Instruction: Generate impression based on findings.

Input: 72-year-old female status post Whipple's procedure in 2014 for IPMN now with recent elevation of LFTs, nausea, and vomiting. ABDOMEN:LIVER, BILIARY TRACT: 2.1 x 1.3 cm segment 6 mildly T2 hyperintense lesion with mild peripheral enhancement which slightly increases on delayed phase images, most likely an atypical hemangioma (series 13/57). No suspicious hepatic lesions are evident on this nondedicated study.Gallbladder surgically absent. Marked intra and extrahepatic biliary ductal dilation with the common bile duct measuring up to 1.4 cm (series 5/1) with abrupt transition at the biliary enteric anastomosis, most suspicious for stricture. Small amount of dependent low T2, high T1 signal within the distal common bile duct, most likely due to biliary sludge.SPLEEN: No significant abnormality noted.PANCREAS: Postsurgical changes from Whipple's procedure. Remaining pancreas is atrophied with main pancreatic ductal dilation measuring up to 10 mm (series 5/1) and multiple dilated side branches visualized. There is an abrupt transition at the pancreatic enteric anastomosis, for which stricture cannot be excluded.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: Pancreaticobiliary tree dilation status post Whipple's procedure. Stricture at the biliary enteric anastomosis is suspected. Stricture at the pancreatic enteric anastomosis is also a possibility, though clinical correlation for such would be needed, comparison to prior imaging if available may be helpful.


Instruction: Generate impression based on findings.

Input: The last well formed disk space is referred to as L5-S1, consistent with prior exam. There is minimal unchanged grade 1 retrolisthesis of L4 on L5. The osseous marrow signal is benign with scattered foci of hemangioma versus focal fat deposition. The vertebral body heights are intact. There is unchanged desiccation of the L3-4, L4-5 and L5-S1 disks with mild loss of disk height at L3-4, and L4-5 and moderate loss of disk height at L5-S1. The conus terminates at L1 and shows normal signal and caliber.T12-L1: No disk herniation or spinal stenosis.L1-2: No disk herniation and bilateral facet arthropathy with no spinal stenosis.L2-3: Minimal disk bulge, ligamentum flavum thickening, and bilateral facet arthropathy without significant spinal canal or neural foraminal stenosis.L3-4: Mild diffuse disk bulge, ligamentum flavum thickening, bilateral facet arthropathy causing no significant spinal canal or neural foraminal stenosis.L4-5: Previously seen right paracentral protrusion has improved with decreased but persistent mass effect upon the right traversing L5 nerve root in the right subarticular zone. There is a dorsal annular fissure. Minimal spinal canal stenosis, improved from prior examination. No significant neural foraminal stenosis.L5-S1: Diffuse disk bulge, asymmetric to the left, moderate bilateral facet arthropathy and ligamentum flavum thickening causing no significant spinal canal or left neural foraminal stenosis. There is mild right neural foramina narrowing. The disk material encroaches upon the bilateral descending S1 nerve roots without significant stenosis involving the subarticular zone.

Output: Compared to 8/13/2012, there is slight decrease in size of L4-L5 paracentral protrusion. There may be however some residual mass effect upon the traversing right L5 nerve root in the subarticular zone. There is also mild right L5-S1 neural foraminal narrowing. Otherwise no significant spinal canal or neural foramina stenosis is seen in the lumbar spine.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Clinical question: Evidence of malignancy. Signs and symptoms: Patient with focal area of enhancement in right C6 vertebrae which enhances. CT of the cervical spine:Examination demonstrate a lytic lesion in the right superior aspect of C7 vertebrae. There is thinning of the cortex posteriorly and at the level the superior endplate of T1 however without any break/defect of the cortex.Finding correspond to the previously noted enhancing focus in C7 on prior MRI exam. Possibility of malignancy should be considered. There is no evidence of fracture or malalignment. There is also no evidence of any additional foci of cystic change of the column.Limited images through the skull base are also negative.The alignment the vertebral column is within normal.

Output: 1.There is an osseous lytic lesion within the superior right lateral aspect of T7 vertebrae corresponding to the region of enhancement noted on prior MRI. This lesion measures approximately 12 x 8 x 8-mm in size. There is no evidence of extension of the lesion into the cortex and no evidence of fracture. Possibility of malignancy should be considered till proven otherwise.2.Negative nonenhanced CT of cervical spine otherwise.


Instruction: Generate impression based on findings.

Input: Acute esotropia left. Orbits: There is no evidence of intraorbital mass lesions. The extraocular muscles are intact bilaterally, without evidence of deformity or atrophy. The globes, lacrimal glands, orbital fat, and optic nerves are unremarkable bilaterally. The orbital walls appear to be intact.Brain: The cerebellar tonsils display a pointed morphology and are low-lying, extending up to approximately 8 mm inferior to the foramen magnum. In addition, the posterior fossa capacity is relatively small and there is crowding of the foramen magnum contents. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is a small developmental venous anomaly in the right medial orbitofrontal gyrus. The brain parenchyma otherwise appears unremarkable. The cavernous sinuses appear to be intact. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift. The major cerebral flow voids are intact. There is minimal scattered paranasal sinus mucosal thickening and right mastoid air cell fluid.

Output: 1. Findings indicative of Chiari type 1 malformation, which can potentially be associated with acquired esotropia. 2. No evidence of intraorbital lesions or gross extraocular muscle abnormalities.3. No evidence of intracranial tumors or acute infarction.REFERENCES:1. Lewis AR, Kline LB, Sharpe JA. Acquired esotropia due to Arnold-Chiari I malformation. J Neuroophthalmol. 1996 Mar;16(1):49-54.2. Bixenman WW, Laguna JF. Acquired esotropia as initial manifestation of Arnold-Chiari malformation. J Pediatr Ophthalmol Strabismus. 1987 Mar-Apr;24(2):83-6.3. Biousse V, Newman NJ, Petermann SH, Lambert SR. Isolated comitant esotropia and Chiari I malformation. Am J Ophthalmol. 2000 Aug;130(2):216-20.Discussed with Dr. Folk at 8:40 AM on 1/29/16.


Instruction: Generate impression based on findings.

Input: History of pancreatic cyst December 2006. EUS at that time was consistent with pseudocyst. Presents with bloating, gas and altered bowel habits. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology, size and signal intensity. Several scattered liver cysts.No suspicious liver lesion biliary ductal dilatation or vascular abnormality.Normally distended gallbladder.The vessels are patent.SPLEEN: The spleen is normal in morphology size signal intensity and enhancement without a focal lesion.PANCREAS: In the pancreatic body there is a 1.7 x 1.3 cm lobular cystic lesion (series 8/24). There is no upstream pancreatic ductal dilatation or parenchymal atrophy. There is a component of the lesion which demonstrates intrinsic T1 weighted moderate hyperintensity suggestive of proteinaceous/hemorrhagic products. Postcontrast and subtraction images demonstrated internal enhancing components. There may be small septations as well. The lesion does not appear to communicate with the pancreatic duct.The pancreas parenchyma is normal in intrinsic T1-weighted signal intensity. Following secretin administration there is appropriate excretory response without ductal ectasia.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: New pancreatic body solid-cystic lesion measuring 1.7 cm demonstrating internal enhancing components, suspicious for a malignancy such as an islet cell tumor and less likely a mucinous neoplasm.


Instruction: Generate impression based on findings.

Input: 6 year old male, evaluate extent of orbital cellulitis. MRI 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. The major cerebral flow voids are intact. The right maxillary sinus, right anterior ethmoidal air cells and right nasal cavity are completely filled by extensive T2/FLAIR signal. The skull and scalp soft tissues are grossly unremarkable.MRI ORBIT: There are inflammatory changes within the periorbital soft tissues as well as along the soft tissues overlying the right nasal ala and maxillary bone. There is complete opacification of the right maxillary sinus, right anterior ethmoidal air cells and right nasal cavity.There is a rim-enhancing collection along the inferomedial wall of the right orbit measuring about 5 x 5 mm in the axial plane (series 1201, image 5). Both orbits are otherwise intact. No intraconal or extraconal space mass is identified. The extraocular muscles are intact. The lacrimal glands are symmetric and within normal limits in size and configuration. There is no optic nerve enhancement appreciated. The suprasellar cistern is intact .

Output: 1. Right periorbital cellulitis with a small 5 mm rim-enhancing collection along the inferomedial wall of the right orbit which could represent a small subperiosteal abscess. No intracranial extension.2. Extensive right maxillary, anterior ethmoidal air cells and right nasal cavity opacification. Findings were discussed with Dr. Nishitani by phone on 12/24/2016 at 10:05 AM.


Instruction: Generate impression based on findings.

Input: Female, 87 years old, with brain metastases from breast cancer, evaluate for SRS planning. A 9 mm cortically based enhancing mass is evident within the left precentral gyrus inducing moderate adjacent edema. A 7 mm cortically-based enhancing mass is also seen in the right postcentral gyrus with minimal associated edema. A 3-mm enhancing focus is evident within the right caudate nucleus. No other enhancing lesions are seen. No significant generalized mass effect is detected. The ventricles remain stable and normal in size.

Output: Three enhancing parenchymal lesions are identified as above which most likely represent metastases.


Instruction: Generate impression based on findings.

Input: Reason: see MRI hip; has mass just superior-medial to ischial spine and thigh fullness; eval for mass or soft tissue deformity History: see above Left hip:Markers were placed along the anterolateral margin of the left hip region. Just above these markers, at the level of the left iliac crest, is a 6.0 x 3.0 x 4.8 cm collection of fat signal intensity within the subcutaneous tissues which may represent a lipoma. We see no enhancement of this mass on postcontrast sequences. We see no additional mass lesions on the postcontrast images. Please note that this study was not protocoled for detailed evaluation of the labrum, however, there is mild heterogeneity of the signal intensity within the superior labrum which could represent a labral tear, but the clinical significance of this is uncertain. There is a small amount of fluid within the hip without evidence of a large effusion. On the large field-of-view images, mild osteoarthritis affects the sacroiliac joints bilaterally. Facet joint osteoarthritis affects the lower lumbar spine. There are multiple presumed uterine fibroids.Left femur/thigh:We see no soft tissue mass within the thigh. The signal intensity of the soft tissues of the thigh is within normal limits. The signal intensity of the femur is normal. Osteoarthritis affects the knee.

Output: Lipoma situated within the subcutaneous soft tissues along the lateral aspect of the left iliac crest corresponding to the patient's palpable area of concern. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Subependymoma, (WHO Grade 1), resection of tumor from 4th ventricle. There are stable postoperative findings related to fourth ventricular tumor resection. 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, and scalp soft tissues are grossly unremarkable. There is right maxillary sinus retention cyst formation.

Output: Stable postoperative findings related to fourth ventricular subependymoma resection, without evidence of recurrent tumor.


Instruction: Generate impression based on findings.

Input: Reason: Hx of NF-1, s/p excision of multiple MPNST, now with enlarging Right inguinal mass, evaluate for new MPNST History: above Stable postsurgical changes related to left lower extremity amputation and hip disarticulation with associated fatty muscle atrophy of the left hip musculature. Again seen are innumerable cutaneous lesions/masses within the pelvis, compatible with neurofibromas. Sacral dural ectasia and scalloping of the posterior aspect of the vertebral bodies also appears similar to prior. There has been interval increase in size of the masslike lesion in the region of the previously resected right inguinal neurofibroma, immediately anterior to the femoral vessels and abutting the medial psoas at the level of the acetabular dome. This lesion is isointense to skeletal muscle on T1 weighted images and hyperintense on T2, with heterogeneous enhancement, currently measuring 2.6 x 2.5 cm, previously 1.7 x 1.5 cm in transverse dimension. The adjacent poorly defined edema has decreased in size, which was likely in part post-surgical in nature.The reference left posterior pelvic lesion measures 4.4 x 3.9, previously 4.4 x 4.4 cm, not significantly changed when compared to prior. The remainder of the innumerable neurofibromas appear grossly similar to previous.

Output: Innumerable lesions related to patient's neurofibromatosis. There has been slight interval increase in size of the right inguinal mass which is concerning for residual/recurrent malignant peripheral nerve sheath tumor, as detailed above.


Instruction: Generate impression based on findings.

Input: Status post resection of skull based meningioma on 4/8/14: 6 month follow up residual tumor. There has been interval evolution of postoperative findings related to right pterional craniotomy for resection of a planum sphenoidal tumor. There is persistent mild residual dural thickening and enhancement in the right paraclinoid region with a punctate nodular focus that extends into the right optic nerve canal with apparent mild impingement upon the right optic nerve. There is mild atrophy and diffuse T2 hyperintensity of the right optic nerve as well. The orbital contents are otherwise unremarkable.

Output: Postoperative findings with small amounts of residual tumor in the right paraclinoid region with extension into the right optic nerve canal with evidence of associated chronic compressive right optic neuropathy.


Instruction: Generate impression based on findings.

Input: 71 years, Male, newly diagnosed metastatic non-small cell lung cancer to the brain. Limited sequences of the brain are obtained per radiation treatment planning protocol. There are at least 10 enhancing lesions scattered in the bilateral cerebral hemispheres, cerebellum, and brainstem. A relatively large necrotic left parietal mass measures 3.3 x 2.7 x 2.3 cm, with a component medially which appears to extend into the posterior falx. There is an adjacent small left parietal lesion superior and laterally which extends to the dural surface. The largest right cerebral hemisphere lesion is in the right temporal lobe and measures 15 x 16 x 11 mm. Noted are small lesions including the right thalamus as well as involving the right superior tectal plate which narrows the cerebral aqueduct, but remains otherwise patent. Ventricles remain normal in size; no hydrocephalus. Small foci of susceptibility effect are noted associated with some of the lesions compatible with minimal chronic blood products. Cerebellar lesions are relatively small although two lesions on the right appear to extend in a somewhat linear fashion along the cerebellar surface with configuration suspicious for leptomeningeal disease.There is moderate degree of vasogenic edema associated with the left parietal lesion as well as mild associated mass effect on the left lateral ventricle. There is however no significant midline shift or evidence of herniation.Partially imaged cervical spine demonstrates moderate to severe spinal canal stenosis at the C3-C4 and C4-C5 levels related to disc osteophyte complexes, and ligamentum flavum thickening. There also appears to be spinal canal stenosis more inferiorly at C5-C6 and below.

Output: 1. Diffuse intracranial metastatic disease with greater than 10 lesions throughout the brain as described above. Notably, a relatively large left parietal mass is associated with moderate degree of edema; a small right midbrain tectal lesion narrows the cerebral aqueduct without evidence of hydrocephalus; there is suspicion of dural and leptomeningeal involvement as described above, and small foci of hemorrhage associated with the lesions.2. No significant midline shift or herniation.3. Moderate to severe spinal canal stenosis at the C3-C4 and C4-C5 levels on a degenerative basis.


Instruction: Generate impression based on findings.

Input: Procedure laser ablation MRI images were obtained with a laser ablation probe in place.

Output: Procedure laser ablation MRI images were obtained with a laser ablation probe in place.


Instruction: Generate impression based on findings.

Input: 69-year-old female with severe left hip pain. ACETABULAR LABRUM: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: No acute fracture or dislocation. Bone marrow signal is within normal limits without evidence of edema.SOFT TISSUES: No significant abnormality noted. ADDITIONAL

Output: Unremarkable left hip MRI without specific findings to account for the patient's pain.


Instruction: Generate impression based on findings.

Input: Right hemisphere infiltrating astrocytoma. There are postoperative findings related to There is infiltrative high T2 signal in the right frontal and insular lobes, as well as in the right basal ganglia and thalamus, with a cystic cavity in the right frontal lobe. There are also several scattered foci of enhancement in the right frontal lobe. 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: Preoperative planning MRI for a right hemisphere infiltrating astrocytoma.


Instruction: Generate impression based on findings.

Input: Reason: locking of the left knee. R/o internal derangement History: locking; had fraying cartilage seen on earlier MRI MENISCI: The medial and lateral menisci appear intact.ARTICULAR CARTILAGE AND BONE: The lateral compartment articular cartilage appears intact. The medial compartment articular cartilage appears intact. There is superficial fraying of the articular cartilage of the lateral facet of the patella comparable to that seen on the prior study. The femoral trochlea appears shallow, superiorly, suggesting mild femoral trochlear dysplasia.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The assessment as there appears intact.ADDITIONAL

Output: 1. Mild superficial fraying of the articular cartilage of the lateral facet of the patella appearing similar to the prior study.2. Additional findings suggestive of mild patellofemoral instability as described above.


Instruction: Generate impression based on findings.

Input: 46-year-old female with paresthesias. Please do dr javed MS protocol and compare to prior. The craniovertebral junction appears within normal limits. The cervical spine alignment is maintained and the cervical vertebral bodies and disc spaces are appropriate in height. The bone marrow signal is within normal limits. The cervical spinal cord has normal signal characteristics and overall morphology. There is no abnormal enhancement within the spinal cord. A tiny central disc protrusion is seen at the C5-6 level, unchanged. There is no significant compromise to the spinal canal or neural foramina. The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: 1.No abnormal signal or enhancement within spinal cord.2.Minimal degenerative findings in the cervical spine are unchanged.


Instruction: Generate impression based on findings.

Input: Reason: prostate cancer History: see above PELVIS:PROSTATE:Prostate Size: 5.8 x 3.7 x 3.7 cmPeripheral Zone: No suspicious lesions identified. Mild scarring at the base bilaterally, more pronounced on right side than left, no rounded borders detected to suggest underlying masslesion.Central Gland: Multiple BPH nodules.Seminal Vesicles: No significant abnormality.Extracapsular Extension: No significant abnormality.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: 5 mm utricle cyst.

Output: 1.No suspicious lesion identified.2.Small utricle cyst.


Instruction: Generate impression based on findings.

Input: Knee pain MENISCI: There is buckle handle type tear of the lateral meniscus with central displacement of the body and posterior horn (series 501 image 16). Medial meniscus is normal in morphology and signal characteristics.ARTICULAR CARTILAGE AND BONE: Osseous alignment is within normal limits. There is no evidence of bone marrow signal abnormality. We see no fluid-filled articular cartilage defect.LIGAMENTS: There is mild edema along the lateral capsular structures of the knee, likely related to underlying lateral meniscal tear. Anterior cruciate ligament, posterior cruciate ligament, medial collateral ligament, and lateral collateral ligament are intact.EXTENSOR MECHANISM: Quadriceps tendon and patellar ligament are intact.ADDITIONAL

Output: Displaced buckle handle-type tear of the lateral meniscus and other findings as above.


Instruction: Generate impression based on findings.

Input: Clinical question: Patient with spinal metastases, neck pain. Signs and symptoms: Neck pain Nonenhanced CT of the cervical spine:Previously described on prior MRI of the cervical spine with the study the lesion to the vertebral body of C5 is not identified on this study. There is subtle low attenuation of C7 vertebral body consistent with patient's known metastatic lesion. There is no evidence of fracture of this vertebrae and the alignment of vertebral column is unremarkable.Nonenhanced CT of thoracic spine:The alignment the vertebral column is within normal limits. Examination identifies previously detected metastatic lesion to T1 with mild compression deformity and minimal bulge of vertebrae into the spinal canal. There is no involvement of the pedicle of T1. The alignment remains intact. Mild compression deformity of vertebral body of T5 along its superior aspect and the internal lytic changes. There is no definitive involvement of the pedicles of T5. No definitive evidence of any additional lytic changes of vertebral column is detected.No definitive metastatic lesion to the facets of the pedicles of vertebral column.Nonenhanced CT of the lumber spine:The alignment of vertebral column is unremarkable. No definitive for the study kidneys to the lumber spine is detected.No evidence of central spinal stenosis or neural foramina compromise.There is very subtle low-attenuation involving S2 vertebral body however been no distinct destruction of the cortex or any perispinal soft tissue abnormality. Possibility of metastatic disease cannot be entirely ruled out.

Output: 1.Multiple metastatic disease to the thoracic spine and a suspected metastatic lesion to as to as detailed.2.There is mild compression fracture of T1 and T5 and mid no involvement of the pedicles of T1 or T5.3.The alignment of the vertebral column throughout the spine remains normal.


Instruction: Generate impression based on findings.

Input: Female 74 years old with history of GBM s/p craniotomy.Additional clinical history from electronic medical records:Underwent craniotomy with complete radiographic resection (7/22/14, Dr. Lesniak). She lacked EGFRv3 mutation. She received RT/TMZ and then TMZ. This was for a total of 6 cycles of TMZ. When there was progression of disease she enrolled in RTOG1205 for which she received re-RT, as well as additional bevacizumab. She had then been continuing bevacizumab off study under the care of Dr. Nicolau in Florida. More recently, she returned to Chicago and received a dose of bevacizumab on 05/18/2016 with Dr. Narula. She underwent right temporal craniotomy and viral vector injection on 6/27/2016. Interval reresection of suspected tumor recurrence along the anterior aspect of the right temporal resection cavity. There are expected post-surgical findings with fluid and air noted within an enlarged resection cavity. The previously seen faintly rim-enhancing and diffusion restricting lesion appears to be completely or near completely excised. An additional nodular area along the superior margin of the original resection cavity with diffusion restriction and faint peripheral enhancement appears stable to minimally increased in size from prior exam and measures approximately 16 x 12 mm (series 17 image 175). There is a nonspecific thin rim of enhancement along the anterior and posterior margins of the resection cavity which is likely postsurgical. There is confluent T2/FLAIR white matter hyperintensity surrounding the resection cavity, not significantly changed from prior exam. Additional non-specific patchy periventricular and subcortical T2 hyperintensity is also noted. There is no evidence of acute infarct. There is no midline shift or herniation. The major cerebral flow voids are intact. Findings of prior bilateral cataracts surgeries noted. There is an unchanged subcentimeter enhancing lesion in the left parietal bone, which is non-specific. The paranasal sinuses are grossly unremarkable.

Output: 1. Complete or near complete resection of recurrent tumor along the anterior aspect of the original resection cavity. 2. Redemonstration of nodular thickening superior to the original resection cavity is also suspected to represent tumor and appears stable to minimally increased in size.


Instruction: Generate impression based on findings.

Input: 41-year-old female with right knee pain. Evaluate for medial meniscus tear and degenerative changes. MENISCI: There is a complex tear of the posterior horn of the medial meniscus with a radial component. The anterior horn of the medial meniscus appears normal. The anterior horn of the lateral meniscus is not visualized. The posterior horn of the lateral meniscus appears normal.ARTICULAR CARTILAGE AND BONE: There is generalized thinning of the articular cartilage along the femoral condyles and tibial plateaus. There is subchondral bone marrow edema within the lateral femoral condyle and lateral tibial plateau. There is generalized thinning of the articular cartilage along the patellar facets and femoral trochlea. There are several areas of partial thickness defects along the articular cartilage of the medial and lateral patellar facets with adjacent subchondral bone marrow edema. In addition there are areas of partial thickness defects along the articular cartilage of the femoral trochlea with adjacent subchondral bone marrow edema. There is residual red marrow noted more proximally within the imaged femur and tibia.LIGAMENTS: The cruciate and collateral ligaments appear normal.EXTENSOR MECHANISM: The extensor mechanism appears normal.ADDITIONAL

Output: 1. Complex tear of the posterior horn of the medial meniscus with a radial component. The anterior horn of lateral meniscus is not visualized.2. Moderate articular cartilage thinning and degeneration and other findings as described above.


Instruction: Generate impression based on findings.

Input: Male 55 years old Reason: History of multiple myeloma, evaluate disease History: diffuse joint pain SKULL: No significant abnormality notedCERVICAL SPINE: Severe degenerative changes affects the mid to lower cervical spine which large arterial osteophytes and disc space narrowing.Carotid calcifications are present.No evident lucent lesions.THORACIC SPINE: The bones are demineralized. There is multilevel degenerative disc disease and anterior osteophytes.There are multiple rib fractures.LUMBAR SPINE: Degenerative changes affects the lower lumbar spine predominantly at L4-L5 anterior disc osteophytes.RIBS: There are multiple rib fractures with healing.PELVIS: Multiple lucent lesions are noted in the ischium bilaterally. No acute fracture or malalignment.UPPER EXTREMITY: Large expansile lesion involving the right scapula. Lesions also involve the right clavicle and acromion. The avascular necrosis of the right humeral head is better evaluated by MRI.There are several scalloped lucencies involving the right proximal humerus compatible with myelomatous deposits.Subtle lucency in the right distal radius aspect suspicious for myelomatous lesion.Degenerative changes affects the left acromioclavicular joint. There are several well marginated lucencies involving the left proximal humerus compatible with myelomatous deposits. No evident myelomatous deposit in the left forearm.LOWER EXTREMITY: Multiple well-defined lucencies involving the right proximal femur compatible with myeloma.Sclerotic lesion involving the metaphysis of the right proximal tibia may represent an enchondroma. There are few scattered lucencies involving the left proximal femur.

Output: Multiple myeloma with lesions involving the humerus femurs pelvis as detailed above


Instruction: Generate impression based on findings.

Input: 6-month-old female with tuberous sclerosis and hydronephrosis, evaluate. BLADDER  Wall Thickness: Normal  Contents: Large ureterocele is present within the bladder. Distal Ureter -- SFU Grade**  Right: 0  Left: 3   Ureteral Jets Right: Not observed  Left: ObservedKIDNEYS  Cortical Echogenicity: Normal.   Medullary Echogenicity: Normal   Pelvicaliceal System -- SFU Grade*  Right: 0 Left upper pole: 2  Left lower pole: 2   Length*** Right: 6 cm Left: 6.6 cm   Mean for age: 5.5 cm  Range for age: 4.5 - 7 cmADDITIONAL OBSERVATIONS: None.

Output: Left duplicated ureters with large ectopic ureterocele and partial obstruction of the upper pole moiety.*SFU grading system: Grade 0: No hydronephrosis. Grade 1: The renal pelvis is visualized. Grade 2: A few but not all of the calices are identified in addition to the renal pelvis. Grade 3: Virtually all the calices are seen. Grade 4: Grade 3 and parenchymal thinning. **SFU grading system retrovesical ureter: Grade 0: No ureteral dilatation. Grade 1: Ureter less than 7 mm. Grade 2: Ureter is 7-10 mm. Grade 3: Ureter is over 10 mm. Fernbach SK, Maizels M, Conway JJ. Ultrasound Grading of Hydronephrosis: Introduction to the System used by the Society for Fetal Urology. Pediatric Radiology (1993) 23: 478-480.***Rosenbaum DM, Korngold E, Teele RL. Sonographic Assessment of Renal Length in Normal Children. AJR Am J. Roentgenol (1984) 142:467-469


Instruction: Generate impression based on findings.

Input: Absence epileptic syndrome, not intractable without status epilepticus, increased seizure frequency, evaluate for encephalopathy, inflammation or infection. Examination is mildly motion degraded. 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 hippocampi appear grossly symmetric. 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: MRI of the brain is within normal limits.


Instruction: Generate impression based on findings.

Input: Images are significantly limited by patient motion. The cervical spine is in normal alignment, with straightening of the normal cervical lordosis. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal. There is no pathological spinal enhancement.There is a minimal posterior osteophyte disc complex at C6-C7 with slight left-sided prominence and left uncovertebral hypertrophy. Left facet arthropathy is also noted, contributing to overall moderate left and mild right foraminal narrowing. There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the remainder of the cervical spine. There are multiple areas of abnormal nodular and perhaps leptomeningeal enhancement involving the visualized brainstem and cerebellum. These are not definitely identified on the outside brain MR images. There is extensive T2/STIR hyperintensity within the brachium pontis bilaterally. There is an oval T2 hyperintense nonenhancing T1 hypointense lesion within the midline posterior deep subcutaneous fat, which may represent an inclusion cyst.THORACIC SPINE

Output: 1.No abnormal contrast enhancement within the cervical or thoracic spinal canal, within motion limitation.2.Very minimal cervical and thoracic spondylotic changes as detailed above.3.Partially visualized abnormalities within the visualized intracranial structures, including multiple enhancing nodular lesions as well as leptomeningeal enhancement suspected along the cerebellum, not seen on outside brain MRI images. Extensive abnormal signal in the brachium pontis bilaterally. These findings are of uncertain etiology, possibly representing an inflammatory process.


