Instruction: Generate impression based on findings.

Input: Clinical question: Preop for OR today. Signs and symptoms: Brain tumor Pre- and post enhanced brain MRI:Examination is performed utilizing a Stealth protocol and is not a true diagnostic study.Small ring-enhancing metastatic lesion in the right cerebellum measuring at 9 x 8 mm without significant change since prior exam. Large necrotic ring-enhancing tumor in the left occipital with extensive surrounding vasogenic edema is again identified. It measures at least at 44 x 25 x 43 Without significant change since prior study. Tumor similar to prior exam appears to encase the tip of the left occipital horn of lateral ventricle. There is no detectable additional foci of parenchymal, meningeal or calvarial enhancement.Mildly prominent supratentorial ventricular system without interval change since prior exam or deviation of midline.

Output: 1.Large necrotic metastatic enhancing tumor measuring up 44 x 25 x 43 in the left occipital and posterior temporal and a small 9 x 8 mm right cerebellar metastatic lesions without significant change.2.No additional parenchymal, leptomeningeal or calvarial abnormal enhancement.


Instruction: Generate impression based on findings.

Input: Dizziness, unsteady gait: progressive imbalance with walking for 6 weeks. History of invasive anorectal carcinoma. There is mild cerebellar volume loss, particularly involving the vermis. There is a subcentimeter linear focus of susceptibility effect in the left pons with slight extension into the cerebral peduncle. There is also patchy T2 hyperintensity throughout the pons. There is also mild scattered cerebral white matter T2 hyperintensity particularly in a periventricular distribution and mild diffuse cerebral volume loss. There is no evidence of mass or acute infarct. There is no abnormal intracranial enhancement. There is a mega cisterna magna. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits and ears are grossly unremarkable. The skull appears to be intact. There are bilateral lens implants. There is mucosal thickening in the ethmoid sinuses.

Output: 1. Nonspecific mild cerebellar volume loss, particularly involving the vermis, and mild diffuse cerebral volume loss. 2. A subcentimeter linear focus of susceptibility effect in the left pons with slight extension into the cerebral peduncle may represent a chronic hemorrhagic lacunar infarct. 3. Patchy T2 hyperintensity throughout the pons and mild scattered cerebral white matter T2 hyperintensity particularly in a periventricular distribution likely represent chronic small vessel ischemic disease4. No evidence of intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: Diagnosis: Migraine, unspecified, not intractable, with status migrainosusClinical question: carotid/ vertebral stenosisSigns and Symptoms: L sided numbness, headache MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. Incidental note is made of partial empty sella.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 intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is very small. The posterior communicating arteries are very small. The vertebral arteries are similar in size.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries.

Output: 1.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related. 2.There is no evidence of intracranial aneurysm3.There is no evidence for intracranial or extracranial cerebrovascular occlusive disease.


Instruction: Generate impression based on findings.

Input: 63-year-old male with infected stump. Evaluate for osteomyelitis. RIGHT FOOT:Postsurgical changes of prior amputation through the first through fifth metatarsals. There is no bone marrow signal abnormality to suggest osteomyelitis of the right foot, as clinically questioned. No sinus tract or cortical destruction are identified. There is decreased signal abnormality in within the remnant of the 5th metatarsal which appears to correspond to sclerosis seen on recent radiographs. There is increased signal abnormality within the soft tissues along the plantar aspect of the calcaneus and proximal midfoot. There is also increase in signal abnormality within the flexor digitorum and flexor hallucis longus muscle bellies. No focal fluid collection is identified to suggest abscess formation.LEFT FOOT:The patient is status post transmetatarsal amputation through the first and fifth metatarsals. There is increased T2 and decreased T1 signal abnormality within the remnant of the fifth metatarsal base, suspicious for osteomyelitis. No sinus tract or cortical destruction are identified. There is increased signal abnormality within the soft tissues in the surrounding area. Additionally there is decreased T1 and T2 signal abnormality within the distal portions of the fourth and fifth metatarsal remnants which appears to correspond to sclerosis seen on recent foot radiographs. No focal fluid collection is identified to suggest abscess formation.

Output: 1. Findings suspicious for osteomyelitis of the 5th metatarsal remnant of the left foot, as described above.2. Findings suggestive of soft tissue inflammation/edema without evidence of osteomyelitis of the right foot.


Instruction: Generate impression based on findings.

Input: 60-year-old male status post prostatectomy for evaluation of recurrence or metastatic disease. PSA 0.22 (7/14/16) PELVIS:PROSTATE:Prostate Size: Status post prostatectomy.Peripheral Zone: Status post prostatectomy.Central Gland: Status post prostatectomy.Seminal Vesicles: Surgically absent.Extracapsular Extension: Not applicable.BLADDER: Mild mass effect on the right bladder wall from cystic lesion described below. LYMPH NODES: Mildly prominent bilateral inguinal lymph nodes are nonspecific. No significant lymphadenopathy. BONES, SOFT TISSUES: Large T2 hyperintense collection measuring 6.0 x 4.9 cm along the right obturator internus muscle may represent a lymphocele or seroma in the post prostatectomy status. No suspicious bone lesions. OTHER: No significant abnormality noted.

Output: 1.No specific evidence of local recurrence. 2.Lymphocele versus seroma along the right obturator internus as described above.


Instruction: Generate impression based on findings.

Input: Grade II oligodendroglioma s/p RT and now on PCV. There are stable post-treatment findings in the left frontal lobe with unchanged confluent T2 hyperintensity surrounding the resection cavity, without abnormal enhancement. The ventricles are unchanged in size and configuration. There is no evidence of acute infarction or acute intracranial hemorrhage. The skull and extracranial structures are unchanged, including the probable fibrous dysplasia of the right orbital roof.

Output: Stable post-treatment findings in the left frontal lobe without evidence of tumor progression.


Instruction: Generate impression based on findings.

Input: Female, 71 years old, with left lateral gaze deviation. Brain MRI:A 3 mm focus of restricted diffusion is evident within the right dorsal paramedian pons just below the facial colliculus, in the region of the PPRF. No other restricted diffusion is seen.Multiple small chronic infarcts are seen involving the right pons and right ventral medulla, the bilateral thalami, and in the left cerebellar hemisphere. These lesions appear unchanged from the prior exam.No evidence of acute intracranial hemorrhage is seen. The ventricular system is normal in size and morphology.MRA brain:At least moderate narrowing of the laceral segment of the left ICA is seen. The right terminal ICA appears to be at least moderately narrowed as well. These findings are unchanged. The right A1 segment is hypoplastic. A normal-appearing ACOM artery is visualized. No high-grade vascular stenosis or occlusion is suspected within the MCA distributions. The vertebrobasilar system is free of significant vascular stenosis. A small PCOM artery is evident on the right, and there may be a very small PCOM artery on the left. No aneurysm or vascular malformation is detected.MRA neck:No high-grade stenosis is suspected within the carotid vessels of the neck by NASCET criteria. No high-grade stenosis is suspected within the vertebral vessels of the neck. Image quality is probably not adequate for the detection of very subtle areas of vascular narrowing.

Output: 1.Small, acute ischemic lesion in the right dorsal paramedian pons, just below the facial colliculus in the vicinity of the PPRF.2.Multiple scattered small chronic strokes, including within the pons and medulla, unchanged.3.Moderate chronic microvascular ischemic disease, unchanged.4.At least moderate narrowing is evident within the left ICA laceral segment and at the right terminal ICA, unchanged from prior. No definite high-grade stenosis is seen elsewhere intracranially.5.No significant vascular stenosis is detected in the vessels of the neck.


Instruction: Generate impression based on findings.

Input: Lung cancer with metastasis. Status post radiation for cord compression. Presented with urinary retention. The vertebral column alignment is near-anatomic, aside from mild straightening of the cervical and lumbar lordosis. There are postoperative findings related to T4 and T5 partial corpectomy and posterior fixation hardware from T2 through T8, which created artifact that largely obscures the spinal canal from T2 through T3 and from T4 through T8. Otherwise, there are relatively small ventral and dorsal indentations of the thecal sac by degenerative disc-osteophyte complexes and ligamentum flavum thickening at C5-C6 and C6-C7. There is no abnormal spinal cord signal at these levels, as well as inferior to T8. There is interval increase in size of the T1 hypointense and T2 hyperintense sacral mass that markedly narrows the spinal canal and compresses the S1-S2 and S2-3 sacral foramina, especially on the left side. There is also increase in size of a T1 hypointense and T2 hyperintense lesion in the anterosuperior portion of the L3 vertebral body. There is an incompletely-imaged left thoracic soft tissue mass abutting the aortic arch.

Output: 1. Postoperative findings related to T4 and T5 partial corpectomy and posterior fixation hardware from T2 through T8, which created artifact that largely obscures the spinal canal from T2 through T3 and from T4 through T8. 2. Mild indentation of the cervical spinal cord by disc-osteophyte complexes and thickened ligamentum flavum at multilevel level. Otherwise, assessment of the spinal canal in the mid thoracic region is limited by the artifact from the posterior fixation hardware. 3. Interval increase in size of the sacral metastasis with increased spinal canal and sacral foramina narrowing, especially on the left side. Please refer to the separate pelvis MRI report for additional details.4. Interval increase in size of a metastatic lesion in the anterosuperior L3 vertebral body. 5. The left thoracic soft tissue mass abutting the aortic arch is incompletely imaged.


Instruction: Generate impression based on findings.

Input: The pituitary gland enhances homogenously. There is no evidence of sellar or parasellar lesions. The infundibulum is intact and situated in the midline. There is an intact posterior pituitary bright spot. The optic apparatus is intact. There are nonspecific scattered foci of T2 hyperintensity in the partially-imaged cerebral white matter.

Output: No evidence of pituitary adenoma or other sellar lesion.


Instruction: Generate impression based on findings.

Input: 3 months, Male, former 23 week, corrected gestational age of 38 weeks. Evaluate for PVL. History of grade 4 IVH. There are areas of T1 hyperintensity, T2 hypointensity, with susceptibility effect in the germinal zones along the surface of the lateral ventricles posteriorly. There is also susceptibility effect in the dependent aspects of the occipital horns. Findings are consistent with known history of intraventricular hemorrhage. Small foci of prior hemorrhage in the bilateral cerebellar hemispheres also noted. There is mild prominence of the lateral ventricles without clear evidence of hydrocephalus.There is mild thinning of the periventricular white matter in the parietal and occipital regions. No cystic changes in the periventricular white matter.Normal T1 and T2 shortening expected for a term infant in the posterior limbs of the internal capsule is not definitively appreciated suggesting possibility of delayed myelination and can be further assessed with follow-up studies. There is prominence of the extra-axial spaces along the bilateral cerebral convexities likely reflecting combination of mild parenchymal volume loss and small extra-axial collections without mass effect.No diffusion abnormality to suggest acute ischemia. No intracranial mass or mass effect. No midline shift or herniation. Calvarium and extra cranial soft tissues are grossly unremarkable.

Output: 1. Evidence of prior intraventricular hemorrhage.2. Mild thinning of the parieto-occipital white matter consistent with white matter injury of prematurity/periventricular leukomalacia.3. Small bilateral extra-axial collections without mass effect.4. Mild prominence of the lateral ventricles without clear evidence of hydrocephalus.5. Myelination of the posterior limbs of the internal capsules, which is expected for corrected gestational age, is not clearly appreciated and suggests hypomyelination. Findings can be further assessed with follow-up studies.


Instruction: Generate impression based on findings.

Input: 37-year-old male with right knee pain. Evaluate for patellofemoral chondromalacia. MENISCI: The medial and lateral meniscus appear intact.ARTICULAR CARTILAGE AND BONE: There is focal full-thickness articular cartilage defect along the medial aspect of the medial facet of the patella with underlying subchondral signal abnormality. The lateral and medial compartments appear relatively spared. Multiple foci of subcentimeter low signal abnormality within the medial and lateral femoral condyle likely represent bone islands.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: Focal full-thickness articular cartilage defect along the medial facet of the patella as described above.


Instruction: Generate impression based on findings.

Input: Ms. Lange is a 48-year-old female with BRCA1 mutation presenting for high-risk breast cancer screening. She has a personal history of right lumpectomy for IDC with medullary features in 2003. She is status post radiation and chemotherapy. She has a family history of breast cancer in her sister diagnosed at age of 28 and ovarian cancer in a paternal aunt. There is scattered fibroglandular tissue in both breasts.Minimal parenchymal enhancement is noted bilaterally.No suspicious enhancement is seen in either breast. Post surgical changes in the right breast and axilla are again noted including volume loss. 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: Procedures, 2/11/2015 2:31 PM Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 66%, the LV end diastolic volume index is 73 ml/m2 (normal range: 65+/-11), the LVEDV is 148 ml (normal range 109+/-23), the LV end systolic volume index is 25 ml/m2 (normal range 18+/-5), the LVESV is 51 ml (normal range 31+/-10), the LV mass index is 47 g/m2 (normal range 67+/-11), and the LV mass is 96 g (normal range 114+/-24). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. No ventricular septal defect is noted.Left AtriumThe left atrium is normal in size. No inter-atrial septal defect is noted. 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 83 ml/m2 (normal range 69+/-14), the RVEDV is 167 ml (normal range 110+/-24), the RV end systolic volume index is 37 ml/m2 (normal range 22+/-8), and the RVESV is 75 ml (normal range 35+/-13). Right AtriumThe right atrium is moderately enlarged. Aortic ValveThe aortic valve is trileaflet. The right coronary cusp is mildly thickened. The valve opens widely but there is mild aortic regurgitation (regurgitant fraction 11%).Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is trace pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is moderate tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size. They drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Normal LV size and systolic function (LVEF 66%) without evidence of underlying myocardial fibrosis, inflammation, or infiltration.2. Normal RV size and systolic function (RVEF 55%).3. Moderate right atrial dilation.4. Moderate tricuspid regurgitation.5. No ventricular septal defect, atrial septal defect, or anomalous pulmonary venous drainage. No evidence of significant cardiac shunt. Qp/Qs 1.1. 6. Mild aortic regurgitation.


Instruction: Generate impression based on findings.

Input: Severe right sided headache with visual symptoms. CT and MRI were done, which showed a right parietal cavernoma. There is a lesion with extensive susceptibility effect in the superior portion of the right postcentral gyrus that measures up to 8 mm. There is an associated small developmental venous anomaly, but no surrounding vasogenic edema. There is no evidence of intracranial hemorrhage or acute infarct. There are a few scattered foci of nonspecific cerebral white matter T2 hyperintensity without susceptibility effect or 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: Findings compatible with a right parietal lobe cavernous malformation.


Instruction: Generate impression based on findings.

Input: Evaluate for progression of leptomeningeal carcinomatosis from breast cancer treated with WBRT. The abnormal leptomeningeal enhancement has markedly diminished and there is minimal residual T2-FLAIR hyperintensity in the left parietal sulci. There is no evidence of intraparenchymal abnormal enhancement. There is unchanged nonspecific patchy T2 hyperintensity in the periventricular white matter, particularly in the parietal regions. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are unchanged.

Output: 1. Interval improvement in the leptomeningeal carcinomatosis.2. No evidence of intraparenchymal metastases.


Instruction: Generate impression based on findings.

Input: Seizure-like activity. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears unremarkable. In particular, the hippocampi are unremarkable and there is no evidence of heterotopia. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable.

Output: No discernible seizure foci.


Instruction: Generate impression based on findings.

Input: Osteomyelitis First digit (thumb): There is no evidence of osteomyelitis. There are osteoarthritic changes of the MCP joint.Second digit (index): There is abnormal signal intensity and enhancement of the distal and middle phalanges of the index finger as well as destruction of the base of the distal phalanx and the majority of the middle phalanx. There is inflammation and edema of the surrounding soft tissues with an enhancing tract extending to the dorsal surface of the digit. There is no definite fluid collection to suggest abscess within the distal index finger. There is enhancement along the flexor tendon apparatus that extends proximally to the level of the mid metacarpal. The flexor digitorum superficialis splits at the level of the of the distal diaphysis of the second metacarpal with both halves extending deep to the profundus tendon; this may represent a normal Camper's chiasm accentuated by tenosynovitis although the presence of a longitudinal split tearing of the tendon cannot be excluded. Arthritic changes at the second MCP joint are likely degenerative in etiology. There is mild enhancement and edema of the base of the proximal phalanx of the index finger which is thought to be secondary to the arthritic changes or reactive to the flexor tenosynovitis as opposed to osteomyelitis. Edema extends from the index finger into the thenar eminence with additional mild soft tissue inflammation of the remaining hand.Third digit (middle): There is amputation of the ring finger through the base of the middle phalanx. There is no evidence of osteomyelitis.Fourth digit (ring): There is chronic erosive deformity of the PIP joint but no marrow signal abnormalities to indicate osteomyelitis.Fifth digit (pinky): There is no evidence of osteomyelitis.Wrist: Multiple low signal intensity foci are noted within the carpal bones which likely reflect degenerative cysts or chronic erosions. There is no evidence of osteomyelitis. There is perhaps a small chronic erosion of the radial styloid, but marrow signal intensity of the visualized portions of the distal radius and ulna is normal. There is mild synovitis of the distal radioulnar joint and perhaps mild tenosynovitis along the extensor tendons of the first dorsal compartment.

Output: Osteomyelitis of the distal and middle phalanges of the index finger with tenosynovitis of the flexor apparatus and other findings as described above.


Instruction: Generate impression based on findings.

