Instruction: Generate impression based on findings.

Input: Brisk right arm and leg No restricted diffusion to suggest acute infarction. No evidence for acute intracranial hemorrhage or extra-axial collection. Moderate supra- and infratentorial white matter foci of T2 hyperintensity, slightly progressed from the prior exam, most compatible with chronic small vessel ischemic disease. No evidence of mass, mass effect, or midline shift. Mild prominence of the ventricles and sulci is likely related to volume loss. The pituitary gland is normal in size. No diffusion-weighted abnormalities are identified. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are grossly aerated. The orbits are within normal limits.

Output: 1.No acute intracranial abnormality. 2. Moderate chronic small vessel ischemic disease, slightly progressed from prior.


Instruction: Generate impression based on findings.

Input: Reason: pain and swelling History: pain Again seen is bipartite patella similar to prior study. Tiny patellofemoral osteophytes. Probable small joint effusion. We otherwise see no specific findings to account for patient's pain.

Output: Bipartite patella. Mild osteoarthritis of the knee. Small joint effusion.


Instruction: Generate impression based on findings.

Input: Bilateral L5 radiculopathy. There is a disc bulge and facet joint hypertrophy at L4-5 that results in moderate right and severe left neural foraminal stenosis. There is also a disc bulge at L3-4 that results in moderate right and mild left neural foraminal stenosis. In conjunction with epidural lipomatosis at these levels, there is moderate spinal canal stenosis at these levels. There is no significant spinal canal or neural foraminal stenosis at the other lumbar spine levels. There are intravertebral disc herniations in the inferior L3 and L4 vertebral bodies with associated adjacent bone marrow degenerative signal alterations. The vertebral body heights are otherwise preserved. There is a punctate posterior right facet joint synovial cyst at L1-2. There is straightening of the lumbar spine alignment in the sagittal plane, but no spondylolisthesis. The imaged portions of the spinal cord appear to be unremarkable. There is a 20 mm wide probable cyst in the right kidney, although this is incompletely characterized.

Output: 1. A disc bulge and facet joint hypertrophy at L4-5 results in moderate right and severe left neural foraminal stenosis. Likewise, a disc bulge at L3-4 results in moderate right and mild left neural foraminal stenosis. In conjunction with epidural lipomatosis at these levels, there is moderate spinal canal stenosis at these levels.2. A 20 mm wide probable cyst in the right kidney is incompletely characterized. A renal ultrasound may be useful for further evaluation.


Instruction: Generate impression based on findings.

Input: History of bilateral retinoblastoma (left enucleation and right eye cryo- and laser therapy and five rounds of chemotherapy): off therapy evaluation. Orbits: There are postoperative findings related to left enucleation with an implant and prosthesis in position. There is expected volume loss and high T2 signal in the remaining portions of the left optic nerve. There is no evidence of mass lesions in the left orbit. The right orbit appears unremarkable. There is diffuse moderate mucosal thickening in the paranasal sinuses. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma, pineal gland, 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.

Output: 1. Postoperative findings related to left enucleation without evidence of tumor recurrence in the left orbit.2. No evidence of tumor recurrence in the right orbit.3. No evidence of intracranial tumors.


Instruction: Generate impression based on findings.

Input: Intermittent abdominal pain and altered bowel habits. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The small bowel is adequately distended with oral contrast. The small bowel fold pattern is maintained.The terminal ileum is well seen. There is no abnormal small bowel wall thickening, enhancement or restricted diffusion. No perienteric inflammatory changes such as fibrofatty proliferation.The small bowel is normal in caliber. No fixed luminal narrowing or prestenotic/upstream dilatation to suggest a flow-limiting stricture.No evidence of sinus tract or fistula formation.No free fluid or loculated fluid collection.The colon is unremarkable.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: See discussion above.BONES, SOFT TISSUES: No active perianal disease is identified.OTHER: No significant abnormality noted.

Output: No findings to suggest active small bowel inflammation, fibrostenotic or fistulous disease.


Instruction: Generate impression based on findings.

Input: Nodule on posterior scalp that has tripled in size over the last few months. There is a well-defined heterogenous nodular cystic lesion in the left temporoparietal scalp that measures up to 22 mm with internal patchy enhancement that dissipates over time, as well as scattered areas of susceptibility effect. There is an vessel in the underlying scalp that appears to penetrate the lesion. There are additional subcentimeter cystic lesions in the midline occipital scalp and right retroauricular scalp. The calvarium is intact. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are unremarkable.

Output: The findings are indicative of a hemorrhagic epidermal inclusion or pilar cyst in the left temporoparietal scalp that measures up to 22 mm. Additional subcentimeter cystic lesions in the midline occipital scalp and right retroauricular scalp also likely represent inclusion or pilar cysts.


Instruction: Generate impression based on findings.

Input: Seizures, evaluate for etiology of brain lesions MRI brain:There are multifocal areas of cortical restricted diffusion involving the parietal and occipital lobes, left greater than right. There is an additional punctate focus of restricted diffusion in the right temporal operculum. Increased T2 signal surrounding these lesions is compatible with vasogenic edema. Postcontrast images show mild leptomeningeal and parenchymal enhancement associated with these regions. Punctate foci of hemorrhage are associated with the occipital lobe lesions. There is no significant mass effect, midline shift, or herniation. The ventricles and sulci are normal in size.MRA brain:The anterior intracranial circulation appears patent without flow-limiting stenoses. The posterior intracranial circulation appears patent without flow-limiting stenoses. No evidence of aneurysm.MRV brain:MR venography without gadolinium is of suboptimal quality. The venogram demonstrates grossly patent intracranial venous circulation. The left transverse sinus is not seen on the venogram but demonstrates good enhancement on postcontrast images. There is no evidence of venous sinus thrombosis.

Output: 1. Multifocal areas of cortical restricted diffusion primarily in the parietal and occipital lobes, with associated vasogenic edema, minimal hemorrhage, and mild enhancement. Primary differentials include infection/cerebritis as well as multiple infarcts. Given posterior distribution, underlying PRES is a consideration although would be very unusual in this age group. Mitochondrial disease such as MELAS is also a consideration but also not classic. Inflammatory process such as ADEM is also less likely given the pronounced areas of cortical restricted diffusion.2. No significant stenosis involving the major arterial vasculature on MRA. No evidence of venous sinus thrombosis on MRV.


Instruction: Generate impression based on findings.

Input: Male 52 years old Reason: stem cell transplant patient with dilated bile duct seen on recent abdominal US. History: abdominal pain, nausea, emesis ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. It is unremarkable for unenhanced technique. The gallbladder is mildly distended without calculi. Gallbladder wall is normal in thickness.Common bile duct measures 10 mm near the head of the pancreas. Minimal intrahepatic central biliary ductal dilatation. Probable hepatic cyst in the left hepatic lobe.SPLEEN: No significant abnormality noted.PANCREAS: Pancreatic duct is normal in caliber. There is mild to moderate pancreatic atrophy.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Nephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small amount upper abdominal ascites.

Output: 1.Common bile duct measuring up to a 1 centimeter in the head of the pancreas; the etiology of which is not evident. This may be physiologic in a patient over 50 years of age.2.Mild perihepatic ascites.3.Study was terminated per patient's request.


Instruction: Generate impression based on findings.

Input: Malignant neoplasm of unspecified part of unspecified bronchus or lung [C34.90], Reason for Study: ^Reason: Hx NSCLC, surveillance for metastases History: None No evidence of acute ischemic or hemorrhagic lesion.No evidence of abnormal enhancement.Scattered T2/flair high signal intensity lesions on periventricular white matter and centrum semiovale indicate nonspecific small vessel ischemic disease.The ventricles, sulci and cisterns are unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear. Atrophic right maxillary sinus with fluid collection, otherwise unremarkable.

Output: 1. No evidence of abnormal enhancement. No acute ischemic or hemorrhagic lesion.2. Non specific small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: MRI Neck:Relevant measurements for velopharyngeal insufficiency are as follows, although no volumetric measurements were made:HPL = 3.4 cmVL = approximately 3.0 cmVelar thickness = approximately 9 mmOPD = 3.3 cmOPD/VL = 1.1ACBA = 139 degreesPCBA = 160 degreesADA = 106 degreesVPW = 2.4 cmMPW = 3.2 cmPHARYNX/LARYNX: The nasopharynx, oropharynx, and hypopharynx are unremarkable. Cleft palate evaluation is limited on this MR exam, although no gross defect is identified. The larynx is unremarkable. The trachea looks deviated slightly to the right but evaluation of this is limited given the curvature of the spine to the right which may be positional. The esophagus is unremarkable. There is no abnormal soft tissue mass or pathological enhancement.GLANDS: The contrast-enhanced appearance of the submandibular, sublingual, and parotid glands bilaterally is unremarkable. The thyroid gland is unremarkable. ORAL CAVITY: The oral tongue and the floor of mouth are unremarkable.CERVICAL SOFT TISSUES: Scattered mildly enlarged nodes of Rouviere bilaterally measuring up to 1.6 cm and left submandibular lymph node measuring up to 1.6 cm which is nonspecific and likely reactive in etiology.OTHER: The visualized intracranial structures are unremarkable. Mild mid-face hypoplasia and low set ears are suggested. Hypertelorism is incidentally noted.Pulsation artifact limits evaluation of structures in the upper mediastinum, including the expected thymus. MRA Neck: There is a separate origin of the left subclavian artery, left common carotid artery, and brachiocephalic artery from the arch. The right common carotid artery bifurcates at the upper aspect of the thyroid gland which is somewhat low but is of normal caliber. The left CCA bifurcates more cranially at a more normal level. The left vertebral artery is minimally dominant. There is no evidence of stenosis or occlusion.

Output: 1.Asymmetrically low bifurcation of the right common carotid artery at the level of the upper pole of the thyroid gland at approximate C5 level. The cervical vasculature is otherwise of normal course and caliber.2.Measurements compatible with velopharyngeal insufficiency as noted above including widened velopharynx and shorter hard palate, with associated platybasia. Cleft palate not grossly visualized on this MR exam.3.Mildly enlarged superior retropharyngeal lymph nodes and left submandibular lymph node which are nonspecific but most likely reactive in a patient of this age.


Instruction: Generate impression based on findings.

Input: 62-year-old male with left adrenal mass. ABDOMEN:LIVER, BILIARY TRACT: No suspicious hepatic lesions. Redemonstration of small, peripheral portal hepatic venous shunt is noted in the right hepatic lobe.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: There is redemonstration of a 5 x 3.1 x 5.6 cm part cystic and part solid left adrenal mass. Again, the cystic components demonstrate thin-walled enhancement, and the solid component demonstrates homogeneous enhancement. On in-and-out of phase images, there is a equivocal loss of signal to indicate microscopic fat within the soft tissue component. As a result, the lesion remains indeterminate, and malignancy cannot be excluded.KIDNEYS, URETERS: Small bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Compression deformities of T12 and L1 vertebral bodies, as detailed on MRI lumbar spine from 6/5/2015.BONES, SOFT TISSUES: Body wall anasarca.OTHER: Mild abdominal ascites.

Output: Part cystic and part solid left adrenal mass is overall indeterminate. Malignancy cannot be excluded. Biopsy versus short interval follow-up imaging can be performed as clinically indicated.Findings discussed with Dr. Wang at 10:00 AM on 6/10/2015.


Instruction: Generate impression based on findings.

Input: MRI HEAD: There are postoperative changes of left posterior temporoparietal craniotomy with associated susceptibility artifacts. There is no restricted diffusion to suggest acute ischemic stroke. There is moderate periventricular and subcortical punctate white matter T2 hyperintensities, including basal ganglia and right thalamus, which may represent small vessel ischemic changes, unchanged from previous MRI. The ventricles and cortical sulci are unchanged from previous. There is no hydrocephalus. The basal cisterns remain patent. There is no midline shift or mass effect. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. MRA HEAD: There is a 5 mm x 4.6 mm wide necked saccular aneurysm at the M2 segment of the left MCA, as demonstrated on previous angiogram from 3/27/2015. The size and configuration of the aneurysm do not show any significant interval change since prior angiography.There is no evidence of increased vasculature in the left temporoparietal lobe at the site of previous surgery.The intracranial internal carotid arteries are normal in course and caliber. The middle and anterior cerebral arteries are unremarkable. The vertebral arteries, basilar artery, and posterior cerebral arteries are normal in course and caliber. There is no evidence of flow-limiting stenosis or vascular malformation.

Output: 1. No evidence of acute ischemic stroke or acute subarachnoid hemorrhage.2. Moderate small vessel ischemic disease, unchanged.3. 5 mm x 4.6 mm wide necked aneurysm at the M2 segment of the left MCA, not significantly changed since the prior angiogram from 3/27/2015.4. Postsurgical changes of left posterior temporo-parietal craniotomy for AVM repair, with extensive susceptibility artifacts related to the surgical clips. Within these limitations, no evidence of increased vasculature seen at this region to suggest vascular malformation.


Instruction: Generate impression based on findings.

Input: 50-year-old female with a family history of breast cancer in her sister diagnosed at 40 years of age. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Clinical question: Preoperative MRI for stereotactic biopsy. Signs and symptoms: History of radiosurgery, see MRI report, the lesion larger. Pre-and post-enhanced fusion brain MRI:Examination redemonstrates a left posterior frontal -- parietal falcine meningioma measuring maximum of 23 x 24-mm in transaxial dimensions similar to prior exam. There is redemonstration of subtle extension of meningioma across the midline to the right without change. Extensive surrounding T2 hyperintensity and associated mass effect representing edema remains also similar to prior study. There is a band of T2 signal abnormality weight enhancement surrounds the tumor and suggestive of post treatment changes/radiation necrosis with all patient with change.There is also revisualization of a tiny superficially located enhancing mass without surrounding edema or mass effect in the left inferior temporal gyrus and measuring maximum of 7.6-mm in size.Revisualization of a stable enhancing focus within the right posterior temporal bone and measuring approximately 8.2 mm in size. Stable previously known left-sided arachnoid cyst in the posterior fossa with extension across the midline to the right paramedian area

Output: 1.No evidence of an acute or new finding since prior study.2.Stable left falcine meningioma, with stable surrounding signal changes and enhancement suggestive of postradiation changes/necrosis.3.Stable tiny enhancing tumor in the left inferior temporal gyrus suspicious for a cavernoma.4.Stable tiny focus of intraosseous enhancement in the right temporal measuring approximately 8.2 mm in size.5.Stable arachnoid cyst in the posterior fossa on the left and mid extension to right paramedian.


Instruction: Generate impression based on findings.

Input: Pituitary adenoma 3 year follow up study. There are postoperative findings in the sella. There is no significant in the appearance of the pituitary gland and infundibulum. There is no mass effect upon the optic apparatus.

Output: No significant interval change in the treated pituitary gland.


Instruction: Generate impression based on findings.

Input: Unspecified cerebral artery occlusion with cerebral infarction.Clinical question: h/o R frontotemporal stroke with hemorrhagic conversion in 3/2015. Re-asses for malignancySigns and Symptoms: stroke vs malignancy, assess for vascular disease MRI of the brainThere is a focus of encephalomalacia along the right frontal lobe at the junction of right superior and middle frontal gyri which has evolved since the prior exam from 3/3/2015. There are associated small foci of susceptibility present in the adjacent tissues. Some are gyral based and represent petechial blood while a couple others represent small hemorrhages.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.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries. The left A1 segment is larger than the right A1 segment. The intracranial vasculature is irregular.The right internal carotid artery is irregular and narrowed at the level of the distal cavernous segment with focal fusiform dilation at the clinoidal segment.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. There is fetal origin of the left PCA. The right p1 segment is hypoplastic. The right PCOMA and the right P1 segment are similar in diameter.There is high grade stenosis at the distal right vertebral artery.

Output: 1.No evidence for cerebrovascular occlusive disease.2.No evidence for intracranial aneurysm.3.Right frontal lobe infarction in evolution since late February associated with petechial blood and small foci of hemorrhagic conversion.4.There is high grade stenosis at the distal right vertebral artery.5.The right ICA is mildly narrowed with a focal dilation at the clinoidal segment.6.The intracranial vasculature is irregular and atherosclerotic appearing.


Instruction: Generate impression based on findings.

Input: A patient submitted outside studies for review. Submitted for review are a diagnostic mammogram and ultrasound (7/18/16), right diagnostic mammogram (8/13/2016), and left diagnostic mammogram (9/28/2016) performed at Presence Saint Joseph Hospital. In addition, a breast MRI (10/11/2016) was done at Advocate Illinois Masonic Hospital. For comparison, a prior mammogram is available dated 7/25/2014. On 7/18/16, a screening mammogram was done at Presence Saint Joseph Hospital. The CC views are limited due to inadequate compression. The breast parenchyma is extremely dense, unchanged in pattern and distribution. There is a new cluster of calcifications spanning 2.2 cm within the right upper outer breast posterior depth, without a CC correlate secondary to technique. In addition, there are a few calcifications in the right breast noted 3.5 cm anteromedial to the cluster. In the left breast, a new faint cluster of calcifications is present in the upper outer quadrant. On 8/13/16, a right diagnostic mammogram with spot magnification and exaggerated CC views was done at Presence Saint Joseph Hospital. The breast parenchyma is extremely dense, unchanged in pattern and distribution. There redemonstration of a cluster of indeterminate calcifications within the right upper outer breast at posterior depth, which span 2.2 cm and overlie the pectoralis muscle on MLO view. There is also redemonstration of a few faint calcifications 3.5 cm anteromedial to the cluster. A same day ultrasound was done, which did not demonstrate a correlate lesion.On 9/28/16, a left diagnostic mammogram with spot magnification views was done at Presence Saint Joseph Hospital for a suspicious cluster of calcifications within the left upper outer quadrant. Same day stereotactic biopsy was done with clip placement. Post-procedure mammogram demonstrates a clip in the appropriate location with a 10 mm hematoma along the anterior aspect. Specimen radiograph shows the majority of the calcifications within the specimen. Pathology returned DCIS grade 2, which is concordant with mammographic findings.On 10/11/16 a breast MRI was completed at Advocate Illinois Masonic Hospital.Exam was post processed by Dynacad. Exam is limited due to motion along the lateral aspects of both breasts. No definite biopsy clips identified. On postcontrast images, extensive parenchymal enhancement is seen bilaterally. There is asymmetric bandlike non-mass enhancement along the posterolateral aspect of the right breast at the 9:00 position, but it is difficult to determine if it is parenchymal enhancement or non mass enhancement associated with the calcifications.

Output: Cluster of calcifications within the left upper outer quadrant with pathological diagnosis of DCIS grade 2. Clip in appropriate location. Additional cluster of suspicious calcifications within the right upper outer breast spanning 2.2 cm at posterior depth, with a couple of additional faint calcifications located more anteromedially. On MRI, there is question of asymmetric band-like non-mass enhancement along the posterolateral aspect of the right breast. However, extensive background parenchymal enhancement limits evaluation. Recommend repeat MRI during day 7-11 of the menstrual cycle for further evaluation.Stereotactic biopsy and post procedure mammogram of the right breast can be submitted. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: 24-year-old with right nipple discharge and multiple masses seen on recent MRI. Targeted ultrasound for the smaller right retroareolar masses is requested. A targeted right ultrasound was performed for the MRI areas of concern. Targeted ultrasound at the right breast 12 o'clock and 7 o'clock positions demonstrated additional intraductal masses. At the 12 o'clock position an intraductal mass measures 10 x 7 mm. At the 7 o'clock position an intraductal mass measures 5 x 5 mm.

Output: Multiple masses in the right breast may represent papillomas. The patient's imaging findings were discussed with Dr. Chhablani. Based on all the findings, the largest mass seen sonographically on the prior ultrasound and on MRI will be biopsied under ultrasound guidance.BIRADS: 3 - Probably benign finding.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration.


Instruction: Generate impression based on findings.

Input: Patient post partum NSVD 1/13/16, complaining of continuous pelvic and pubic pain difficulty with ambulating she hears a popping/clicking noise when she walks. Exam is slightly limited by motion artifact.BONE MARROW: No bone marrow signal abnormalities are noted.SOFT TISSUES: Small amount of fluid within the pelvis, likely representing postpartum changes. Otherwise, no significant abnormality noted. JOINTS: The glenoid labrum of bilateral joints are grossly normal.ADDITIONAL

Output: 1.No specific findings to account for patient's symptoms. Radiographs of the hips and pelvis are recommended for better assessment of the bony structures.2.The glenoid labrum of bilateral hip joints are grossly normal. If there is a high clinical suspicion for labral abnormality, MRI arthrogram may be helpful.


Instruction: Generate impression based on findings.

Input: Focal seizures with secondary generalization, most likely temporal semiology. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma, including the hippocampi, appears unremarkable. There is no evidence of grey matter heterotopia. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable. There is a right auricular subcutaneous lipoma that measures up to 20 mm. There is fluid and mucosal thickening in the bilateral maxillary, right ethmoid, and right frontal sinuses.

Output: 1. No gross structural intracranial abnormality.2. FIndings suggestive of acute sinusitis.


Instruction: Generate impression based on findings.

Input: Unexplained LOC, or seizures, also memory loss History: LOC, memory loss. There is an area of encephalomalacia in the anterior left frontal lobe. There are mild scattered foci of cerebral and pontine white matter T2 hypertensity. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is no abnormal intracranial enhancement. There is diffuse cerebral volume loss. 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. Encephalomalacia in the anterior left frontal lobe may represent sequela of prior infarction or trauma. 2. Mild scattered foci of cerebral and pontine white matter T2 hypertensity are nonspecific, but may represent chronic small vessel ischemic disease. 3. Diffuse cerebral volume loss without a specific pattern to suggest a particular neurodegenerative process.4. No evidence of intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: Lung cancer, s/p chemoRT, planning for resection. There are unchanged subcentimeter foci of susceptivity effect and adjacent streaky enhancement in the right middle frontal gyrus white matter. There are a few nonspecific cerebral white matter T2 hyperintense foci. There is no evidence of acute infarct. There are trace bilateral frontal convexity subdural effusions. 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, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There are biparietal foramina. There is unchanged dorsiflexion of the dens.

Output: 1. The abnormalities in the right frontal lobe may represent mineralization from prior injury or inflammation, cavernous malformations, and/or microhemorrhages, perhaps related amyloid angiopathy, as opposed to metastatic disease. 3. Unchanged dorsiflexion of the dens.


Instruction: Generate impression based on findings.

Input: 50-year-old female with right-sided neck pain that radiates to her arm and hand. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained. Bone marrow signal is within normal limits. Limited evaluation of the intracranial structures is unremarkable. Minimal right disc osteophyte complex at C4-C5 without thecal sac effacement, spinal canal or foraminal stenosis. Small right paramedian disc protrusion at C5-C6 with slight flattening of the thecal sac and ventral cord. The cervical spinal cord has normal signal characteristics and overall morphology.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: A right paramedian disc protrusion at C5-C6 causes effacement of the thecal sac and slight flattening of the ventral cord.


Instruction: Generate impression based on findings.

Input: 16 year old female with hypertensive crisis, seizure. Rule out edema. There is no evidence of intracranial hemorrhage, mass or edema. Low-attenuation within the right posterior parietal lobe along the high convexity is consistent with patient's given history of prior stroke. Intra-sulcal punctate calcification may be related to prior hemorrhage or leptomeningeal calcifications. No acute cortical stroke is seen. If there is clinical concern for acute ischemia, MRI may be considered.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Right posterior parietal encephalomalacia consistent with previous stroke. No acute cortical stroke is seen, however, if there is clinical concern for acute ischemia, an MRI may be considered.


Instruction: Generate impression based on findings.

Input: Pain in right arm. Ecchymoses Demineralization limits sensitivity. Distinct swelling is observed overlying the lower arm without a distinct underlying focal abnormality, soft tissue or osseous. No evidence of associated distinct fracture or cortical changes. MRI may be needed if further characterization is needed clinically. Partially visualized moderate shoulder osteoarthritis.

Output: Demineralization and mild osteoarthritic changes of the shoulder, incompletely visualized


Instruction: Generate impression based on findings.

Input: Clinical question: Daily headache. Signs and symptoms: Daily headaches. Nonenhanced brain MRI:Negative diffusion weighted images. Flair and T2-weighted images demonstrate 3 nonspecific punctate foci of hyperintensity in the right anterior frontal and left convexity frontal lobe.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination otherwise.The signal voids of major intracranial arterial branches are identified. The signal intensity of intracranial venous sinuses are unremarkable.Unremarkable calvarium and soft tissues of the scalp.Unremarkable images through the orbits. All paranasal sinuses and bilateral mastoid air cells and middle ear cavities demonstrate normal pneumatization signal patterns.

Output: Unremarkable nonenhanced brain MRI. Please see above comments.


Instruction: Generate impression based on findings.

Input: headache during sex No evidence of acute ischemic or hemorrhagic lesion on this scan.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. The mastoid air cells are clear.The left side sphenoid sinus shows opacification.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal flow enhancement in bilateral ICAs, MCAs and ACAs.Bilateral Pcom arteries were identified and patent. Acom artery is also patent.There is no evidence of intracranial arterial aneurysm, significant intracranial arterial luminal stenosis or occlusion.Smaller than 3mm sized intracranial arterial aneurysm cannot be identified on MR angiography. Therefore, if clinically indicated, diagnostic cerebral angiography can be considered for further evaluation.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion on this scan.2. Left sphenoid sinus opacification.3. No evidence of intracranial aneurysm on MRA.Rec: If clinically indicated, diagnostic cerebral angiography can be considered for further imaging evaluation.


Instruction: Generate impression based on findings.

Input: 18-year-old female with migraine headaches, reported to have a nonspecific nodular T2/FLAIR hyperintense focus along the medial right temporal lobe on outside MRI. There is a subtle subcentimeter non-enhancing focus of T2/FLAIR hyperintensity along the surface of the right posterior aspect of the temporal horn, presumably corresponding to the abnormality described on outside study which is not available for direct comparison. The signal abnormality is best seen on coronal STIR series 1301, image 24 and axial FLAIR series 401, image 13. There is minimal nonspecific asymmetric enlargement of the right temporal horn in this region.Brain parenchyma is otherwise unremarkable. There is no restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: 1.Subtle subcentimeter non-enhancing focus of T2/FLAIR hyperintensity along the surface of the right posterior aspect of the temporal horn is nonspecific and of uncertain clinical significance. Differential considerations include nonspecific gliosis and tiny focus of subependymal gray matter heterotopia. There is also the possibility that this is developmental in etiology given the minimal asymmetric enlargement of right temporal horn.2.Brain parenchyma is otherwise unremarkable.


Instruction: Generate impression based on findings.

Input: Left-sided neck paresthesias. Right fourth/fifth finger paresthesia for 3 months. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained aside from minimal retrolisthesis of C3 on C4. There is a subcentimeter focus of T1 hypointensity and STIR hyperintensity involving the anterior base of the dens which is nonspecific. Bone marrow signal is otherwise unremarkable. No discrete destructive or infiltrative osseous lesions are evident. The cervical spinal cord has normal signal characteristics and overall morphology.Mild multilevel degenerative changes are seen including mild generalized facet arthropathy, relatively worse at the right C7-T1 level. Individual levels as below: C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: Small disc osteophyte complex including uncovertebral hypertrophy. There is mild right and moderate left neural foraminal stenosis. No significant compromise to the spinal canal.C4-5: No significant compromise to the spinal canal or neural foramina.C5-6: Minimal disc osteophyte complex and ligamentum flavum thickening. No significant spinal canal stenosis. There is minimal left neural foraminal stenosis related to uncovertebral hypertrophy and mild facet arthropathy.C6-7: No significant compromise to the spinal canal or neural foramina.C7-T1: No significant compromise to the spinal canal or neural foramina. Mild bilateral facet arthropathy, right greater than left.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: 1. Mild multilevel degenerative changes in the cervical spine as described above. There is no significant spinal canal stenosis at any level or cord signal abnormality. Neural foraminal stenosis is relatively worse at the left C3-C4 level where there is moderate stenosis.2. Subcentimeter T1 hypointense, T2/STIR hyperintense vertebral lesion at C2 which may represent an atypical hemangioma, but is nonspecific.


Instruction: Generate impression based on findings.

Input: Male, 61 years old, with history of meningioma status post resection, three-month follow-up examination. Evidence of tumor resection from the left lateral ventricular atrium is again seen. Acute postoperative findings have resolved. There remains a thin surgical tract through the left parietal lobe and mild distortion and thickening along the atrial margins.No evidence of any residual or recurrent enhancing tumor is seen. No new intracranial lesions are identified. There is no evidence of significant parenchymal edema or mass effect. Scattered punctate foci of FLAIR hyperintensity within the cerebral hemispheres are nonspecific. Ex vacuo dilatation of the left ventricular atrium is seen. Otherwise, the ventricular system is within normal limits.

Output: Expected findings are demonstrated status post resection of a meningioma from the left lateral ventricular atrium. No evidence of residual or recurrent tumor is seen.


Instruction: Generate impression based on findings.

Input: Multiple sclerosis: ataxia and dysphagia. There are extensive, largely confluent, T2 hyperintense and T1 hypointense lesions involving the supratentorial and infratentorial white matter. In particular, there is a new enhancing lesion in the midline medulla. There are several newly enhancing lesions, including within the left superior frontal gyrus, parietal lobe, posterior right frontal corona radiata, and right occipital lobe. On the other hand, previously demonstrated abnormal enhancement in the right parietal lobe has resolved. There is a developmental venous anomaly in the right frontal lobe. The ventricles are stable in size and configuration, including diffuse cerebral volume loss as well as cavum septum pellucidum and vergae. The skull, orbits, and extracranial soft tissues are unremarkable.

Output: Extensive demyelinating lesions in the supratentorial and infratentorial brain parenchyma with several new enhancing lesions and interval resolution of previously demonstrated abnormal enhancement in other areas.


Instruction: Generate impression based on findings.

Input: 38-year-old man with right knee pain following an injury on 5/14/2016 MENISCI: The medial and lateral menisci appear intact.ARTICULAR CARTILAGE AND BONE: Bone marrow signal intensity is within normal limits. No focal defects in the articular cartilage of the knee are seen. There is mild diffuse thinning along the weightbearing surfaces of the knee, and age-related finding.LIGAMENTS: The ACL, PCL, MCL and LCL complex appear intact. EXTENSOR MECHANISM: The quadriceps tendon and patellar tendon appear intact.ADDITIONAL

Output: No acute abnormalities are seen to account for the patient's knee pain.


Instruction: Generate impression based on findings.

Input: There is an area of abnormal signal and enhancement in the left sphenoid portion of the skull base adjacent to the sphenoid sinus. This corresponds to a lucent area on prior 2011 PET/CT, on which there was no corresponding hypermetabolic lesion evident. No abnormal orbital mass or abnormal enhancement is seen. The optic nerves are normal in size and morphology, and are symmetric bilaterally. The extraocular muscles are unremarkable.

Output: 1. No orbital lesion or orother specific abnormality to account for the patient's symptoms. 2. Nonspecific left sphenoid bone marrow abnormality most likely present since 2011, not suspected to represent an aggressive process. If there is clinical concern, dedicated CT may be obtained to further assess the osseous features.


Instruction: Generate impression based on findings.

Input: Glioblastoma. On temozolomide. The study is mildly to moderately limited by patient motion.The ring-enhancing mass in the right temporal lobe has perhaps very minimally increased in size. Axially, the lesion measures 5.4 cm x 4.6 cm compared to 5.1 cm x 4.6 cm previously in December 30, 2015. Additionally, the intensity and thickness of the rim contrast enhancement are improved but this may relate to differences in technique (the current examination was obtained on 1.5 Tesla system while the previous examination was obtained on a 3.0 T system). Also, ependymal/subependymal contrast enhancement involving the atrium of the right lateral ventricle is less conspicuous.The similar though smaller lesion deeply seated in the anterior-inferior aspect of the right parietal lobe is not significantly changed in size but also shows less intense rim contrast enhancement. It measures axially 3.0 cm x 2.2 cm compared to 3.3 cm x 1.9 cm previously. Lateral to this, the T1-hyperintense hematoma has regressed in size measuring 1.8 cm compared to 2.7 cm previously. The T2 hyperintensity in the white-matter surrounding the ring-enhancing lesions is not significantly changed nor the associated mild mass-effect. Mild midline shift remains unchanged. Mild dilatation of the third and lateral ventricles is also unchanged. Periventricular and deep white-matter T2-hyperintensity in the left cerebral hemisphere, which is separate from the tumor, is unchanged. Also, cortical T2-hyperintensity in the left temporal lobe and subcortical abnormality in the left parietal lobe also remain unchanged and may represent foci of additional tumor.

Output: 1.Compared to previous examinations from December 30, 2015 and January 29, 2016, the two right temporal and parietal ring-enhancing lesions are not significantly changed nor the associated infiltrative edema and mass-effect. The dominant right temporal ring-enhancing lesion may be very minimally larger but the contrast enhancing rim is thinner and the associated subependymal enhancement is less conspicuous.2.Focal T2-hyperintensity in the left temporal and parietal lobes also remain unchanged and may reflect foci of gliomatosis.


Instruction: Generate impression based on findings.

Input: 84-year-old female with neck pain. Status post C2 spine fracture in May 2015. The bones appear demineralized, limiting evaluation. Severe degenerative disc disease affects the lower cervical spine with anterior osteophyte formation. There is preservation of vertebral body heights. Evaluation of the C2 vertebral body is limited due to overlying anatomy, including the mastoid air cells and patient positioning. If strong clinical concern for acute fracture, further evaluation with CT or MRI examination is recommended. Calcifications within the soft tissues of the right lateral neck presumably resides within the carotid vasculature.

Output: Severe degenerative disc disease of the lower cervical spine. The C2 vertebral body is obscured by overlying anatomy. If strong clinical concern for cervical spine fracture, further evaluation with CT or MRI examination is recommended.


Instruction: Generate impression based on findings.

Input: Male, 54 years old, with spasticity. Assess for demyelinating disease. Brain:The cerebral and cerebellar hemispheres and brainstem show normal signal intensity and morphology. No restricted diffusion is seen. The right cerebellar tonsil extends slightly below the foramen magnum compatible with ectopia.No evidence of parenchymal edema, mass, or mass effect is seen. There is no evidence of intracranial hemorrhage or abnormal extra-axial fluid. The ventricular system is normal in caliber and morphology. The marrow signal characteristics are unremarkable. Mucosal thickening and/or mucus retention cysts are seen within the bilateral maxillary sinuses. Also noted is polypoid mucosal thickening within the posterior left nasal cavity. The right mastoid air cells show T2 hyperintense signal suggestive of fluid opacification.C spine:A long segment of T2 hyperintensity is seen affecting predominantly the right dorsal aspect of the spinal cord beginning at the C2-3 level and continuing down to at least to the C5-6 level. This abnormality is associated with no significant mass effect. No evidence of any blood product is seen.The cervical lordosis is mildly reversed. Vertebral body heights are preserved. No evidence of concerning marrow replacement or marrow edema is detected. Degenerative endplate signal alteration is seen at C5 and C6.C2-3: Left facet hypertrophy. No significant spinal canal or neuroforaminal stenosis. C3-4: Left facet hypertrophy. Right-sided uncovertebral hypertrophy. No significant spinal canal stenosis. Moderate left and mild right foraminal narrowing. C4-5: Left facet hypertrophy. Mild posterior disk osteophyte formation. Mild ventral thecal sac effacement without significant spinal canal stenosis. No significant foraminal narrowing. C5-6: Left greater than right facet hypertrophy. Posterior disk osteophyte formation asymmetric to the right subarticular zone. Mild effacement of the right ventral thecal sac, but no significant generalized canal stenosis. Mild right foraminal narrowing. C6-7: Left facet hypertrophy. Minimal posterior disk osteophyte formation. No significant generalized spinal canal stenosis. Mild left foraminal narrowing. C7-T1: No significant spinal canal or neuroforaminal stenosis.

Output: A long segment of T2 signal abnormality is evident affecting predominantly the right dorsal aspect of the spinal cord. This abnormality extends from at least C2-3 to C5-6.The morphology of this lesion, and the lack of any lesions intracranially, would argue against classic multiple sclerosis. However, an atypical demyelinating process, such as neuromyelitis optica, could be considered. Other possibilities would include post-infectious autoimmune as well as non-infectious inflammatory conditions. Active infection is considered less likely but cannot be entirely eliminated.As above, evaluation of the brain is unremarkable with no additional findings to account for or help explain the patient's symptoms. Note is made of paranasal sinus mucosal thickening and a possible polyp in the left nasal cavity. Correlation with symptoms is suggested.


Instruction: Generate impression based on findings.

Input: Clinical question: 74 year old female with metastatic breast cancer with involvement of prevertebral and paravertebral tissues in the cervical spine. Status post RT. Evaluate for change. Compared to prior exam from 6 -- 15 -- 11. Enhanced CT of soft tissues of neck:40 cc of Omnipaque 350 was given for this study. Multidetector helical CT of entire soft tissues of neck are acquired. Coronal and sagittal 2-D reformatted images are also acquired.Examination demonstrates a soft tissue mass in the right carotid space at the level of the skull base and C1 level. The mass surrounds the right transverse process of C1 and is inseparable from right vertebral artery at C1 level. There are diffuse lytic changes in the C1 vertebrae as well as lateral mass of C2 on the right. There is subtle mass effect and anterior displacement of the right internal carotid artery secondary to tumor. The tumor also reaches the right styloid fragment. The right internal jugular is compressed by the mass however remains patent. When compared with prior exam there is subtle interval decrease in the bulk of the tumor and apparently less mass effect on the carotid. There is no definitive extension of tumor into the spinal canal on this exam. On prior study there was a slight widening of the right epidural space likely secondary to tumor at C1 level. The very irregular shape of tumor makes precise measurement difficult however on axial image 22 at C1 level the extra osseous component of tumor measures 22 x 27.5-mm. And coronal post infused reformatted image 40 cranial cephalad axis of tumor measures 22-mm. A previous reported right-sided lymph node at the level of two also demonstrate interval decrease in its size. This node measures 6.6-mm in size compared to prior measurements of 11.8 times 8.6-mm. Or there is no evidence of any new lymphadenopathy. The vasculature of the neck remains intact. Limited images through the apices of the lungs demonstrate apical scarring and without definitive evidence of metastases. No appreciable interval change since prior exam. Please review dedicated report of CT of chest performed the same date as this study. Possible small metastatic lesions in C5 and C7 best appreciated on sagittal reformatted bone density image 22. These findings were present on prior study. If further evaluation of spine metastatic lesions are desired dedicated pre-and post enhanced MRI of cervical spine is recommended.

Output: 1.Interval significant decrease in the size of tumor at C1 and C2 right paraspinal region. Lytic metastatic lesions in C1 and C2 may be the source of this right-sided paraspinal soft tissue mass. