the lumbar spine without subluxation at L4-5 and lesser degree L1-23.Signal changes within the paraspinous musculature are present. This could represent edema from recent surgery or denervation atrophy.4.There is a fluid collection behind the thecal sac at the surgical site which is well-circumscribed.5.There are multiple renal cysts present measuring up to 5.6 cm in size.


Instruction: Generate impression based on findings.

Input: Diplopia and upward gaze. History of head concussion. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No evidence of intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: Leg weakness and heaviness. Lumbar radicular pain, multiple joint AVN, high titers APS Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits aside from straightening. Bone marrow signal is benign. The conus medullaris is normal in position.There is developmental narrowing of the lumbar spinal canal without high-grade spinal canal stenosis at any level. No significant disc disease is present from T12-L1 to L4-L5. At L5-S1, there is disc desiccation as well as a central disc protrusion which partially effaces the lateral recesses without significant central spinal canal stenosis. There is fairly mild neural foraminal narrowing at this level, relatively greater on the left. There is also mild generalized facet hypertrophy throughout the lumbar spine.Paraspinous soft tissues demonstrate prominence of the subcutaneous fat but are otherwise unremarkable. There is a cyst in the right kidney.

Output: 1. Development of narrowing of the lumbar spinal canal without high-grade spinal canal stenosis or neural foraminal stenosis at any level.2. There is a central disc protrusion at the L5-S1 level with partial effacement of the lateral recesses and mild neural foraminal narrowing at this level.


Instruction: Generate impression based on findings.

Input: 5 x 6 cm nodule of the left posterior neck, waxing/waning in size, assess depth or if adherent to adjacent structures A subcutaneous T2 hyperintense cystic lesion is seen in the left posterior neck under a vitamin E capsule marker measuring 4.1 x 2.5 cm (image 33, series 901). This measures up to 3 cm in craniocaudal dimension (image 29, series 601). This has minimal mass effect on the underlying left trapezius muscle, however the fat plane between the cyst and muscle is preserved and there is no evidence of muscular invasion. Very thin peripheral enhancement is seen on the postcontrast images, however no internal enhancement is seen. Given its proximity to the skin surface, this may represent a sebaceous cyst. No other masses are identified.No cervical lymphadenopathy is seen. The airway appears patent. The visualized intracranial structures which include the posterior fossa are intact. The paranasal sinuses and mastoid air cells are clear.The parotid, submandibular, and thyroid glands appear intact. The carotid and vertebral vascular flow voids are intact.Degenerative changes are present on the seen in the lower cervical spine with scattered areas of neural foraminal narrowing, however no significant central canal stenosis.

Output: Simple cyst involving the left posterior neck subcutaneous soft tissues. While this is nonspecific, given its proximity to the skin surface, this may represent a sebaceous cyst. No invasion of the underlying musculature.


Instruction: Generate impression based on findings.

Input: Ms. Nagle is a 51-year-old female with a family history of breast cancer in her maternal grandmother diagnosed in her 40s. Personal history of benign left breast biopsy. No current breast related complaints. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.High T2 signal hepatic lesion seen on prior studies is partially visualized, likely a benign cyst or hemangioma.

Output: No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: NS - Routine Screening Mammogram.


Instruction: Generate impression based on findings.

Input: Slurred speech [R47.81], Reason for Study: ^Reason: ? Stroke History: slurred speech, RLE weakness There are localized restricted diffusion lesions on the left side of pons indicating acute ischemic infarct. There is no evidence of hemorrhagic conversion. Localized T2/flair high signal intensity lesions on the left external capsule right thalamus indicating lacunar infarctions.Underlying brain shows scattered T2/flair high signal intensity lesions on periventricular white matter indicating nonspecific small vessel ischemic disease.The ventricles, sulci and cisterns are unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate multifocal intracranial arterial luminal stenosis. Among them, the distal left internal carotid artery just above the posterior communicating artery origin and mid basal artery demonstrate more than 50% of luminal stenosis.There is no evidence of intracranial aneurysm.

Output: 1. Left pontine acute ischemic infarct without evidence of hemorrhagic conversion.2. Nonspecific small vessel ischemic disease and scattered lacunar infarctions.3. Multifocal intracranial arterial luminal stenosis indicating atherosclerotic lesions. In particular, left distal ICA and mid basilar artery stenosis appear to be more than 50% of luminal stenosis.4. No intracranial arterial aneurysm is seen.


Instruction: Generate impression based on findings.

Input: 62-year-old male with altered mental status. There is extensive bifrontal encephalomalacia and postsurgical changes of a frontal craniotomy. There is associated hyperostosis of the planum sphenoidale secondary to prior meningioma. Focal soft-tissue prominence within the surgical bed, may represent tumor recurrence. However this is a nonspecific appearance. For further clinical evaluation MRI may be considered.There is ex vacuo dilation of the frontal horns of the lateral ventricles secondary to postsurgical change. The remaining ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are otherwise radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Expected postsurgical change with questionable focal soft-tissue prominence within the surgical bed, which may represent tumor recurrence. However, this is a nonspecific appearance. For further clinical evaluation MRI may be considered.


Instruction: Generate impression based on findings.

Input: Female 15 years old with knee and thigh pain, evaluate The bones appear slightly demineralized. The femur appears normal without specific findings to account for patient's pain.

Output: Bones appear slightly demineralized, but no specific findings to account for patient's pain.


Instruction: Generate impression based on findings.

Input: 28-year-old man with history of Crohn's status post ileocecectomy 8/2016, now presents with right lower quadrant phlegmon and pneumaturia. ABDOMEN:LIVER, BILIARY TRACT: Poor signal in the dome of the liver. A few subcentimeter cysts are noted in the right lobe, otherwise the liver is normal in signal and morphology.No intra or extrahepatic biliary ductal dilatation. The gallbladder appears normal.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: 6 mm cyst in the left renal midpole, otherwise the kidneys appear normal. There is mild prominence of the right renal collecting system and ureters. There is inflammation in the bowel and mesentery adjacent to the mid and distal right ureter.RETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: Multiple thickened, enhancing loops of small bowel are seen predominantly in the right lower quadrant near the anastomotic site from prior ileocecectomy. Mild diffusion restriction within these loops indicates acute inflammation. There is a moderate amount of interloop fluid. There is a stellate fluid collection in the right lower quadrant with thick enhancing wall (1801/62) which appears to extend between loops of small bowel and to the dome of the bladder measuring approximately 55 x 43 mm. Additionally, there is an apparent ~2 cm tract communicating (1601/27) between small bowel loops and the right bladder dome.Of note, the transverse, descending, and rectosigmoid colon appear relatively normal.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: Nondependent susceptibility artifact in the bladder indicates intraluminal air. In the right lateral dome of the bladder, there is an approximately 33 mm broad-based area of serosal and intramural thickening and enhancement. Within this area, there is an apparent tract (described above) which appears to traverse the wall of the right dome of the bladder (1801/48).LYMPH NODES: No significant lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1.Acutely inflamed small bowel loops, predominantly in the right lower quadrant near the proximal anastomosis with interloop fluid suspicious for Crohn's flare.2.Stellate shaped collection of fluid with enhancing wall which is suspicious for network of enteroenteric fistulae versus interloop abscess (area present on prior preoperative CT imaging, increased).3.Possible enterovesicular fistula tract involving the right dome of the bladder.


Instruction: Generate impression based on findings.

Input: 55-year-old female with pain in the humerus and right shoulder 4 weeks not responding to physical therapy. No mass felt. Rule out rotator cuff pathology. RIGHT HUMERUS:The bone marrow signal intensity of the humerus is within normal limits. The musculature of the arm appears normal. There is fluid within the bicipitoradial bursa indicating a bursitis. Please note that this study was not protocoled for detailed evaluation of the distal biceps tendon. If there is clinical concern for distal biceps tendon pathology, MRI of the elbow could be considered. There is a small amount of fluid within the elbow joint.RIGHT SHOULDER:ROTATOR CUFF: On the coronal oblique fat saturated T2 weighted images, there is increased signal intensity within the distal fibers of the supraspinatus tendon and along the bursal surface fibers of the tendon. While on the coronal oblique images, these findings are suggestive of a high-grade partial-thickness tear, the increased signal intensity appears to extend through the entire thickness of the tendon on the sagittal oblique sequences, suggesting focal full-thickness disruption. Overall the tear is approximately 1 cm in the AP dimension. There is intermediate signal intensity within the adjacent supraspinatus tendon indicating moderate tendinosis. There is fatty atrophy along the myotendinous junction of the supraspinatus which otherwise appears normal. There are also small intrasubstance cysts along the myotendinous junction of the supraspinatus. There is intermediate signal intensity within the anterior fibers of the infraspinatus tendon indicating tendinosis. There is a collection of cysts extending along the myotendinous junction of the infraspinatus. There is mild fatty infiltration of the infraspinatus. There is intermediate signal intensity of the distal fibers of the subscapularis suggesting mild tendinosis with small cysts within the underlying humeral head. The subscapularis muscle appears intact. The teres minor muscle and tendon appear intact.SUPRASPINATUS OUTLET: Mild to moderate osteoarthritis affects the acromioclavicular joint. There is trace fluid within the subacromial-subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is within normal limits. There is a small linear focus of fluid signal intensity within the posterior superior labrum suspicious for a small tear. The remainder of the labrum is unremarkable.BICEPS TENDON: There is increased intrasubstance signal within the tendon of the long head of the biceps at its transition from the rotator interval to the intertubercular groove suggesting mild tendinosis.

Output: 1. Near full-thickness to full-thickness tear of the distal supraspinatus with tendinosis and intrasubstance cysts along the myotendinous junctions of the supraspinatus and infraspinatus.2. Osteoarthritis of the acromioclavicular joint.3. Probable small tear of the superior glenoid labrum.4. Mild tendinosis of the tendon of the long head of the biceps.5. Normal-appearing humerus and arm musculature.6. Bicipitoradial bursitis. Although we see no full-thickness tear of the tendon of the long head of the biceps, the study was not protocoled for detailed evaluation of the distal biceps tendon. If there is clinical concern for a partial thickness tear, MRI examination of the elbow could be considered.


Instruction: Generate impression based on findings.

Input: LUE weakness, L facial droop. There is no evidence of restricted diffusion in the brain, brainstem, or cerebellum. THere is no gross tumor or midline shift, within the limits of the diffusion-weighted imaging.

Output: Diffusion-weighted imaging shows no evidence of acute infarct.


Instruction: Generate impression based on findings.

Input: Preoperative planning for right temporal lobe mass. Limited axial images for preoperative stealth planning are provided. There is a T2 hyperintense and T1 isointense peripherally enhancing mass centered in the medial right temporal lobe measuring approximately 3.5 cm. A small amount of surrounding T2 signal consistent with vasogenic edema is demonstrated. There is mild associated mass effect. No midline shift is appreciated. No additional enhancing lesions are identified. The ventricles are nondistended. No extra-axial fluid collections are visualized.There is trace fluid present in the right mastoid air cells. There is diffuse mucosal thickening of the sphenoid sinuses with mild mucosal thickening of the right frontal and ethmoid air cells..

Output: 1. Peripherally enhancing mass centered in the medial right temporal lobe measures up to 3.5 cm.2. Paranasal sinus mucosal thickening and trace fluid in the right mastoid air cells.


Instruction: Generate impression based on findings.

Input: Clinical question: Left basal ganglial hemorrhage follow-up. Signs and symptoms: Right-sided weakness. CT of brain without infusion:A well-demarcated hematoma in the left basal ganglia measures 19 mm in transverse axis (axial image 13) and 31.8-mm in AP axis (axial image 14) in comparison with the prior MRI and CT examination there is no evidence of increase in the size of the hematoma. The periphery of hematoma is less defined than prior study which is consistent with breakdown of hemorrhage. There is subtle mass effect on the adjacent left lateral ventricle. This examination is otherwise unremarkable and stable and without any new additional findings.

Output: No evidence of new hemorrhage and essentially stable exam since prior study.


Instruction: Generate impression based on findings.

Input: 14-year-old male with left knee pain and swelling. MENISCI: Fraying of the inner edge of both menisci without underlying tear or other abnormality.ARTICULAR CARTILAGE AND BONE: No significant abnormality noted.LIGAMENTS: Thickening toward the proximal femoral attachment of the medial collateral ligament with overlying extensive inflammation and fluid. This is compatible with a grade 1 sprain of the medial collateral ligament. The cruciate ligaments appear intact. The lateral collateral ligament is intact.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: Findings compatible with a grade 1 sprain of the medial collateral ligament.


Instruction: Generate impression based on findings.

Input: Male, 16 years old. TS, annual followup. ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesions. No intrahepatic or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Punctate foci of T2 hyperintensity in the left renal cortex, compatible with angiomyolipomas, are unchanged from the prior study. An additional subcentimeter focus of low signal on both T1 and T2 sequences in the right renal cortex is also unchanged from multiple prior studies and may reflect a small focus of scarring. No new lesions are identified. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Unchanged punctate renal cortical angiomyolipomas.


Instruction: Generate impression based on findings.

Input: 62-year-old man with history of pancreatitis and pancreatic fluid collection. Please note this examination is slightly limited by patient motion.ABDOMEN:LIVER, BILIARY TRACT: There is a 7 mm hepatic cyst (series 3, image 11). The liver is otherwise normal in signal and morphology. There is mild intrahepatic biliary ductal irregularity. No dominant stricture or mass. The portal vein is not visualized and there were numerous collateral vessels in the hepatic hilum.SPLEEN: The spleen is normal.PANCREAS: Within the body/tail of the pancreas (series 3, image 17) there is a 15 x 9 mm T2 hyperintense, nonenhancing focus which appears to communicate with the pancreatic duct. No debris is seen within this lesion.Additionally, there is a 6 x 6 mm area of intermediate T2 signal and low T1 signal in the mid pancreatic tail (series 12, image 243) without enhancement which is in the same location as, but smaller than, a pseudocyst seen on the CT from 8/10/2015. There is slightly increased T2 signal within the parenchyma of the pancreatic tail.Adjacent to this tail lesion, there is a smooth stricture of the pancreatic duct (series 7, image 5). Secretin augmentation demonstrates a slightly blunted exocrine response, however the duodenal C-loop fills with fluid.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple left renal cysts are noted. The kidneys are otherwise normal and enhance symmetrically.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: There is a moderate left pleural effusion with adjacent atelectasis.

Output: 1.Interval decrease in size of pancreatic tail pseudocyst from 8/10/2015 with residual adjacent pancreatic duct stricture.2.Mild inflammation in the pancreatic tail.3.Lesion in the pancreatic head/neck which likely represents a side branch IPMN and less likely a small pseudocyst as was present on the CT dated 7/1/2015 prior to the pancreatitis4.Cavernous transformation of the portal vein.5.Left pleural effusion.


Instruction: Generate impression based on findings.

Input: T2 N2B M0 tonsil squamous cell carcinoma on OPTIMA protocol. There is no measurable residual right palatine tonsil tumor. There is no significant residual cervical lymphadenopathy. For example, a right level 2A lymph node measures 9 x 13 mm, previously 8 x 16 mm. There are secretions in the right vallecula. The thyroid and salivary glands are unchanged. The osseous structures are intact. The imaged intracranial structures and orbits are unremarkable.

Output: 1. Marked decrease in size of the right palatine tonsil tumor, without measurable disease. 2. Decrease in size of the right cervical lymphadenopathy.


Instruction: Generate impression based on findings.

Input: There are scattered foci of T2 hyperintensity within the white matter, subcortical in location, without associated mass effect, restricted diffusion, susceptibility abnormality, or enhancement. There are no similar appearing lesions in the posterior fossa. The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain. Incidental note is made of a subcentimeter lesion within the scalp soft tissues overlying the right frontal bone with an appearance of sebaceous cyst.Images of the internal auditory canals demonstrate the seventh and eighth nerves to be normal in size and symmetric bilaterally without masses or enhancing lesions along the course of these nerves or in the cerebellopontine angle cisterns bilaterally. The inner ear structures are normal in appearance and symmetric bilaterally without congenital inner ear anomalies identified on either side. There are no vascular anomalies.

Output: 1.There are scattered foci of T2 hyperintensity within the white matter, subcortical in location, without associated mass effect, restricted diffusion, susceptibility abnormality, or enhancement. There are no similar appearing lesions in the posterior fossa. These findings are nonspecific and the differential diagnosis would most likely include chronic small vessel ischemic disease, migraine sequelae, or perhaps residua from previous head trauma. Given lesional morphologies and locations, demyelination is felt to be unlikely.2.Negative MRI of the brain and internal auditory canals including gadolinium enhancement. Specifically, there are no MRI findings to explain the patient's left hearing loss.


Instruction: Generate impression based on findings.

Input: 73-year-old male with cirrhosis and liver mass status post RFA/TACE ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: The examination of the previously seen liver mass is somewhat limited by suboptimal timing of arterial phase scan. This limits the evaluation of the mass because visualization of arterial phase enhancement of mass is difficult.Segment VIII hepatic lesion measures 4.9 x 5.5 cm (Series 14, Image 24), previously measuring 5.3 x 5.6 cm on MRI. The hypodense and radio opaque portions of the mass are unchanged. The liver has a cirrhotic morphology, appearing similar to the prior examination. The hepatic vasculature is patent. No ascites is seen.No intra- or extrahepatic biliary ductal dilatation. The gallbladder is unremarkable.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral renal hypodensities are unchanged.RETROPERITONEUM, LYMPH NODES: Abdominal aortic atherosclerotic calcifications.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Thoracic spine degenerative changes.OTHER: No significant abnormality noted

Output: 1. Liver mass is unchanged with characteristics and measurements described.2. No new sites of disease.