Input: history of parotid lymphoma 20 years ago. Status post surgery/RT. Evaluate for recurrence. Also with METs to left hip, left arm and right leg. CT of the soft tissues of the neck.Images through the skull base and including cavernous sinuses, paranasal sinuses remain within normal limits. Opacification of mastoid air cells on the left may represent otitis and or secondary to prior prior treatment and compromise of the eustachian tube. There is a focal defect within the left jugular bulb with no enhancement which may represent a clot. The left internal jugular vein is not visualized and presumed occluded. Left carotid is patent. Within the soft tissues of the neck on the left side a large cluster of irregular calcification is noted immediately adjacent to the vertebral column which extends from the level of C1 inferiorly to approximately C3 -- C4 intervertebral disk level. This is not associated with any definitive soft tissue mass or enhancement. I am not certain of the etiology of this finding. However the above finding may represent calcification within a treated tumor, dystrophic calcification or embolic material. This finding is not within the parotid region and the left parotid gland is believed to have been surgically removed. No definitive evidence of a mass or pathologic adenopathy in the neck is detected. A left paramedian submental node measures 9 mm times 14-mm in transaxial dimension (axial image 47). Limited images of the apices of the lungs demonstrates no metastatic lesion please review the dictated report of CT of chest performed the same date. No definitive mediastinal abnormality. Bony density of the area of exam is negative for metastatic lesions.An MRI examination of soft tissues of the neck is recommended for better evaluation of areas of calcification and in particular to exclude the possibility of an associated soft tissue mass. Extensive degenerative changes of cervical spine with multilevel neural foramina compromise is noted.If there are outside studies available comparison will be made and if necessary an addendum will be added.CT of brain with infusion.No evidence of metastatic disease to the brain, leptomeninges or the calvarium is detected. Examination however demonstrates minimal small vessel disease.

Output: 1.Minimal small vessel disease and otherwise negative CT of brain with infusion.2.Excessive cluster of calcification within the soft tissues of the neck on the left adjacent to the vertebral column with no associated soft tissue mass or bony destruction or abnormal enhancement. The findings may represent posttreatment changes. Further follow-up with an MRI is recommended3.No evidence of residual parotid gland on either side.4.No evidence of a soft tissue mass or pathologic adenopathy.5.Extensive opacification of left mastoid air cells.1.


Instruction: Generate impression based on findings.

Input: Female 16 years old Reason: right knee pain s/p OCD lesion surgery MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: There is an osteochondral defect in the lateral aspect of the medial femoral condyle with fluid signal surrounding the lesion suggesting instability. Overlying cartilage is nondisplaced.LIGAMENTS: Cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: Osteochondral defect in the medial femoral condyle with findings suggestive of instability.


Instruction: Generate impression based on findings.

Input: 56-year-old male with history of urothelial carcinoma status post resection. ABDOMEN:LIVER, BILIARY TRACT: Fatty liver.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Status post right nephroureterectomy. No evidence of recurrent disease in the operative bed.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.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER:No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No evidence of recurrent or metastatic disease.


Instruction: Generate impression based on findings.

Input: Chiari malformation, post decompression, headaches, worsening symptoms. Brain: There are postoperative findings related to Chiari decompression surgery. The cerebellar tonsils extend to the level of C1, which is unchanged. There is no significant crowding of the neo-foramen magnum and there is apparent CSF flow across the anterior and posterior aspects of the neo-foramen magnum, similar to the prior exam. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift. The major cerebral flow voids are intact. The orbits are grossly unremarkable. There are a few scattered secretions in the paranasal sinuses. Cervical Spine: There has C1 laminectomy as part of the Chiari decompression surgery. There is no evidence of residual fluid collections in the surgical bed. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology.

Output: Unremarkable findings related to Chiari decompression surgery without evidence of hydrocephalus, pseudomeningocele, or syrinx.


Instruction: Generate impression based on findings.

Input: Secondary malignant neoplasm of brain [C79.31] / Secondary malignant neoplasm of other parts of nervous system [C79.49], Reason for Study: ^Reason: h/o non small cell lung ca with brain met s/p resection and RT History: surveillance The left occipital lobe enhancing mass lesion shows changed its configuration on axial scan but does not show significant size change since prior scan. Previously it was more peripheral enhancement with central non enhancing portion but today's scan shows more enhancing portion central portion of the mass.Surrounding edema of the lesion shows interval decrease since prior scan.Right frontal T2/FLAIR high signal intensity lesion without focal enhancement is again demonstrated without evidence of interval change since prior scan.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Interval change of enhancement pattern with decreased surrounding edema but without evidence of significant size change of the left occipital mass lesion since prior scan. 2. Unchanged right frontal lobe lesion since prior scan. 3. No evidence of new abnormal enhancing lesion.4. No acute ischemic or hemorrhagic lesion.


Instruction: Generate impression based on findings.

Input: The internal auditory canals are symmetrical and normal in size and signal intensity. The inner ears are normal, with normal T2 signal and no pathological enhancement. No abnormal mass or abnormal enhancement is seen within the cerebellopontine angle cisterns bilaterally or within the internal auditory canals. Mastoid air cells are clear.Limited evaluation of the brain demonstrates no evidence of intracranial mass or mass effect. No midline shift or herniation. No hydrocephalus or extra-axial collections. Major flow-voids are preserved.

Output: There is no mass or abnormal enhancement involving the cerebellopontine angles, inner ears, or internal auditory canals.


Instruction: Generate impression based on findings.

Input: Lung cancer with history of brain metastases. There is a newly apparent punctate focus of restricted diffusion in the right parietal lobe. There are multiple unchanged punctate foci of susceptibility effect in the bilateral cerebral hemispheres. There is unchanged diffuse cerebral white matter T2 hyperintensity bilaterally, predominantly in a periventricular distribution. There is no abnormal intracranial enhancement. There is a newly apparent punctate focus of restricted diffusion in the right parietal lobe. There is diffuse cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are unremarkable. There is minimal mucosal thickening in the maxillary sinuses.

Output: 1. A newly apparent punctate focus of restricted diffusion in the right parietal lobe likely represents a recent infarct and less likely an atypical metastasis.2. Multiple unchanged punctate foci of susceptibility effect in the bilateral cerebral hemispheres appear to correspond to treated metastases.3. Unchanged diffuse cerebral white matter T2 hyperintensity bilaterally is nonspecific, and may represent treatment effects and/or chronic small vessel ischemia.


Instruction: Generate impression based on findings.

Input: 57 year-old female with ataxia and cerebellar mass. Evaluate for evolution of cerebellar mass. Again noted is a posterior fossa space-occupying hypodense lesion measuring 3.5 x 2.6 cm and appears minimally decreased in size since the previous examination (Image 10; series 4). This previously measured 3.8 x 2.7 cm. There is an adjacent focus of hyperdensity in the right cerebellum measuring 1.9 x 0.8 cm which appears unchanged compared to previous study (Image 7; series 4). This previously measured 1.7 x 0.8 cm. Differential considerations include hematoma versus mass lesion with petechial hemorrhage. Contrast enhanced MRI could be considered for further evaluation of this finding. Again noted is effacement of the fourth ventricle associated with moderate supratentorial ventriculomegaly and transependymal edema which appears unchanged when compared to the previous study. These findings are likely related to obstructive noncommunicating hydrocephalus. The calvaria and skull base are radiographically normal. The visualized paranasal sinuses are normally pneumatized. There is opacification of the left mastoid air cells and thickening of the left external auditory canal which appears unchanged compared to previous study. Incidental noted is made of bilateral lens prosthesis. There is calcification within the left globe.

Output: There is no significant interval change since the previous examination. 3.5 cm space-occupying mass lesion within the left cerebellum with an associated hyperdensity which could represent blood product or mass lesion with mineralization. There is associated effacement of the fourth ventricle and moderate noncommunicating hydrocephalus unchanged since the previous examination. MRI examination for further characterization is recommended.


Instruction: Generate impression based on findings.

Input: 67-year-old male patient status post OLT for PSC. Biopsy in 2012 suggested extrahepatic biliary obstruction. ABDOMEN:LIVER, BILIARY TRACT: Postsurgical changes from choledochojejunostomy with patent anastomosis. No intrahepatic or extrahepatic biliary ductal dilatation. Hepatic vasculature is patent.No suspicious hepatic lesions.SPLEEN: No significant abnormality noted.PANCREAS: Prominent pancreatic duct measures up to 4 mm in maximal diameter.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Numerous T2 hyperintense lesions without enhancement in the bilateral kidneys compatible with renal cysts. Probable subcentimeter hemorrhagic cyst in the left kidney.There is a 1.3 x 1.3 cm lesion (series 103 image 29) in the midpole of the left kidney that is isointense on T2 and appears to have some enhancement on subtraction images. This lesion is not well seen on prior CT.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Right upper quadrant ileostomy with peristomal hernia. No evidence of bowel obstruction.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No intrahepatic or extrahepatic biliary ductal dilatation and patent choledochojejunostomy anastomosis.2.Lesion in the midpole of the left kidney with enhancement is suspicious for renal cell carcinoma, such as papillary subtype.


Instruction: Generate impression based on findings.

Input: Benign neoplasm of cerebral meningesClinical question: s/p tumor resectionSigns and Symptoms: s/p tumor resectionComments: Please obtain thin cuts through CP angle The CSF spaces are appropriate for the patient's stated age with no midline shift. The cerebellar tonsils extend approximately 2 mm below the level of the foramen magnum.The patient is status post removal of a left cerebellar pontine angle cistern mass in the left suboccipital craniotomy site just behind the mastoid. There is some signal hyperintensity within the subdural space adjacent to the left cerebellar hemisphere at the surgical site. There is soft tissue swelling present along the overlying skin tissues. There is some thickening of the dura anterior lateral to the brainstem at the left cerebellopontine angle cistern. This measures approximately 6 x12 mm axial dimensions and 6 x 15 mm sagittal dimensions.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 mild mucosal thickening in the sphenoid sinus.. The visualized portions of the mastoid air cells demonstrate minor opacities in the left mastoid air cells. The visualized portions of the orbits are intact.

Output: Since the prior exam patient has undergone left cerebellopontine angle cistern surgery for removal of a mass. There is a small lesion present at the left cerebellopontine angle cistern which is suspected to represent some residual neoplasm. There is some residual postoperative swelling.


Instruction: Generate impression based on findings.

Input: Nasopharyngeal carcinoma, s/p induction. Neck: There is a left nasopharyngeal mass that measures up to approximately 4 cm, previously approximately 5 cm. The tumor also now appears necrotic. The tumor abuts the carotid sheath, but there is no evidence of intracranial extension or skull base erosion. There is decreased narrowing of the nasopharyngeal airway. There are secretions in the right lateral nasopharyngeal recess. A cystic or necrotic right level 2B lymph node measures 20 x 30 mm in axial cross-section, previously 22 x 34 mm. Other smaller cervical lymph nodes are unchanged. The salivary glands and thyroid are unremarkable. There is no evidence of acute infarction. The orbits are unremarkable. The cervical spine is intact. Brain: 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.

Output: 1. Interval decrease in size and development of necrosis of the left nasopharyngeal tumor. 2. Slight interval decrease in size of the right level 2B lymphadenopathy.


Instruction: Generate impression based on findings.

Input: Evaluate ventricle size. Status post subgaleal shunt. Now with increasing HC. No evidence of change in the size of lateral ventricles since prior MRI examination of 7 -- 9 -- 2009. No evidence of ventricular shunt. No evidence of hemorrhage, edema, mass-effect, midline shift.

Output: No evidence of change in the size of particular system since prior MRI exam.


Instruction: Generate impression based on findings.

Input: Clinical question: MS evaluate disease burden, compared to 2013 study. Signs and symptoms: Myoclonus, right sided paresthesia cognitive issues, imbalance to the left. Pre-and post enhanced brain MRI:No diffusion weighted abnormalities.Examination redemonstrates chronic nonenhancing findings of multiple sclerosis in the periventricular and subcortical as well as the corpus callosum of mild degree. Minimal similar findings are also present in the pons. When compared with prior exam there is no convincing evidence of any change of findings in the supratentorial space however there is mild progression of disease in the pons with evidence of a new nonenhancing plaque.The cortical sulci and ventricular system as well as the CSF spaces remain within normal for patient stated age of 61 and is stable since prior exam.The signal void of major intracranial arterial branches are identified.The signal intensity of the intracranial venous sinuses are within normal and with normal pattern of enhancement.Under local images through the orbits, paranasal sinuses and mastoid air cells.Pre-and post enhanced cervical MRI:There are no prior exams for comparison.Examination demonstrates only questionable small foci of T2 hyperintensity in the left paramedian cord at C5 and C6 levels without detectable abnormal enhancement are caliber and signal intensity of the cord is otherwise within normal.There are mild to moderate degenerative disk disease in particular at C5 -- C6 and C6 -- C7 levels. The findings result in moderate left and mild right neural foraminal compromise at C5 -- C6 and significant bilateral neural foraminal compromise at C6 -- C7 levels. Mild central spinal stenosis at C6 -- C7.There is slight straightening of cervical lordosis likely secondary to degenerative disease.There is no detectable abnormal enhancement the vertebral column.Pre-and post enhanced thoracic MRI:There is normal signal intensity and caliber thoracic cord and without abnormal enhancement.There is normal signal intensity and alignment the vertebral column without abnormal enhancement.There is no evidence of spinal canal or significant neural foraminal compromise at any level. Hypertrophy changes of posterior elements at T8 -- T9 however results in mild to moderate left neural foraminal compromise.Three limited partial visualization of L1 -- 2 disk level demonstrates very extensive degenerative disk disease with significant loss of disk height and extensive spur formation. There are no prior lumbar spine imaging for comparison. Correlate with history and symptomatology and considered dedicated MRI of lumbar spine if clinically deemed necessary.

Output: 1.Pre-and post enhanced brain MRI demonstrate no evidence of an acute enhancing demyelinating plaque. Stable mild chronic multiple sclerosis in the supratentorial brain parenchyma since prior exam. Minimal findings of chronic demyelinating disease in the pons and with evidence of minute interval progression since prior outside institution MRI exam from 2013. 2.Pre-and post enhanced MRI of the cervical spine demonstrate only questionable tiny nonenhancing foci of T2 hyperintensity at C5 and C6 which could also be result of degenerative changes. Degenerative changes at C5 -- C6 and C6 -- C7 levels results in mild central spinal stenosis at C6 -- C7 level and with significant bilateral neural foraminal compromise.3.Unremarkable pre-and post enhanced MRI of the thoracic spine. At the very edge of the field of exam there is partial visualization of significant disk disease at the L1 -- L2 level and with extensive bony formation. Correlate with history neurological findings and considered follow-up with dedicated lumbar MRI if clinically deemed necessary.


Instruction: Generate impression based on findings.

Input: There are mild disc bulges in the lumbar spine at L3-4, L4-5, and L5-S1 encroaching upon the bilateral neural foramen, but no significant spinal canal stenosis. 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 fatty filum or dysraphism. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: 1. No definite evidence of spondylolysis, within the limits of MRI.2. Mild disc bulges at L3-4, L4-5 L5-S1, with mild bilateral L5-S1 neural foramen stenosis, but no significant spinal canal.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 50 years Male (DOB:12/25/1965)Reason: 3 t scanner History: surveillancePROVIDER/ATTENDING NAME: PETER C. WARNKE PETER C. WARNKE There is a small focus of susceptibility effect present in the right middle frontal gyrus posteriorly measuring approximately 5 mm which is associated with surrounding vasogenic type edema with T2 and FLAIR hyperintensity. It enhances following gadolinium administration. On the prior exam it was barely visible and demonstrated punctate enhancement.Another focus of susceptibility effect is present in the right inferior parietal lobule. This associated with some thin ring enhancement pattern. The thin ring enhancing lesion now measures 10 mm and previously measured 19 x 12 mm.The patient is status post right parietal craniotomy. The craniotomy flap appears to be offset and is associated with the abdomen dilatation of the adjacent brain to the calvarial contour. There is susceptibility effect centered within the right postcentral gyrus probably resulting from prior treatment.T2 and FLAIR signal hyperintensity extends from T2 and FLAIR signal hyperintensity adjacent to right parietal lobe lesions to the posterior limb of the internal capsule and the suggestive of a wallerian degeneration.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 demonstrate some opacities in the left mastoid air cells. The visualized portions of the orbits are intact.

Output: 1.Since the prior exam a previously punctate lesion in the right frontal lobe has enlarged. This suggests metastatic disease.2.Since the prior exam the right inferior parietal lobe lesion has decreased in size and may represent posttreatment evolution.3.Status post right parietal lobe surgery. 4.There are some associated suggestion of Wallerian degeneration related to parietal lobe lesions.


Instruction: Generate impression based on findings.

Input: Female 54 years old Reason: abdominal pain and distension upper abdomen History: pain and abdominal distension ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. No suspicious hepatic lesions. Hepatic and portal veins are patent. Biliary tree is without diagnostic abnormality.Gallbladder is nondistended. No gallstones are evident.SPLEEN: No significant abnormality noted.PANCREAS: Pancreas is normal in morphology and signal. The pancreatic duct is mildly prominent and drains via the minor papilla crossing the common bile duct anteriorly in a pancreas divisum configuration. No evidence of acute pancreatitis.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right renal upper pole cyst. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Findings of pancreas divisum without evidence of acute pancreatitis.


Instruction: Generate impression based on findings.

Input: 55-year-old man with history of lumbar radiculopathy. Five lumbar type vertebral bodies are presumed to be present. There are degenerative endplate changes with Schmorl's nodes, otherwise vertebral body heights are within normal limits. Alignment is within normal limits. An area of T2 hyperintense signal and T1 isointense signal is seen in the posterior L1 vertebral body extending into the right pedicle (500/6). There is no cortical destruction. Additionally, a similar, smaller round lesion is seen in the L2 right pedicle. These lesions are favored to represent hemangiomas. The bone marrow signal is benign. The conus medullaris is normal in position.Multilevel degenerative changes are seen, as described below:T11-T12: There is disc desiccation and loss of disc height with a disc bulge. Although this level was not imaged on the axial sequences, there is at least moderate narrowing of the spinal canal.T12-L1: There is disc desiccation and loss of disc height. Disc osteophyte complex causes mild-to-moderate narrowing of the spinal canal, moderate narrowing of the right neural foramen and mild narrowing of the left neural foramen.L1-L2: Relatively minimal disc disease. There is minimal disc bulge without significant narrowing of the lateral recesses, neural foramina, or spinal canal.L2-L3: There is disc desiccation along with slight bulging of the disc and ligamentum flavum hypertrophy. This causes mild neural foraminal narrowing bilaterally. No spinal canal stenosis.L3-L4: There is disc desiccation along with slight bulging of the disc and ligamentum flavum hypertrophy. This causes mild neural foraminal narrowing bilaterally. No spinal canal stenosis.L4-L5: There is disc desiccation, height loss, and formation of disc osteophyte complex. There is moderate neural foraminal narrowing on the right and severe neural foraminal narrowing on the left. There is mild central canal stenosis.L5-S1: There is disc desiccation with a central posterior protrusion. This causes mild narrowing of the left lateral recess and neural foramen. There is impression on the thecal sac without significant central canal stenosis.Simple bilateral renal cysts noted. Otherwise, paraspinous soft tissues are within normal limits.

Output: Degenerative changes as described above with multilevel neural foraminal and spinal canal stenosis.


Instruction: Generate impression based on findings.

Input: Female; 44 years old. Reason: brachytherapy planning (interstitial) History: brachytherapy planning (interstitial) PELVIS:Lack of intravenous contrast limits sensitivity for pathology.UTERUS, ADNEXA: Significant interval decreased size of cervical cancer with no discretely measurable tumor evident on the current exam. The uterus is now in retroverted and retroflexed positioning due to decreased tumor posteriorly. New interstitial brachytherapy therapy device is seen in the left uterus.BLADDER: Interval decreased left hydroureter. No evidence of bladder involvement.LYMPH NODES: Decreased size of reference left internal iliac lymph node now measuring 1 x 0.7 cm (series 41/34), previously 2.1 x 1.8 cm.BOWEL, MESENTERY: No evidence of rectal involvement.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small amount of free fluid in the pelvis.

Output: 1. Significant interval decreased size of cervical cancer.2. Decreased left internal iliac lymph node.3. Resolution of left hydroureter.4. Lack of intravenous contrast limits sensitivity for pathology.


Instruction: Generate impression based on findings.

Input: Male, 11 years old, with history of left parietal DNET status post resection, nine month follow-up exam. A small resection cavity is redemonstrated in the left inferior parietal lobule showing no significant interval change. There is no new pathologic signal abnormality or enhancement within or adjacent to the resection cavity. No new intracranial lesions are detected.The pineal gland remains enlarged and enhancing measuring approximately 10 x 10 x 12 mm, unchanged from prior exams. No evidence of parenchymal edema or mass effect is seen. No abnormal extra-axial fluid collections are detected. The ventricles are normal in size and morphology.

Output: 1.Stable left parietal resection site with no evidence of residual or recurrent tumor.2.Stable enlarged pineal gland.


Instruction: Generate impression based on findings.

Input: 56-year-old man with history of ulcerative colitis status post colectomy and end ileostomy, now with diarrhea and weight loss. ABDOMEN:LIVER, BILIARY TRACT: The liver appears normal. The gallbladder is normal. There is no intra or extrahepatic biliary duct dilatation.SPLEEN: The spleen is normal.PANCREAS: The pancreas is normal.ADRENAL GLANDS: The adrenal glands are normal.KIDNEYS, URETERS: Bilateral renal cysts are noted, the kidneys are otherwise normal.RETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: The patient is status post total colectomy with a right lower quadrant ileostomy. The bowel is well distended with contrast without evidence of wall thickening or diffusion restriction.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Examination limited by noncontrast technique. Postoperative findings of total colectomy and right lower quadrant ileostomy without evidence of inflammation.


Instruction: Generate impression based on findings.

Input: Follow up on abnormal CT scan findings: left leg numbness. There is a focus of susceptibility effect with central areas of T1 hyperintensity in the inferior pons that measures up to 9 mm with an associated developmental venous anomaly that extends to the prepontine cistern. There is no surrounding T2 hyperintensity. There is a cystic defect in the left parietal lobe that measures up to approximately 4 cm and communicates with the left lateral ventricle with a punctate focus of susceptibility effect along the anterior margin of the cystic defect and thinning of the overlying calvarium. There are also a smaller cystic defects in the parenchyma anterior to this lesion that do not communicate with the lateral ventricle. There is diffuse surrounding confluent T2 hyperintensity in the white matter, without associated mass effect. There is no midline shift or herniation. The orbits are unremarkable. There are right maxillary sinus retention cysts.

Output: 1. Subcentimeter pontine cavernous malformation with associated developmental venous anomaly, but no evidence of surrounding edema.2. Left parietal lobe porencephalic cyst with a punctate focus of chronic hemorrhage and adjacent cystic encephalomalacia and gliosis.


Instruction: Generate impression based on findings.

Input: 67 years Male (DOB:11/15/1948)Reason: low back pain History: low back painPROVIDER/ATTENDING NAME: JAVAD HEKMATPANAH JAVAD HEKMATPANAH Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is disc desiccation at this level. There is a disc bulge at this level. There is mild facet hypertrophy at this level.At L4-5 there is bilateral facet and ligamentum flavum hypertrophy present as well as a diffuse disc bulge and effacement of the fat at the lateral recesses sees bilaterally. There is crowding of the nerve roots within the thecal sac. There is a cystic lesion present adjacent to the right facet joint which further narrows the spinal canal most likely representing synovial cyst or a ligamentum flavum cyst..At L3-4 there is no significant compromise to spinal canal or neural foramina. There is a disc bulge present this level associated with some mild ligamentum flavum and facet hypertrophy.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: Findings are compatible with spinal stenosis at L4-5 related to disc bulge, facet hypertrophy and a right sided cystic lesion from the right facet joint either representing a synovial cyst or ligamentum flavum cyst.


Instruction: Generate impression based on findings.

Input: 58-year-old male with history of hepatitis C cirrhosis, HCC. Evaluate for metastases. Evaluate cardiopulmonary status. Pre-liver transplant candidate. LUNGS AND PLEURA: Mild paraseptal apical predominant emphysema. Right upper lobe calcified granuloma. Scarring or atelectasis at the bases. No suspicious pulmonary nodules. No pleural effusions.MEDIASTINUM AND HILA: Residual thymic tissue. Normal cardiac size. Mild coronary artery calcifications. No significant mediastinal or hilar lymphadenopathy.CHEST WALL: No significant axillary lymphadenopathy. No suspicious osseous lesions.UPPER ABDOMEN: Hypertrophy of the left lobe with atrophy of the right lobe and nodular contour of the liver compatible with the given history of cirrhosis. Splenomegaly incompletely evaluated. Hypodense lesion in segment 5 most likely represents patient's known HCC (image 70/86). Additional hypodense lesions in the right lobe of the liver are too small to characterize. If further evaluation is required a dedicated liver CT/MRI may be considered.

Output: 1. No evidence of thoracic metastatic disease.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 34-year-old female with history of cervical cancer. Evaluate extent of disease. PELVIS:UTERUS, ADNEXA: There is a T1 and T2 hypointense cervical mass measuring 3.8 x 1.8 x 3.3 cm (series 501, image 41; series 601, image 23); this mass does not demonstrate significant enhancement. There is abutment of the serosa posteriorly (series 601, image 24) without evidence of invasion of the fat. Additionally, there is possibly extension into the endocervical canal. BLADDER: No significant abnormality noted.LYMPH NODES: A few tiny external iliac chain lymph nodes bilaterally without specific suspicious features.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Findings consistent with known cervical cancer as detailed.


Instruction: Generate impression based on findings.

Input: Abdominal pain and distention with eating and drinking. Evaluate for any small bowel mass or inflammation. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Normal caliber and course of the small bowel. No evidence of enteritis or discrete bowel mass.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No significant abnormality to explain the patient's symptoms.


Instruction: Generate impression based on findings.

Input: 19 years old, male with past medical history of bipolar disorder abd polysubstance abuse, transferred here for work up for possible giant cell myocarditis. He is referred for MRI to evaluation LV function and rule out infiltrative process. Left VentricleThe left ventricle is normal in size. The overall LV ejection fraction is 56%, the LV end diastolic volume index is 71 ml/m2 (normal range: 74+/-15), the LVEDV is 142 ml (normal range 142+/-34), the LV end systolic volume index is 31 ml/m2 (normal range 25+/-9), the LVESV is 62 ml (normal range 47+/-19), the LV mass index is 57 g/m2 (normal range 85+/-15), and the LV mass is 113 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left Atrium The left atrium is normal in size. Right VentricleThe right ventricle is normal in size. The overall RV ejection fraction is 50%, the RV end diastolic volume index is 81 ml/m2 (normal range 82+/-16), the RVEDV is 162 ml (normal range 142+/-31), the RV end systolic volume index is 43 ml/m2 (normal range 31+/-9), and the RVESV is 86 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation, but the severity of aortic regurgitation can be underestimated by the MRI pulse sequence used in this study.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation, but the severity of mitral regurgitation can be underestimated by the MRI pulse sequence used in this study.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation, but the severity of pulmonic regurgitation can be underestimated by the MRI pulse sequence used in this study.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation, but the severity of tricuspid regurgitation can be underestimated by the MRI pulse sequence used in this study.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Normal LV function.2. No late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.


Instruction: Generate impression based on findings.

Input: Male, 65 years old. Left hip pain. ACETABULAR LABRUM: The acetabular labrum is diffusely degenerated, with a discrete tear involving the posterior labrum and extending inferiorly.ARTICULAR CARTILAGE AND BONE: There is diffuse near complete loss of the acetabular cartilage and moderate to marked thinning of the femoral head articular cartilage, with underlying subchondral cyst formation in both the acetabulum and femoral head. Bone marrow signal elsewhere in the pelvis, the right proximal femur, and the lower lumbar spine appears grossly normal.SOFT TISSUES: No significant abnormality noted. ADDITIONAL

Output: 1.Moderate to severe degenerative changes including femoral-acetabular articular cartilage loss and subchondral cyst formation.2.Diffuse labral degeneration and a posterior labral tear.


Instruction: Generate impression based on findings.

Input: Right shoulder pain after pedestrian versus auto 2/20/2015. Fell onto right shoulder, now with rotator cuff tear symptoms. Question of traumatic rotator cuff tear, likely supra/infraspinatus. No clinical symptoms with subscapularis. ROTATOR CUFF: There is perhaps mild increased signal intensity of the distal supraspinatus tendon suggesting tendinopathy. No full thickness rotator cuff tear is seen. The infraspinatus, teres minor, and subscapularis muscles/tendons are intact. SUPRASPINATUS OUTLET: There is a moderate amount of fluid in the subacromial/subdeltoid bursa which may represent a bursitis. The acromioclavicular joint is normal in appearance. GLENOHUMERAL JOINT AND GLENOID LABRUM: There is a non-displaced fracture of the greater tuberosity of the humerus with surrounding bone edema. The fracture fragment measures approximately 12 x 15 mm on the coronal oblique view. Glenohumeral joint alignment is normal. There is no glenohumeral joint effusion. The labrum is grossly intact. BICEPS TENDON: The biceps tendon is intact. ADDITIONAL

Output: 1. Non-displaced fracture of the greater tuberosity of the humerus with surrounding bone edema.2. Fluid within the subdeltoid bursa may represent subdeltoid bursitis.3. Mild supraspinatus tendinopathy, but no rotator cuff tear.


Instruction: Generate impression based on findings.

Input: Worsening neck pain, radiculopathy, cervical stenosis Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. There is mild retrolisthesis of C4 on C5 and minimal at C5 on C6 similar to prior. There is minimal worsening of height loss involving the posterior posterior aspect of the C4-C5 and C5-C6 discs. Bone marrow signal is benign. Motion degradation on some of the sequences slightly limits evaluation. However no definite cord signal abnormality is appreciated.Degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: No significant compromise to the spinal canal or neural foramina.C4-5: Disc osteophyte complex eccentric to the right with bilateral uncovertebral hypertrophy. There is mild spinal canal stenosis. There is moderate right and mild to moderate left neural foraminal stenosis. C5-6: Disc osteophyte complex with bilateral uncovertebral hypertrophy. There is mild to moderate spinal canal stenosis. There is moderate bilateral neural foraminal stenosis.C6-7: No significant compromise to the spinal canal or neural foramina.C7-T1: No significant compromise to the spinal canal or right neural foramen. Minimal left neural foraminal narrowing which appears slightly worseThe vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: Minimal interval progression of degenerative changes compared to 12/10/2012. Degenerative changes are again seen at the C4-C5 and C5-C6 levels. There is mild C4-C5 and mild to moderate C5-C6 spinal canal stenosis. Neural foraminal stenosis at C4-C5 and C5-C6 is also evident bilaterally as described above.


Instruction: Generate impression based on findings.

Input: Alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign. The cervical and upper thoracic cord are normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.C2/3: UnremarkableC3/4: Minimal posterior osteophyte disc complex and uncinate hypertrophy without stenosisC4/5: Minimal posterior aspect disc complex without stenosisC5/6: Minimal posterior osteophyte disc complex and left uncinate hypertrophy without stenosisC6/7: Mild posterior osteophyte disc complex eccentric to the left with left uncinate hypertrophy. There is mild left neural foraminal stenosis.C7/T1: Unremarkable

Output: C6/7: Mild left neural foraminal stenosis.


Instruction: Generate impression based on findings.

Input: Wedge compression fracture of unspecified thoracic vertebra, initial encounter for closed fracture [S22.000A], Reason for Study: ^Reason: eval for cord compression based on findings on CT Chest w of pathologic fracture of T3 with mild posterior extension There are multiple bone lesions on thoracolumbar vertebrae including T3, T7, T8, T11, T12 and L1 indicating multifocal metastatic lesions.Among them, T3 vertebral body lesion shows about 10% of compression fracture with mild retropulsion. The thecal sac is indented and shows minimal spinal canal stenosis but the spinal cord signal intensity is normal.The T7 lesion shows extension of the lesion toward left pedicleThere is mild diffusion bulging of disc at the level of T89.Multifocal loculated pleural effusions are seen on the right side.There is normal thoracic kyphosis and the alignment is anatomic. The conus medullaris terminates at the T12 level.

Output: Multifocal thoracolumbar vertebral metastatic lesions as described above.T3 vertebral body shows pathologic compression fracture of about 10% with minimal retropulsion.


Instruction: Generate impression based on findings.

Input: Painful eye movements and afferent pupillary defect of left eye. Evaluate for optic nerve abnormalities. Orbits: There is new diffuse high T2 signal and enhancement with mild swelling of the orbital segment of the left optic nerve. The left globe and ocular adnexa are otherwise unremarkable. There is no evidence of mass lesions. The right orbit is unremarkable. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is a small area of subcortical high T2 signal in the right perirolandic region. There are also a few scattered foci of high T2 signal elsewhere in the cerebral white matter. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There are postoperative findings in the paranasal sinuses with interval decrease of the mucosal thickening in the sphenoid and posterior ethmoid sinuses.Cervical Spine: There is diminished cervical lordosis. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is a small posterior disc-osteophyte complex at C5-6, without significant spinal canal or neural foramen stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: 1. Newly apparent left optic neuritis. Differential considerations include an inflammatory process, such as IgG4-related disease or sarcoidosis, vasculitis, demyelinating process, neuromyelitis optica, or perhaps an infectious process, such as Lyme disease or a viral disease, but no evidence of compressive neuropathy.2. A few scattered cerebral white matter lesions are nonspecific, but may represent a demyelinating process, neuromyelitis optica, vasculitis, or infectious/inflammatory process, perhaps related to the optic neuritis, but no evidence of acute infarct. 3. No evidence of cervical spinal cord lesions.4. Postoperative findings related to sinus surgery with interval improvement in the previously demonstrated paranasal sinus inflammatory process.


Instruction: Generate impression based on findings.

Input: A patient submitted outside study for review. Submitted for review are digital mammographic images (4/21/15, 10/14/15), ultrasound images of right breast (10/14/15), images from ultrasound guided biopsy of right breast and postprocedural right mammographic images (10/21/2015) performed at Advocate Lutheran General Hospital. For comparison, digital mammographic images (5/27/14, 12/6/13) are available. DIGITAL MAMMOGRAPHIC IMAGES (4/21/15, 10/14/15):The breast parenchyma is composed of scattered fibroglandular elements (BiRADS Density Category B), unchanged in pattern and distribution. Multiple surgical clips are present at 12:00 position in the right breast, at the site of prior surgery. There is a developing mass at the site of prior surgery in the right breast, measuring 35 x 30 mm on CC view of 10/14/2015. No abnormal findings are seen in the right retroareolar region, where breast MRI (11/2/15) demonstrated an enhancing mass.No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in left breast. ULTRASOUND IMAGES OF RIGHT BREAST (10/14/15):An irregularly shaped hypoechoic mass is visualized at 12:00 position in the right breast, measuring 21 x 18 x 23 mm, corresponding to the mass seen on the mammogram. No abnormal lymph nodes are visualized in 4 images of right axilla.IMAGES FROM ULTRASOUND GUIDED BIOPSY OF RIGHT BREAST AND POSTPROCEDURAL RIGHT MAMMOGRAPHIC IMAGES (10/21/2015):Ultrasound guided needle biopsy was performed for the mass in the right breast with an appropriate needle placement. A marker clip (coil shaped) is present within the mass at anterior aspect.Per outside radiology report, the result was malignant; invasive ductal carcinoma.

Output: Biopsy proven carcinoma in the right breast. BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Female, 70 years old, with chronic dizziness and vertigo. No restricted diffusion is seen. Numerous small foci of T2/FLAIR hyperintensity are seen scattered through the cerebral hemispheres and brainstem. No edema or mass effect is detected. No findings to suggest acute intracranial hemorrhage or any abnormal extra-axial fluid are observed. The ventricles are normal in size and morphology. The right maxillary sinus and right ethmoid air cells are opacified.

Output: 1.No definite acute intracranial abnormality is seen.2.Scattered foci of signal abnormality are nonspecific but statistically most likely represent chronic microvascular ischemia.


Instruction: Generate impression based on findings.

Input: 40 years Male (DOB:1/18/1976)Reason: rule out spinal cord abnormality History: CSF leak lumbar areaPROVIDER/ATTENDING NAME: ROBERT A MULLIKEN Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The spinal cord is tethered and extends down to the level of S2 where there is a spina bifida defect present there is a surgical defect present at this level.Previously noted fluid collections behind the spinous processes of the L4 and L5 and behind the sacrum are smaller on the current. On sagittal imaging fluid collection currently measures approximately 28 x 15 mm sagittal dimensions with a second compartment measuring 42 x 3 mm. This previously measured 54 x 18 mm sagittal dimensions with a second compartment measuring 11 x 46 mm. There appears to be T2 signal hyperintensity extending up to the thecal sac resulting question this represent CSF leak.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is a disc bulge present at this level which is associated with some facet hypertrophy.At L4-5 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.Tethered cord associated with sacral dysraphism. Findings are suggestive of surgically treated myelomeningocele.2.Fluid collections behind of the patient's thecal sac at the lumbosacral junction level have decreased in size. There are findings that suggest that these may represent CSF leak.


Instruction: Generate impression based on findings.

Input: History of liver hypodensities on prior CT. Evaluate for malignancy. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in size, morphology and signal intensity.No intra or extrahepatic biliary ductal dilatation. Normally distended gallbladder.Segment VII 1.1 cm flash filling hemangioma.Segment VIII 1.8 cm typical hemangioma.Segment VI peripheral 1.2 cm typical hemangioma.No focal suspicious liver lesion.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted. Mildly prominent pancreatic duct without mass or pancreatic divisum.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Three benign liver hemangiomas, the largest of which measures 1.8 cm.


Instruction: Generate impression based on findings.

Input: Female, 52 years old. Palpable nodule at right IP joint. The soft tissues of the first finger unremarkable, without abnormal areas of enhancement, solid mass lesions, or discrete fluid collections. There is diffusely increased signal on T2-weighted images within the marrow of the visualized portion of the first metacarpal, without focal lesion, abnormal T1 signal, or abnormal enhancement. Otherwise, the visualized osseous structures, tendons, and ligaments appear intact.

Output: 1.No focal abnormality within the soft tissues of the right first finger to account for the patient's palpable abnormality. Correlation with plain radiographs may be useful for further evaluation.2.Diffusely increased T2 signal without abnormal enhancement within the visualized first metacarpal bone marrow is of unclear etiology, but may reflect a contusion.


Instruction: Generate impression based on findings.

Input: 49-year-old male. Status post RFA. Assess for HCC recurrence. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic morphology with fatty infiltration.Portal vein: Patent Hepatic veins: PatentHepatic artery: PatentLesions: 1. Ablation cavity measures 3.6 x 3.7 cm, previously 3.4 x 3.6 cm. No internal enhancement to indicate local recurrence.2. Two arterially enhancing, T2 hyperintense foci in the right hepatic lobe now show washout and have a capsule, consistent with HCC. 1.4 x 1.2 cm, previously 1.2 x 0.9 cm (series 9, image 22) and 1.5 x 1 cm (series 9, image 25), previously 1.1 x 0.9 cm.Cholecystectomy clips. No biliary ductal dilatation.SPLEEN: Mild splenomegaly with a large splenule. PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right renal cyst. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: Mildly enlarged stable portocaval and gastrohepatic lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Focal fat containing T2 hyperintense lesion in the left L2 vertebral body, unchanged.OTHER: No significant abnormality noted.

Output: Previously noted two small lesions in the right hepatic lobe now have features consistent with HCC, mildly increased in size from prior.


Instruction: Generate impression based on findings.

Input: The thin bilateral convexity subdural hygromas that were noted on the previous outside MRI study are resolved. There is no abnormal signal or enhancement. No evidence of bleed, mass effect, or edema. There is mild prominence of the ventricles and sulci with mild global volume loss, more than the expected for age. No midline shift. There is normal gray-white matter differentiation. The basal cisterns are patent. Normal flow voids of the vessels.

Output: Mild global volume loss greater than expected for the patient's age. Otherwise, the study is unremarkable. The subdural hygromas that were noted in the previous outside MRI study are resolved.


Instruction: Generate impression based on findings.

Input: Cavernoma, please compare to outside images. There is no significant interval change in the right pons multilocular and peripherally enhancing lesion with peripheral hemosiderin that measures up to approximately 15 mm, with mild surrounding vasogenic edema. There is no evidence of 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.

Output: No significant interval change in the right pons cavernous malformation with associated mild vasogenic edema.


Instruction: Generate impression based on findings.

Input: Diagnosis: Memory loss. Weakness Clinical question: cognitive changesSigns and Symptoms: cognitive changes The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is multilevel disc desiccation present. The cervical spinal canal is rather large and accommodating for the spinal cord.The right lower thyroid is enlarged and measures 48 x 71 mm sagittal dimensions. It has heterogeneous signal characteristics on T2-weighted imaging but is predominantly high signal. The left lobe of the thyroid gland is also enlarged with similar signal characteristics and measures 41 x 28 mm axial dimensions and 50 x 28 mm sagittal dimensions.There are multiple T2 signal hyperintense lesions in the pons.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina. At C4-5 there is no significant compromise to the spinal canal or neural foramina. There is a minor disc bulge at this level. There is some minor posterior ligamentous hypertrophy.At C5-6 there is no significant compromise to the spinal canal or neural foramina. There is a very small left paramedian disc protrusion present at this level. There is some minor posterior ligamentous hypertrophy.At C6-7 there is no significant compromise to the spinal canal or neural foramina. There is a very small central disc protrusion present at this level. There is some minor posterior ligamentous hypertrophy.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.There is marked thyroid gland enlargement present. Please correlate with patient's clinical history. One possibility is that this represents a goiter.2.There are some minor degenerative changes present in the cervical spine without significant compromise to spinal canal or neural foramina. No intrinsic spinal cord lesions are appreciated.3.There are multiple lesions present within the pons. Please refer to MRI of the brain from 5/12/2015 for further comments.4.There are no findings appreciated to account for the patient's weakness within the cervical spine


Instruction: Generate impression based on findings.

Input: Alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign. The cervical and upper thoracic cord are normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.Fluid is present within left mastoid air cells.Edematous discogenic reactive endplate change (Modic type I) is evident at C4/5.C2/3: UnremarkableC3/4: Minimal posterior osteophyte disc complex without stenosisC4/5: Mild posterior osteophyte disc complex without stenosis. Note is made of a small left posterolateral endplate disc herniation (Schmorl's node).C5/6: Minimal posterior osteophyte disc complex as well as bilateral uncinate hypertrophy. There is moderate bilateral neural foraminal stenosis.C6/7: Mild posterior osteophyte disc complex as well as bilateral uncinate hypertrophy. There is mild bilateral neural foraminal stenosis.C7/T1: Unremarkable

Output: 1.C5/6: Moderate bilateral neural foraminal stenosis.2.C6/7: Mild bilateral neural foraminal stenosis.


Instruction: Generate impression based on findings.

Input: Disorder of brain, unspecified [G93.9], Reason for Study: ^Reason: Brain mets History: seizure Multifocal variable sized supra and infratentorial enhancing nodules indicating metastatic lesions with surrounding edema.There is a focal susceptibility lesion on the left lateral ventricle periventricular white matter may indicate either mineralization or hemorrhagic lesion. Since the lesion does not show associated enhancement, the possibility of hemorrhage metastasis is a relatively low.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no midline shift, intra or extra-axial fluid collection/hemorrhage. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Multifocal supra and infratentorial variable sized metastatic nodules with the surrounding edema.2. No evidence of acute ischemic lesion.


Instruction: Generate impression based on findings.

Input: postop follow up after large bifrontal meningioma There is evidence of bifrontal craniotomy with debulking of tumor.The area of Gad enhancement are now see on bilateral anterior skull base and posterior aspect of the tumor which is just in front of left side basal ganglia. Tumor mass involving right anterior and posterior ethmoidal sinuses remains unchanged.Approximately 80-90% of tumor mass have been removed.Subtle peritumoral high signal intensities on FLAIR indicating peritumoral edema are seen but the degree of mass effects to surrounding brain parenchyme and bilateral ventricles frontal horns appear to be stable (not worse). The gray-white matter differentiation is normal. There is intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The mastoid air cells are clear.

Output: Postoperative status of bifrontal meningioma, about 90% of tumor mass has been removed.Postoperatively no unusual finding.


Instruction: Generate impression based on findings.

Input: Spinal cord tumor of unknown etiology. Brain parenchyma is normal in attenuation and morphology. The ventricles are symmetric and normal in volume. No abnormal enhancing lesions are seen in the brain parenchyma. Focal enhancing mass is seen at the level of the foramen magnum which measures 2.8 x 2.1 cm transaxially (image 2 of series 7) x 3.1 cm sagittally (image 41 series 80273). The mass enhances homogeneously and appears extramedullary in location. It is unclear if the mass is extradural or intradural in origin. There is no evidence of associated bony destruction or remodeling. Few foci of high density are seen within the mass consistent with calcification. The upper cervical spinal cord is displaced posteriorly and laterally along the right aspect of the canal. No additional enhancing lesions are seen in the spinal canal. Differential considerations include a meningioma and a hemangiopericytoma. Findings can further evaluated with cervical spine MRI.The visceral and vascular structures of the neck are normal. No pathologic lymphadenopathy or abnormal enhancing masses are seen in the soft tissues of the neck. Airway is widely patent. Visualized osseous structures demonstrate degenerative changes without other abnormality. Visualized lung apices are unremarkable.

Output: Enhancing mass at the foramen magnum which appears extramedullary in location and causes mass effect on the spinal cord. Differential considerations include meningioma and hemangiopericytoma.


Instruction: Generate impression based on findings.

Input: Clinical question: Patient with bilateral upper extremity weakness and recent fall. Rule out hemorrhage/other acute processes. Signs and symptoms: Bilateral upper extremity weakness. Nonenhanced head CT:No detectable acute intracranial process. CT however is insensitive for the attention of acute nonhemorrhagic ischemic strokes.Cerebral cortex, cortical sulci and the ventricular system are within normal for patient stated age.The gray -- white matter differentiation is preserved.Calvarium and soft tissues of the scalp are unremarkable.Visualized paranasal sinuses, mastoid air cells and middle ear cavities are pneumatized and unremarkable. Very small retention cyst in the left maxillary sinus however is present.Nonenhanced cervical CT:There is no detectable bony fracture of the cervical spine.There is very significant degenerative changes of cervical spine with resultant near complete fusion of C3 and C4 , significant loss of intervertebral disk at C4 -- C5 and advanced degenerative changes at C5 -- C6 and C6 -- C7 levels. There is reversal of cervical lordosis centered at C3 there C4. There is highly suspected central spinal stenosis at C3, C4 and C5 levels.There are also bilateral multi-level neural foraminal compromise at C3 there C4, C4 -- C5 and to a lesser degree at C5 -- C6 and C6 -- C7 levels.No detectable paraspinal soft tissue abnormalities.Heavy vascular calcification of the right carotid bifurcation is noted.Enlargement of thyroid lobes with inhomogeneous pattern is concerning for goiter. There is no deviation or compromise of the trachea.

Output: 1.Negative nonenhanced head CT.2.No evidence of acute posttraumatic findings of cervical spine. Very advanced degenerative changes of cervical spine with resultant reversal of cervical lordosis and multilevel neural foraminal compromise and suspected central spinal stenosis.


Instruction: Generate impression based on findings.

Input: 65 year-old male. Abnormal scrotal ultrasound. EPIC history: right testicular mass on OSH US. PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No lymphadenopathy. BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Small right fat-containing inguinal hernia.TESTICLES: Normal signal intensity and homogeneous enhancement on all phases of both testicles. No focal mass is evident.EPIDIDYMIS: Subcentimeter left epididymal cyst. Otherwise the epididymidis are unremarkable.

Output: Normal appearance of the testicles with no focal mass. Outside hospital ultrasound images may be submitted for comparison and an attempt to explain the abnormality seen on that study, which is not evident on today's exam; addendum will be issued at time of submission.


Instruction: Generate impression based on findings.

Input: 58 years, Male, status post left parietal tumor resection. Post surgical findings consistent with left parieto-occipital craniotomy for left parietal lobe mass resection are redemonstrated. Minimal cytotoxic edema surrounds the resection cavity, which may transiently enhance on subsequent follow-up imaging. Given the relative lack of significant solid enhancing tumor on the preoperative study, evaluation for residual tumor is slightly limited. There is minimal linear enhancement along the periphery of the resection cavity, at least most of which appears to be related to vasculature. Blood products fill the resection cavity. There is redemonstration of left parietal lobe and left posterior temporal lobe increased T2 signal, which may again represent vasogenic edema and/or underlying infiltrating tumor, with effacement of the posterior horn of the left lateral ventricle and blunting of the parietal convexity sulci. Minimal rightward midline shift is not significantly changed. A small extra-axial fluid collection is again noted adjacent to the craniotomy site consistent with postoperative change.Minimal scattered foci of nonspecific T2/FLAIR hyperintensity are present in the subcortical white matter bilaterally, as on previous examination. There is no evidence of hydrocephalus. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear.

Output: Gross total resection of the left parietal mass. No definite evidence of enhancing residual tumor.


Instruction: Generate impression based on findings.

Input: 53-year-old female status post cardiac arrest, new ischemic stroke, evaluate for prognostication purposes. There is evidence of prominent restricted diffusion in multiple areas throughout the brain including the bilateral thalami, cerebellar hemispheres and vermis, posterior frontal, parietal, temporal, occipital lobes, and perhaps portions of the bilateral basal ganglia. There is associated vasogenic edema most prominently involving the left parieto-occipital region but also involving the right parietal occipital region. There is gyriform hyperintense T1 and susceptibility abnormality within the left parieto-occipital region compatible with subacute hemorrhage. 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 paranasal sinus fluid and mucosal thickening. There are partly imaged postoperative findings in the cervical spine. There appears to be swelling of the anterior tongue. The patient is intubated as well. There is diffuse low signal of the bone marrow, which may be related to renal osteodystrophy.

Output: 1. Bilateral subacute ischemic lesions mainly involving the bilateral posterior cerebral hemisphere with subcortical vasogenic edema and subacute petechial hemorrhagic conversion involving left parietal-occipital regions, perhaps indicating superimposed posterior reversible encephalopathy syndrome.2. Swelling of the anterior tongue may indicate angioedema or the effects of compression.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 44-year-old female with ankle pain. Evaluate insertional Achilles tendinitis. TENDONS: The flexor and extensor tendons appear intact. The peroneal tendons appear intact. There is thickening and increased signal abnormality within the distal Achilles tendon just proximal to its insertion on the calcaneus consistent with mild to moderate tendinosis. The Achilles tendon appears intact. There is enthesophyte formation along the posterior aspect of the calcaneus.LIGAMENTS: The lateral collateral ligament complex and distal tibiofibular syndesmosis appear intact. The visualized portion of the deltoid ligament appears intact. ARTICULAR SURFACES AND BONE: Incidental note is made of an os trigonum. There is a small amount of fluid within the subtalar joint. There is a small amount of fluid within the tibiotalar joint. There is a plantar calcaneal heel spur.ADDITIONAL

Output: Findings consistent with mild to moderate tendinosis of the distal Achilles tendon, which appears intact. Other findings as described above.


Instruction: Generate impression based on findings.

Input: 87 years Female (DOB:12/1/1928)Reason: 87 year old female with metastatic breast CA (to skin) with worsening painless, enophthalmos and restricted motility of right > left eye for last 6 months. History: 87 year old female with metastatic breast CA (to skin) with worsening painless, enophthalmos and restricted motility of right > left eye for last 6 monthsPROVIDER/ATTENDING NAME: SUSAN M KSIAZEK SUSAN M KSIAZEK 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. Punctate T2 and FLAIR signal hyperintense lesions are also present in the internal capsules and brainstem.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate an air-fluid level in the left maxillary sinus The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin.There is a mild thickening of the alar ligaments redemonstrated at C1-2.MRI orbits:The eyeballs are intact. There is redemonstration of enhancement within the intraconal space bilaterally but more prominent than the right relative to the left side. 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 .There is some mild enhancement along the left temporalis muscle which was also present on the prior exam but is less prominent on the current exam. To a lesser degree there is minor enhancement along the right temporalis muscle. This is also less than on the prior exam.

Output: 1.There is enhancement of the intraorbital fat bilaterally but more so on the right than the left side. This was also present on the prior exam. This appearance has not changed substantially. No intraorbital mass is appreciated. Differential considerations include an infiltrative neoplasm versus an inflammatory process. 2.Associated with the orbital infiltrative lesions other is some mild enhancement along the left temporalis muscle which was also present on the prior exam but is less prominent on the current exam. To a lesser degree there is a minor enhancement along the right temporalis muscle which could also be part of the same process. This is also less than on the prior exam.3.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related.4.Punctate lesions in the internal capsules and brainstem are likely vascular related as well 5.There is an air-fluid level in the left maxillary sinus raising the question of acute sinusitis.6.There is redemonstration of some signal hyperintensity in the left temporalis muscle which appears to have regressed relative to the prior exam.7.There is no convincing evidence for brain metastases.


Instruction: Generate impression based on findings.

Input: Male; 73 years old. Reason: 73M s/p aborted cholecystectomy due to dense adhesions History: evaluate gallbladder ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic mass. No biliary ductal dilation. Patent distal cystic duct. Gallbladder is contracted and contains gallstones, similar to prior ultrasound. Normal gallbladder wall thickness accounting for contracted state. The gallbladder wall demonstrates increased enhancement on delayed phase images, suggestive of fibrosis. No pericholecystic fluid or surrounding inflammatory changes to suggest acute cholecystitis. The gallbladder contacts and is likely adhesed focally to the proximal duodenum, as suspected during recent surgery (series 11/28). No focal gallbladder mass. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Contracted gallbladder containing gallstones with findings suggestive of fibrosis involving the gallbladder wall and focal adhesion to the duodenum, as suspected during recent surgery. No evidence of acute cholecystitis. No focal hepatic or gallbladder mass.