Instruction: Generate impression based on findings.

Input: 29-year-old male with NF1 and plexiform neurofibromas in the pelvis. There are innumerable masses of high signal intensity on STIR images, many having a target appearance, within the skin as well as within the subcutaneous and deep soft tissues of the pelvis compatible with nerve sheath tumors and the known history of neurofibromatosis type I. Plexiform neurofibromas involve the lumbar and sacral nerve roots as well as both sciatic nerves, extending beyond the field-of-view of this study. There are also plexiform neurofibromas involving both femoral nerves, slightly prominent on the right. Additional neurofibromas are noted within the pelvis as well as the surrounding musculature but there is no single dominant lesion to suggest malignancy, within the limitations of this noncontrast examination. For reference, a lesion along the lateral aspect of the right abductor musculature measures 2.2 x 1.3 cm, previously 2.2 x 1.3 cm (22; series 301). An additional lesion within the left rectus femoris muscle belly measures 0.8 x 0.8 cm, previously 0.8 x 0.8 cm (image 18; series 301). The bone marrow signal intensity is within normal limits. The hip joints, sacroiliac joints and pubic symphysis are unremarkable.

Output: Findings compatible with neurofibromatosis with plexiform neurofibromas appearing similar to the prior study.


Instruction: Generate impression based on findings.

Input: 66-year-old woman with history of cirrhosis, HCC, and second lesion seen near the gallbladder fossa. ABDOMEN:LIVER, BILIARY TRACT: The liver is cirrhotic in morphology with widened fissures and nodular contour. In segment 5 of the liver (series 6, image 17) there is a 35 x 32 mm T2 hyperintense lesion with central hypointensity which demonstrates peripheral enhancement throughout all phases of contrast including retention on delayed phases. This lesion appeared similar on the previous examination and measured 33 x 28 mm.Additionally, in segment 8 (series 6, image 13) there is a 36 x 30 mm uniformly T2 hyperintense lesion which, on the prior outside study, demonstrated arterial enhancement and washout on delayed phase of imaging. On the current study, the enhancement pattern is indeterminate. This lesion measured 35 x 20 mm on the prior examination.Additionally, in segment 2 (series 6, image 8) there is a subcentimeter lesion which is hyperintense on T2 sequences but not seen on the postcontrast images or the prior, outside examination.There is no intrahepatic or extra hepatic biliary duct dilatation. The gallbladder is normal.SPLEEN: The spleen is normal.PANCREAS: The pancreas is normal.ADRENAL GLANDS: The adrenal glands are normal.KIDNEYS, URETERS: There are subcentimeter renal cysts, otherwise the kidneys are normal and enhance symmetrically.RETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Segment 5 lesion with similar imaging appearance to the prior examination and suspicious for intrahepatic cholangiocarcinoma.2.Segment 8 lesion with indeterminate enhancement characteristics on today's examination, but findings on the prior examination suspicious for hepatocellular carcinoma.3.Segment 2 lesion which is too small to accurately characterize.


Instruction: Generate impression based on findings.

Input: 31 years, Female, Reason: Concern for right-sided fetal diaphragmatic hernia History: Right CDH on ultrasound. PELVIS:UTERUS, ADNEXA: Intrauterine pregnancy occupies the majority of the abdominal cavity. Placenta is seen along the posterior superior aspect uterus. Normal amount of amniotic fluid.FETUS: The liver is displaced superiorly to the apex of the right hemithorax, compatible with a congenital diaphragmatic hernia. The lung on the right is completely compressed. The heart is shifted slightly to the left.No hydronephrosis. No meningocele. Cord is 3-vessel. Brain is grossly normal.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: Mild caliectasis, within normal limits for pregnancy.

Output: Right-sided congenital diaphragmatic hernia.


Instruction: Generate impression based on findings.

Input: Clinical question: evaluate interval change. Signs and symptoms: Same. Unenhanced head CT:There is no evidence of intracranial hemorrhage, mass-effect, midline shift or hydrocephalus. Previously noted multiple foci of low attenuation of the cortex of bilateral posterior frontal lobes, bilateral basal ganglia are poorly visualized. There is only very subtle mass effect of the left high convexity posterior frontal area of cortical/subcortical edema. This is similar to prior MRI exam from 8 -- 4 -- 11. The ventricular system remain within normal range of size and unchanged since prior exam.

Output: 1.No evidence of an acute new findings on this nonfused portable head CT.2.Bilateral hemispheric foci of high signal intensity noted on prior MRI appear as foci of low-attenuation on CT and without any definitive appreciable interval change.


Instruction: Generate impression based on findings.

Input: 75 years Female (DOB:12/22/1940)Reason: altered gait History: altered gaitPROVIDER/ATTENDING NAME: BEN-ZION ROITBERG BEN-ZION ROITBERG Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal. There are left-sided uncovertebral osteophytes present this level associated with disc material which encroaches on the left-sided exiting nerve roots within the neural foramen this level. There is also facet hypertrophy present on the left-sided this levelAt C5-6 there is no significant compromise to the spinal canal or neural foramina. There is moderate left-sided facet hypertrophy at this level. The left-sided uncovertebral osteophytes at this level. There is encroachment of the left-sided exiting nerve roots within the neural foramen at this level.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. The right posterior inferior cerebellar artery loop extends down to the C1-2 levelMRI thoracic spine:The thoracic vertebral bodies are appropriate in the overall alignment and height. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots. At T12-L1 there is endplate reactive change present which has high signal on T2 and is associated with some Schmorl's nodes and a disc bulge. There is no compromise to the spinal canal at this level. There is mild narrowing of the left T12-L1 neural foramen at this level as a result of disc material.T6-7, T7-T8, T8-T9 and T10-T11 there are endplate reactive changes of chronic stage associated with Schmorl's nodes.

Output: 1.There are degenerative changes present in the cervical spine associated with encroachment of the left-sided exiting nerve roots at C4-5 and C5-6.2.There are degenerative changes present in the thoracic spine associated with acute endplate reactive changes.


Instruction: Generate impression based on findings.

Input: 68 year old with history of coronary artery disease, atrial fibrillation and recent pericarditis presenting for evaluation of chest pain. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 65%, the LV end diastolic volume index is 68 ml/m2 (normal range: 74+/-15), the LVEDV is 135 ml (normal range 142+/-34), the LV end systolic volume index is 24 ml/m2 (normal range 25+/-9), the LVESV is 48 ml (normal range 47+/-19), the LV mass index is 37 g/m2 (normal range 85+/-15), and the LV mass is 75 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is small area of atypical late gadolinium enhancement in the basal inferolateral wall to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. This is similar to previous exam. There is no significant diastolic septal bounce. Also, there is no exaggerated respiratory variation of the septal position.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 50%, the RV end diastolic volume index is 78 ml/m2 (normal range 82+/-16), the RVEDV is 156 ml (normal range 142+/-31), the RV end systolic volume index is 39 ml/m2 (normal range 31+/-9), and the RVESV is 78 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a "pseudo-bovine" branching pattern with common origin of right innominate and left common carotid arteries . The aortic root and ascending aorta is mildly dilated (ascending aorta 42 mm, SoV 39 mm).Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is a small pericardial effusion. The pericardium is mildly thickened (4-6mm). It is worst in the basal inferolateral wall. The pericardium has increased signal on T2-weighted imaging and also on late gadolinium enhancement consistent with pericarditis. 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. Mild pericardial thickening with evidence of acute/ subacute pericarditis. No clear evidence of constriction.2. Normal LV size with systolic function (LVEF 65%) with evidence of a small amount of atypical late gadolinium enhancement involving the basal inferolateral wall, which was also present on the prior study. It suggests the presence of underlying myocardial fibrosis, inflammation, or infiltration.3. Normal RV size and systolic function (RVEF 50%).4. Mild aortic root dilation.


Instruction: Generate impression based on findings.

Input: Female 12 years old with a history of neuroblastoma status post autologous stem cell transplant. She also has venoocclusive disease with involvement of the portal vein, as well as thrombus seen in the splenic vein on recent ultrasound, on anticoagulation. Now with acute mental status, evaluate for PRES. There is no evidence of acute infarct. There are multiple areas of abnormal increased T2/FLAIR signal in the cortex and subcortical white matter, in the bilateral parietal and occipital lobes with additional small areas in the frontal lobes, the parasagittal anterior parietal areas near the vertex (greater on the left), right posterior temporal lobe and smaller foci in bilateral cerebellar hemispheres (greater on the right). The brainstem and basal ganglia are spared. There is associated mild sulcal effacement and patchy gyriform enhancement, more conspicuous on the delayed post-contrast images. There is no intraparenchymal hemorrhage at this time.The ventricles and basal cisterns are normal in size and configuration with the left temporal horn of the lateral ventricle slightly smaller than the right as seen on CT, likely a normal variant. There is no midline shift or herniation. There is no extraaxial abnormality or osseous mass. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Multiple areas of bilateral supratentorial and cerebellar cortical/subcortical FLAIR abnormality with mild sulcal effacement and without diffusion restriction or susceptibility are favored to represent PRES, with mild associated patchy enhancement. Differential diagnosis would also include encephalitis, although felt to be much less likely, given lack of basal ganglia and brainstem involvement.


Instruction: Generate impression based on findings.

Input: 49 year old male patient with left medial knee pain for many years. No improvement with physical therapy and injection. MENISCI: There is a horizontal cleavage tear of the posterior horn of the medial meniscus (image 13, series 8) and complex tearing of the anterior horn and body, with extrusion of the body. The lateral meniscus appears intact, however, parameniscal cyst formation along the anterior horn raises the suspicion of an unseen tear.ARTICULAR CARTILAGE AND BONE: There is generalized thinning of the patella medial facet articular cartilage with fraying and delamination. There is generalized thinning of the trochlear articular cartilage and the lateral tibial condylar articular cartilage. There is complete loss of the articular cartilage of the weight bearing portion of the medial femoral condyle with underlying bony edema. There is marked thinning of the medial tibial plateau articular cartilage with a short segment full thickness defect. There is tricompartmental osteophyte formation.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact. Enthesopathic changes are noted about the tibial tubercle.ADDITIONAL

Output: 1. Complex tearing of the medial meniscus and suspicion of an unseen lateral meniscal tear. 2. Tricompartmental chondromalacia, most predominately affecting the medial femoral compartment. 3. Probable loose bodies within the suprapatellar pouch which can be confirmed with plain radiograph.


Instruction: Generate impression based on findings.

Input: Urinary retention and weakness with a sensory level. Assess for transverse myelitis/ADEM. Additional clinical history from electronic medical records: 32Yrs male with no past medical history who was sent to ER from urgent care for workup of myositis vs myelopathy vs GBS. Exam shows limited upgaze and rapid eye movement 2/2 pain w/o tenderness or inflammation and brisk reflexes. Subjective T10 paresthesia level but no sensory loss. Unlikely GBS given brisk reflexes and no weakness, less likely myositis w/ normal CK, but exam concerning for myelopathy given brisk reflexes, level, and constipation. BRAIN:There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is a small right frontal developmental venous anomaly, which is a common incidental finding. 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. Of note, the left posterior cerebral artery is fetal in origin, which is a common variant. The orbits, skull, and scalp soft tissues are grossly unremarkable. There are left maxillary retention cysts. There are small mucosal retention cysts in the nasopharynx.SPINE:Alignment is anatomic. Vertebral bodies are preserved in height. Intervertebral discs are also preserved in height. Marrow is diffusely less fatty than expected without discrete focal lesion or osseous destruction. This is likely benign and related to hematopoietic marrow. Small fat-containing lesions are present in the T1 vertebral body and left L5 pedicle and are most compatible with hemangiomas. There is a small eccentric to the right L5-S1 disc bulge which abuts but does not displace the right traversing S1 and exiting L5 nerve roots. There is no significant degenerative disease at the other levels of the spinal canal is preserved as well as the neural foramina. The spinal cord has normal precontrast signal. The tip of the conus medullaris lies at L1 level. There is faint central contrast enhancement in the lower thoracic spinal cord extending from T8-T9 to mid T11 level. There is also suggestion of faint contrast enhancement along the cauda equina roots. Small T1-hypointense, T2-hyperintense, non-contrast-enhancing kidney lesions may represent cysts but are not completely assessed.

Output: 1.Brain: No evidence of intracranial hemorrhage, mass, or acute infarct. 2.Spine: Faint T8-T11 level spinal cord and cauda equina root enhancement is of unknown significance. While this may represent an imaging artifact, the possibility of an underlying inflammatory process is also reduced.


Instruction: Generate impression based on findings.

Input: Reason: left medial meniscal tear? History: medial left knee pain with positive McMurray's and Apley's tests MENISCI: There is increased signal intensity along the undersurface of the posterior horn of the medial meniscus indicating a tear. There is slight blunting of the free edge of the body of the medial meniscus which may represent fraying. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There are surgical changes within the weightbearing portion of the medial femoral condyle suggestive of osteochondral fixation or transfer. There is heterogeneity of the overlying cartilage, likely representing a combination of degeneration and tearing with possible focal delamination anteriorly. There is edema type signal within the adjacent subchondral marrow. There is also degeneration of the adjacent cartilage of the medial tibial plateau with focal delamination and subchondral edema. There is mild superficial blistering along the lateral facet of the patella as well as thinning of the articular cartilage of the far medial facet of the patella. There are small tricompartmental osteophytes.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Surgical changes of medial femoral condyle osteochondral fixation or transfer with degeneration and tearing of the overlying cartilage as well as tearing of the articular cartilage of the adjacent medial tibial plateau.2. Undersurface tear of the posterior horn of the medial meniscus.3. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Myoclonus and past medical history of cerebellar lesions from encephalitis. Evaluate for etiology of myoclonus. Brain MRI:There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is moderate atrophy involving the bilateral cerebellar hemispheres but no abnormal signal intensity is visualized. The post-contrast exam is motion degraded which limits full evaluation, but there is no obvious abnormal enhancement. The remaining brain parenchyma and pituitary gland appears unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is right maxillary sinus and frontoethmoidal sinus mucosal thickening. There is also a left mucous retention cyst or polyp. Cervical spine MRI:Craniovertebral junction appears within normal limits. There is straightening of the cervical spine which is nonspecific. The cervical vertebral bodies are appropriate in height. Bone marrow signal is within normal limits. The cervical spinal cord has normal signal characteristics and overall morphology.Degenerative changes are seen in the cervical spine as described below:C2-3: There is a small disc bulge without significant compromise to the spinal canal or neural foramina.C3-4: There is a small disc bulge without significant compromise to the spinal canal or neural foramina.C4-5: There is a tiny disc bulge without significant compromise to the spinal canal or neural foramina.C5-6: There is a mild disc bulge and mild uncovertebral and facet hypertrophy which causes mild right neural foraminal stenosis. No significant compromise to the spinal canal or left neural foramina.C6-7: There is a mild disc bulge and mild uncovertebral and facet hypertrophy without significant compromise to the spinal canal or neural foramina.C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: 1.Diffuse bilateral cerebellar hemispheric atrophy which is nonspecific and may be related to the prior history of encephalitis as stated in the history.2.Mild degenerative changes of the cervical spine without cord signal abnormality or high-grade spinal canal or neural foraminal stenosis at any level.


Instruction: Generate impression based on findings.

Input: There is a partially empty sella. The ventricles and basal cisterns are otherwise normal in size and configuration. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is a prominent inferior left basal ganglia perivascular space and minimal bilateral periventricular white matter T2 hyperintensity. The brain parenchyma otherwise appears unremarkable. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1.Essentially normal appearance of the brain. 2.Incidental partially empty sella, which can be associated with pseudotumor cerebri. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Female 46 years old with right knee pain. There is mild medial joint space narrowing, mild sharpening of the tibial spines and tiny lateral compartment osteophytes indicating mild osteoarthritis. Probable joint effusion.

Output: Mild osteoarthritis.


Instruction: Generate impression based on findings.

Input: 60 year old man with SVT, referred for evaluation of underlying fibrosis or infiltrative disease. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 56%, the LV end diastolic volume index is 104 ml/m2 (normal range: 74+/-15), the LVEDV is 212 ml (normal range 142+/-34), the LV end systolic volume index is 46 ml/m2 (normal range 25+/-9), the LVESV is 93 ml (normal range 47+/-19), the LV mass index is 59 g/m2 (normal range 85+/-15), and the LV mass is 122 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. The mid interventricular septum myocardial T1 time is 1032ms, which is within the normal range. His extra-cellular volume fraction was 27%, which is within the normal range. No evidence of myocardial iron overload based on T2*.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 53%, the RV end diastolic volume index is 94 ml/m2 (normal range 82+/-16), the RVEDV is 193 ml (normal range 142+/-31), the RV end systolic volume index is 45 ml/m2 (normal range 31+/-9), and the RVESV is 91 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root at the SOV measures 40mm. The remainder of the ascending aorta is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 56%. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. No evidence of myocardial iron overload.2. The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 53%.3. Mild mitral and tricuspid regurgitation.4. The aortic root is mildly dilated.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: NF1 and frequent headaches and plexiform of left eyelid and orbit. Orbit: There is an infiltrative and enhancing left preseptal and postseptal mass, which does not appear to have significantly changed. There is mild mass effect upon the other left intraorbital structures. The left optic nerve is intact. The right orbits is unremarkable.Brain: There are new T2 hyperintense lesions in the anterior and posterior portions the corpus callosum, eccentric to the left, as well as a new T2 hyperintense lesion in the right cerebellar hemisphere white matter. Otherwise, many of the supratentorial and infratentorial T2 hyperintense lesions are unchanged. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. New bright spots related to neurofibromatosis type 1 in the anterior and posterior portions the corpus callosum, eccentric to the left, as well as a new bright spot in the right cerebellar hemisphere white matter. Otherwise, many of the supratentorial and infratentorial T2 hyperintense lesions are unchanged. 2. The left preseptal and postseptal plexiform neurofibroma has not significantly changed.


Instruction: Generate impression based on findings.

Input: Radiculopathy. The vertebral body heights are maintained. Mild loss of vertebral disc signal at L4-5 and L5-S1 along with minimal loss of disc height. Mild straightening of the lumbar lordosis, otherwise the alignment is anatomic. Nonspecific heterogeneous marrow signal without discrete lesion. The visualized spinal cord is normal in signal and morphology. The conus medullaris terminates at the L1-2 level.T12-L1: No disc bulge, spinal canal stenosis, or neuroforaminal narrowing.L1-L2: No disc bulge, spinal canal stenosis, or neuroforaminal narrowing.L2-L3: No disc bulge, spinal canal stenosis, or neuroforaminal narrowing.L3-L4: Mild diffuse disc bulge. Mild thickening of the ligamentum flavum. Minimal left neural foraminal narrowing. No significant right neural foraminal or spinal canal stenosis.L4-L5: Moderate disc bulge slightly asymmetric to the right with a central annular fissure. Mild hypertrophy of the ligamentum flavum. Minimal left and mild to moderate right neural foraminal narrowing. No spinal canal stenosis.L5-S1: Prominent right paracentral annular fissure and disc protrusion. Mild hypertrophy of the ligamentum flavum and facet arthropathy. The disc protrusion effaces the lateral recesses and impinges on the bilateral S1 nerve roots, right greater than left. There is also mild bilateral neural foraminal narrowing. Mild spinal canal stenosis.

Output: Prominent central disc protrusion at L5-S1 which impinges on the S1 nerve roots, right greater than left. There is also mild bilateral neural foraminal narrowing at this level.


Instruction: Generate impression based on findings.

Input: 18 year old male with history of Hodgkin's lymphoma and chemotherapy, chronic pulmonary embolism on anticoagulation, referred for cardiac MRI. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 60%, the LV end diastolic volume index is 99 ml/m2 (normal range: 74+/-15), the LVEDV is 212 ml (normal range 142+/-34), the LV end systolic volume index is 40 ml/m2 (normal range 25+/-9), the LVESV is 85 ml (normal range 47+/-19), the LV mass index is 49 g/m2 (normal range 85+/-15), and the LV mass is 104 g (normal range 164+/-36). There are no regional wall motion abnormalities present. The native T1 myocardial relaxation time is 1040*-1050ms, which is borderline. The T2 STIR myocardial:skeletal muscle ratio is normal. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is mild-moderately dilated with normal systolic function. The overall RV ejection fraction is 60%, the RV end diastolic volume index is 130 ml/m2 (normal range 82+/-16), the RVEDV is 276 ml (normal range 142+/-31), the RV end systolic volume index is 51 ml/m2 (normal range 31+/-9), and the RVESV is 110 ml (normal range 54+/-17).Right AtriumThe right atrium is mild-moderately dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is at least mild-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 and drain normally into the right atrium.PericardiumThere is no pericardial effusion. Pericardial thickness is 4mm. There is no evidence of pericardial edema or inflammation. Extracardiac FindingsThere is a large anterior mediastinal mass which displaces, but does not appear to compress, the innominate vein and SVC slightly posteriorly. There is an additional right paratracheal mass which was seen on previous chest imaging. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with normal systolic function (EF 60%). 2. There is no evidence of late gadolinium enhancement to suggest an underlying infiltrative, inflammatory or fibrotic process. There is no myocardial edema.3. The right ventricle is mild-moderately dilated with normal systolic function (EF 60%).4. There is no evidence of pericardial thickening or pericardial effusion. 5. At least mild-moderate tricuspid regurgitation.6. Large anterior mediastinal mass and paratracheal mass consistent with history of Hodgkin's lymphoma. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Neurofibromatosis type I. Neck pain. CERVICAL SPINE: There is sagittal straightening of the cervical spine and disc desiccation. There is mild disc height loss at C5-C6. The vertebral bodies are preserved in height and there is no suspicious marrow focal lesion. The spinal canal is preserved other than small indentations by degenerative changes at C5-C6 and C6-C7 as described below. The cervical and upper thoracic spinal cord is unremarkable.C2-C3, C3-C4 and C4-C5: There is no spinal canal or significant foraminal stenosis. There is mild right C4-C5 uncovertebral arthropathy.C5-C6: There is small disc-osteophyte complex but no significant spinal canal stenosis. Uncovertebral and, to a lesser extent, facet arthropathy results in mild-to-moderate left worse than right neural foraminal stenosis.C6-C7: There is minimal central disc protrusion and mild ligamenta flava thickening but no significant spinal canal stenosis. Also, there is no neural foraminal stenosis.C7-T1: There is no spinal canal or foraminal stenosis.NECK:In addition to small lymph nodes on both sides of the neck, which are not enlarged by size criteria, there are small T2-hyperintense nodules in the dorsal subcutaneous tissues which may represent small neurofibromas. There is no definite enlargement of the cervical nerve roots. The thyroid gland and the major salivary glands are unremarkable. The airway is preserved. There is trace anterior ethmoid mucosal thickening. The mastoid air cells are clear. The orbits are unremarkable. The included part of brain is unremarkable as well.

Output: 1.Mild degenerative disease of cervical spine but no significant spinal canal and only mild-to-moderate, left more than right, C5-C6 neural foraminal stenoses. 2.Multiple small T2-hyperintense nodules in the dorsal subcutaneous tissues are nonspecific but may represent small neurofibromas. There is no definite plexiform neurofibroma.


Instruction: Generate impression based on findings.

Input: Persistent neck pain not relieved by physical therapy Examination is mildly motion degraded. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. There is minimal anterolisthesis of C4 on C5 and minimal retrolisthesis of C5 on C6 and C6 on C7. There is also mild anterolisthesis of C7 on T1. Bone marrow signal is benign. The cervical spinal cord has normal signal characteristics and overall morphology.Degenerative changes are seen in the cervical spine as described below:C2-3: Small central disc protrusion. No significant compromise to the spinal canal or neural foramina.C3-4: Minimal disc osteophyte complex and ligamentum flavum thickening contributing to mild spinal canal stenosis. Neural foramina are patent. C4-5: Disc osteophyte complex with uncovertebral hypertrophy and right-sided facet arthropathy. There is mild spinal canal stenosis. There is moderate to severe right neural foraminal stenosis. Left neural foramen is patent.C5-6: Disc osteophyte complex with bilateral uncovertebral hypertrophy and facet arthropathy, worse on the right than the left. There is severe right and moderate left neural foraminal stenosis. Fairly mild spinal canal narrowing.C6-7: Disc osteophyte complex and ligamentum flavum thickening contributing to mild spinal canal stenosis. Uncovertebral hypertrophy and bilateral facet arthropathy contribute to moderate bilateral neural foraminal stenosis.C7-T1: Disc uncovering related to grade 1 anterolisthesis and ligamentum flavum thickening contribute to mild spinal canal stenosis. There is mild left and moderate to severe left neural foraminal stenosis related to facet arthropathy.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits. Diffuse opacification of the bilateral mastoid air cells.

Output: 1. Multilevel degenerative changes throughout the cervical spine with mild degree of spinal canal stenosis from the C3-C4 to the C7-T1 levels, relatively worse at the C3-C4, C6-C7 and C7-T1 levels. No cord signal abnormality. There is also significant multilevel neural foraminal stenoses as detailed above. 2. Diffuse opacification of the bilateral mastoid air cells.


Instruction: Generate impression based on findings.

Input: Any subependymal nodules, giant cell astrocytomas? Tuberous sclerosis. Asymptomatic. There is a punctate focus of susceptibly effect at the right caudothalamic groove. There is are multiple scattered areas of cortical and subcortical white matter T2 hyperintensity in the bilateral cerebral hemisphere. There is no evidence of acute intracranial hemorrhage or cerebral 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, and scalp soft tissues are grossly unremarkable. There are diffuse left tympanomastoid effusions. There is mild bilateral maxillary sinus mucosal thickening.

Output: 1. Stigmata of tuberous sclerosis complex with what may represent a punctate subependymal nodule in the right caudothalamic groove and multiple areas of focal cortical dysplasia. 2. Left tympanomastoid effusions may represent mastoiditis.


Instruction: Generate impression based on findings.

Input: Diagnosis: HeadacheClinical question: ha etiologySigns and Symptoms: HAPatient History: Patient had a concussion x's 2 years ago. C/O Frontal Headaches off & on x's 1 year. Headaches associated with dizziness. No N/V. No blurred vision. The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: MRI of the brain is within normal limits. There is no intracranial lesion identified which can explain the patient's headaches.


Instruction: Generate impression based on findings.

Input: 78-year-old female with altered mental status. Query mass effect or hemorrhage. Review of medical record indicates history of pituitary tumor. Large sellar mass extending towards the cavernous sinus with rim calcifications is consistent with patient's history of pituitary tumor as has been described on prior MRIs. There is no evidence of intracranial hemorrhage or edema. The ventricles and the basal cisterns are normal in size and configuration. The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. Large sellar mass consistent with patient's history of pituitary tumor, likely pituitary macroadenoma. Please note that a meningioma is also a differential consideration for this location.2. No acute intracranial abnormality.


Instruction: Generate impression based on findings.

Input: Male 55 years old. Reason: bilateral shoulder pain s/p rotator cuff surgery. History: above The exam is suboptimal secondary to motion artifact. In addition, susceptibility artifact from suture anchors in the humeral head is present.ROTATOR CUFF: The rotator cuff is intact without evidence of tendon tear. There is abnormal signal within the supraspinatus tendon at its insertion consistent with tendinopathy.SUPRASPINATUS OUTLET: There is widening of the acromioclavicular joint which is likely postoperative in etiology. There is no evidence of external impingement.GLENOHUMERAL JOINT AND GLENOID LABRUM: Normal appearance of the glenoid labrum.BICEPS TENDON: Extra-articular biceps tendon is normally situated in the biceps groove.ADDITIONAL

Output: 1.Postsurgical changes without evidence of a rotator cuff tear.2.Findings consistent with a supraspinatus tendinopathy.


Instruction: Generate impression based on findings.

Input: Ms. Marshall is a 28 year old female recently diagnosed with inflammatory breast cancer of the right breast. There is heterogeneous amount of fibroglandular tissue in both breasts. Moderate background parenchymal enhancement is noted bilaterally, which limits the sensitivity of this examination.RIGHT BREAST: Spanning the entire right breast is extensive clumped heterogenous enhancement, measuring approximately 6.2 x 9.7 x 12.6 cm (AP x ML x SI). Some of this enhancement does drape over the pectoralis muscle, although the muscle itself appears to be of normal contour and enhancement pattern. Of note, there are multiple vessels that traverse through the pectoralis muscle to supply the abnormal breast tissue. Associated findings include diffuse skin thickening/enhancement.LEFT BREAST: In the left lower inner breast, there is an oval enhancing mass identified measuring approximately 1.9 x 1.3 x 1.2 cm. In addition, there is an enhancing focus identified in the left retroareolar region measuring approximately 0.5 cm. Although there are multiple additional scattered foci seen in the left breast, this particular focus enhances greater than the remainder of the foci. The distance between the two enhancing lesions is approximately 3 cm in the SI dimension. AXILLAE: There are multiple abnormal right axillary lymph nodes identified, the largest one of which measures approximately 3.0 cm and contains a biopsy marker clip. In addition, there are several abnormal left axillary lymph nodes, the largest one of which measures approximate 1.9 cm and also contains a biopsy marker clip.

Output: (1) Biopsy-proven inflammatory breast cancer of the right breast. 12.6 cm of extensive enhancement, some of which abuts against the pectoralis muscle. (2) Bilateral abnormal axillary lymph nodes, of which one on each side has been biopsied. Awaiting final pathology results.(3) 1.9 cm mass in the left lower inner breast. An MR-directed ultrasound with possible biopsy is recommended for further evaluation.(4) Enhancing focus in the left retroareolar breast. An MR-directed ultrasound can be performed to search for possible sonographic correlate. If no correlate identified, an MR-guided biopsy is recommended for further evaluation.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: E - Additional Mammo/Ultrasound Workup Required.


Instruction: Generate impression based on findings.

Input: Clinical question: 65 year-old female with left tonsillar squamous cell carcinoma. Now presenting with seizure episode. Rule out hemorrhagic CVA, etc. Signs and symptoms: Seizures Non-infused CT of brain:A new area of low-attenuation involving the cortex and subcortical white matter of the left frontal lobe (axial images 19 and 20) is noted. There is subtle mass effect with this finding. There is no evidence of hemorrhage associated with this finding. This finding is believed to represent a small acute cortical stroke. Considering patient's history possibility of a metastatic lesion should also be considered. Further study with an infused head CT or an MRI is recommended.No evidence of hemorrhage, mass effect, midline shift or hydrocephalus. Calvarium is intact. Very extensive degenerative changes of cervical spine at C1 -- C2 level is noted.

Output: 1.New foci of low-attenuation in the left frontal lobe as detailed. Finding is concerning for ischemic stroke and considering patient's history possibility of a metastatic lesion cannot be entirely ruled out. Follow-up study would be effusion is recommended.2.No evidence of hemorrhage a standard but is questioned or any additional findings.


Instruction: Generate impression based on findings.

Input: Dizziness and giddiness, intractable vertigo, evaluate for structural lesion. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is a 7 mm T2 hyperintense focus in the right superior paramedian cerebellum with associated susceptibility changes and subtle enhancement consistent with cavernoma. There is an associated developmental venous anomaly.The brain parenchyma and pituitary gland appear unremarkable. There is a probable small subcentimeter pineal cyst. Otherwise, there is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. 7 mm cavernous malformation with associated developmental venous anomaly in the right superior paramedian cerebellum.2. No evidence of acute acute ischemia or intracranial mass.


Instruction: Generate impression based on findings.

Input: History of midline pain and incontinence. Evaluate for acute cord compression. There is mild anterior wedging and depression along the superior endplate of T5 without underlying STIR signal abnormality. There are disc bulges at the levels of C5-6 and C6-7 with apparent mild spinal canal stenosis. Additional disc bulges are present at L1-2 and L2-3 without significant spinal canal stenosis. Underlying cord signal is unremarkable. There is no evidence of acute cord compression.

Output: 1. No evidence of acute cord compression.2. Likely mild chronic compression deformity of T5.3. Degenerative disc disease in the lower cervical spine, which can be further evaluated with dedicated spine imaging if clinically warranted.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Most recent PSA 8/2016 was 5.5 ng/mL. Prior PSA from 9/2015 was 5.1 ng/mL. Prolaris score = 3.4. He currently has no urinary symptoms. Prostate biopsy from 2010 was benign. PELVIS:PROSTATE:Prostate Size: 4.9 x 2.6 x 3.7 cmPeripheral Zone: Left peripheral zone T2 low (series 601 image 88) and ADC low (series 708 image 324) focus with early arterial enhancement.Central Gland: Right prostate base at the junction of the transition zone, peripheral zone, and central zone with T2 low (series 601 image 97) and ADC low (series 708 image 364) focus. This may represent extension of hyperplastic nodule from transition zone, but cannot exclude malignancy.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: No evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Left peripheral zone T2 low and ADC low focus with early arterial enhancement, PIRADS 4.2.Right prostate base T2 low and ADC low focus, PIRADS 3.PI-RADS™ v2 Assessment Categories:PIRADS 1 – Very low (clinically significant cancer is highly unlikely to be present) PIRADS 2 – Low (clinically significant cancer is unlikely to be present)PIRADS 3 – Intermediate (the presence of clinically significant cancer is equivocal)PIRADS 4 – High (clinically significant cancer is likely to be present) PIRADS 5 – Very high (clinically significant cancer is highly likely to be present)https://www.acr.org/~/media/ACR/Documents/PDF/QualitySafety/Resources/PIRADS/PIRADS%20V2.pdf


Instruction: Generate impression based on findings.

Input: Patient with vertigo possible cerebral infarction. 82 years old male. Foci of encephalomalacia are present in the left parietal lobe along the left superior parietal lobule and left pre-central gyrus in the left middle frontal gyrus. These correspond to recent foci of infarction identified on the recent MRI exam.A focal hypodensity is present along the left to caudate nucleus corresponding to a prior infarction. Another focus of hypodensity is present left external capsule appearedPeriventricular and subcortical white matter hypodensities are present of a moderate degree.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.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.Mild atherosclerotic calcifications are present along the distal internal carotid arteries.

Output: 1.No evidence for acute intracranial hemorrhage mass effect or edema.2.There is a moderate to marked degree of periventricular and subcortical white matter hypodensity is present which are likely vascular related in a patient this age.3.Foci of encephalomalacia in the left middle cerebral artery distribution correspond to recent foci of infarction identified on the October 2009 exam and the acute phase at that time.


Instruction: Generate impression based on findings.

Input: Ms. Amerik is a 29 year old female with a personal history of BRCA1 mutation and a strong family history of breast cancer, including her mother (diagnosed at the age of 48) and a maternal aunt (diagnosed at the age of 44). Personal history of benign MR guided biopsy of right breast in 2011 for fibroadenoma. The patient is participating in a clinical trial of screening high-risk individuals. There is heterogeneous amount of fibroglandular tissue in both breasts. Moderate background parenchymal enhancement is noted bilaterally, limiting the sensitivity of this examination.Susceptibility artifact from biopsy proven fibroadenoma in the right upper outer breast along with associated minimal surrounding residual enhancement is stable. There is no new abnormal enhancement seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. Follow up should be per the research protocol. BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Routine Screening Mammogram.


Instruction: Generate impression based on findings.

Input: Disorder of brain, unspecified [G93.9], Reason for Study: ^Reason: hx brain lesion. preop planning for craniotomy History: none- preop Multiple fiducial markers attached to the scalp.There is 33.5mm (RL) x 35.7mm (AP) x 40mm (CC) sized irregular margined peripheral enhancing intra axial mass with surrounding edema at the right precuneus. The right lateral ventricle occipital horn is slightly effaced due to mass effects.The ventricles, sulci and cisterns are unremarkable. 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: Right precuneus intra axial mass as described above. Differential diagnosis include malignant lesion such as malignant glioma or metastatic lesion.


Instruction: Generate impression based on findings.

Input: Migraines, NF1, moya moya. MRI: There is an unchanged nonenhancing T2 hyperintense lesion within the periventricular white matter adjacent the left trigone that measures up to 10 mm. There is persistent slight intrinsic T1 hyperintensity within the bilateral globi pallidi and cerebral peduncles. There is a 10 mm wide arachnoid cyst medial to the posterior left cerebellar hemisphere. There is no evidence of intracranial mass, hemorrhage, hydrocephalus or acute infarct. There is a small right maxillary sinus retention cyst.MRA: There are persistent asymmetrically prominent right lenticulostriate vessels and paucity of flow related enhancement beyond the proximal portion of the superior division of the M2 segment of the right MCA, indicating a significant steno-occlusive lesion. There is no significant steno-occlusive disease involving the other major cerebral arteries. There is no evidence of aneurysm.

Output: 1. Unchanged intracranial stigmata of neurofibromatosis type 1, including what likely represents an "unidentified bright object" in the left periatrial white matter. 2. Mild asymmetrically prominent right lenticulostriate vessels suggestive of mild moyamoya associated with steno-occlusive disease of the superior division of the M2 segment of the right MCA.3. No evidence of acute cerebral infarction.


Instruction: Generate impression based on findings.

Input: 60-year-old female with severe pain locking and swelling MENISCI: There is ill-defined increased signal intensity within the medial meniscus indicating intrasubstance degeneration. The meniscus also appears attenuated likely representing chronic attritional tearing. Furthermore, the root attachment of the anterior horn is indistinct which may represent a root avulsion. There is medial extrusion of the body of the medial meniscus. There is increased signal intensity within the posterior horn of the lateral meniscus suggesting intrasubstance degeneration although no discrete tear is seen.ARTICULAR CARTILAGE AND BONE: Severe osteoarthritis affects the medial compartment. The weightbearing surfaces of the medial femoral condyle and medial tibial plateau are largely devoid of articular cartilage with degenerative signal abnormality within the underlying subchondral bone. Moderate osteoarthritic changes affect the patellofemoral and lateral compartments. There are tricompartmental osteophytes. LIGAMENTS: The proximal fibers of the ACL are indistinct on the sagittal images but the ligament appears intact on the coronal images. The PCL is intact. The superficial band of the MCL is intact. The lateral collateral ligament complex is intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1.Severe osteoarthritis and multiple intra-articular loose bodies.2.Degeneration of the meniscus with possible avulsion of the root of the anterior horn of the medial meniscus.


Instruction: Generate impression based on findings.

Input: 61 year old with history of bilateral mastectomies. Left breast IDC in 1990 with TRAM reconstruction and right breast DCIS in 2000. Recurrent left cancer in 2009. Current left breast pain. The patient is status post left mastectomy with autologous reconstruction and right mastectomy with retropectoral silicone implant placement. The silicone implant is unchanged in position and contour.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Female, 26 years old, with abnormality seen on fetal ultrasound, assess for spina bifida. The frontal bones demonstrate symmetric bilateral concavity. The ventricular atria are top normal in size measuring up to 10 mm in diameter. The third ventricle is within normal limits. It does appear that the corpus callosum is at least partially present. No definite additional supratentorial lesions are seen, though fetal motion does reduce sensitivity for subtle abnormalities. The posterior fossa is small and crowded. The cerebellum appears to partially enwrap the brainstem. A small posterior soft tissue defect is seen in the sacral region which exposes the lower sacral spinal canal. Image quality does not allow for the visualization of neural elements at this level.

Output: Findings are seen compatible with Chiari II malformation. This includes a small, crowded posterior fossa and the presence of a sacral meningocele or myelomeningocele. Supratentorially, the ventricular atria are top normal in size. It does appear that the corpus callosum is at least partially present. No definite additional supratentorial lesions are seen, but fetal motion significantly reduces the sensitivity for subtle findings.


Instruction: Generate impression based on findings.

Input: 52-year-old male with urinary incontinence. Cervical spine: There is diffuse fatty marrow. There is minimal anterior wedging of the C5 vertebral body. Otherwise vertebral body heights are intact. There is multilevel disc desiccation with minimal disc space loss at C5-C6. There are posterior disc-osteophyte complexes at C4-C5, C5-C6 and C6-C7 without significant central canal or neural foraminal narrowing. There is absence of the usual cervical lordosis. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable. There is diffuse fatty marrow. Thoracic spine: There is diffuse fatty marrow. There is compression deformity at T7 without increased STIR signal, which is unchanged. There are degenerative marrow signal characteristics along the superior endplate of T7 and inferior endplate of T6. There is a Schmorl's node within the inferior endplate of T9. The thoracic spine alignment is anatomic. There is apparent increased T2 signal within the cord from T7 to T10, which is likely artifactual. There is diffuse lipomatosis in the posterior epidural space that measures up to 7 mm in thickness. However, there is no significant central or neural foraminal stenosis. The paraspinal soft tissues are unremarkable.Lumbar spine: There is diffuse fatty marrow. There is a compression fracture of L2 which is unchanged from the CT of 10/7/2014 and without evidence of edema. There are endplate degenerative bone marrow signal changes at L1-L2 and along the superior endplate of L4. There is multilevel disc desiccation and vacuum disc phenomenon at L1-2. Alignment is anatomic. There is lipomatosis extending from L4-L5 inferiorly. Signal within the distal cord and conus is normal ending at L2. There is multilevel facet arthropathy. At L3-L4, there is a mild disc bulge, asymmetric to the left, but no significant spinal canal stenosis or neural foramen stenosis. At L4-L5, there is epidural lipomatosis associated with mild narrowing of the thecal sac, but no significant neural foramen stenosis. At L5-S1there is a mild diffuse disc bulge, facet hypertrophy with small effusions, and considerable epidural lipomatosis with severe spinal canal stenosis and mild right and moderate left neural foramen stenosis. There is also considerable epidural lipomatosis in the sacral canal with severe spinal canal narrowing. There is also pelvic lipomatosis.

Output: 1.Extensive thoracic, lumbar, and sacral epidural lipomatosis with severe lumbosacral spinal canal narrowing.2.Diffuse osteopenia that may be steroid-induced with chronic compression fracture deformities of the T7 and L2, and perhaps the C5 vertebrae, but no appreciable associated retropulsion.


Instruction: Generate impression based on findings.

Input: Reason: right shoulder pain and decreased range of motion History: as above. ROTATOR CUFF: Mild supraspinatus tendinopathy without discrete tear. The supraspinatus, infraspinatus, teres minor, and subscapularis tendons and muscles are intact.SUPRASPINATUS OUTLET: Moderate osteophyte affects the AC joint. There is bone marrow edema within the distal clavicle and the acromion process. No fluid within the subacromial subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenoid labrum is intact. Glenohumeral joint alignment is within normal limits.BICEPS TENDON: The biceps tendon is intact. ADDITIONAL

Output: 1.Moderate AC joint osteoarthritis. Bone marrow edema within the distal clavicle and the acromion process.2.Mild supraspinatus tendinopathy. No rotator cuff tear.


Instruction: Generate impression based on findings.

Input: Reason: CBD stone, pancreatic head mass obstructing CBD History: elevated t bili; jaundice;. ABDOMEN:LUNG BASES: Elevation of the right hemidiaphragm. Trace right pleural effusion.LIVER, BILIARY TRACT: Significant intrahepatic and extrahepatic biliary ductal dilatation. The common bile duct measures up to 1.4 cm (series 701 image 54) to the level of the pancreatic head, where there is a mixed solid and cystic mass. No evidence of choledocholithiasis. Hydropic gallbladder. Small amount of Pericholecystic and perihepatic fluid. Scattered foci of fat infiltration. No focal hepatic lesions. SPLEEN: No significant abnormality noted.PANCREAS: Again seen in the pancreatic head and uncinate, is a mixed solid and multiloculated cystic mass measuring 4.4 x 3.7 x 6.5 cm (AP x transverse x CC, series 301 image 8, series 401 image 12). Associated calcifications are better seen on CT. No pancreatic ductal dilatation. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Peripancreatic lymphadenopathy again noted. For reference enlarged lymph node measures 1.6 x 1.5 cm (series 1004 image 134). Atherosclerotic disease of aorta.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Pancreatic head/uncinate process mixed solid and cystic mass suspicious for primary pancreatic malignancy. Associated upstream intrahepatic and extrahepatic biliary ductal dilatation and peripancreatic lymphadenopathy. 2.Hydropic gallbladder and mild pericholecystic fluid, may be seen in setting of superimposed acute cholecystitis, findings may be secondary to mass effect from aforementioned pancreatic head mass.


Instruction: Generate impression based on findings.

Input: Bilateral lower extremity weakness. There are small disc-osteophyte complexes at C3-4 through C6-7 without evidence of spinal cord compression. There is also a small disc protrusion at L5-S1. There is lack of the usual cervical lordosis, but no evidence of spondylolisthesis. The vertebral body heights are preserved. The vertebral bone marrow signal is unremarkable. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable. There is a T2 hyperintense focus in the posterior liver.

Output: 1. Small disc-osteophyte complexes at C3-4 through C6-7 without evidence of spinal cord compression. 2. Small disc protrusion at L5-S1. 3. Nonspecific lesion in the posterior liver may represent a cyst or hemangioma, but is incompletely characterized. An ultrasound may be useful for further evaluation.


Instruction: Generate impression based on findings.

Input: 69-year-old female with right shoulder pain ROTATOR CUFF: Small amount of fluid and abnormal signal with the supraspinatus tendon suspicious for a partial thickness tear. No retraction is evident. A cyst and fluid is noted within the muscle fibers of the infraspinatus tendon. The subscapularis is intact. The teres minor is intact. Normal muscle bulk without fatty infiltration.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: No significant abnormality noted.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: 1.Partial thickness tear of the supraspinatus.2.Intramuscular cyst within the infraspinatus is highly suspicious of infraspinatus tear.3.Nonvisualization of the coracohumeral ligament raises the possibility of adhesive capsulitis.


Instruction: Generate impression based on findings.

Input: Male, 56 years old, with a pituitary mass. Presurgical MRI to evaluate lesion. The sella is filled and mildly expanded by a masslike process which is heterogeneous on T2-weighted images and which enhances solidly with the exception of small internal nonenhancing foci. The lesion measures 12 mm SI x 17 mm TV x 13 mm AP. The lesion encroaches slightly on the suprasellar cistern and may contact the optic chiasm. No definite cavernous sinus invasion is seen. The pituitary stalk enhances normally and appears to enter the superior aspect of the lesion at midline. Scattered small foci of white matter T2 hyperintensity are noted in the partially visualized brain. A fluid level is demonstrated in the right maxillary sinus.

Output: The sella is filled and mildly expanded by a mass which is T2 heterogeneous and solidly enhancing. There is some encroachment upon the suprasellar cistern where the optic chiasm may be slightly impinged. No definite cavernous sinus invasion is seen.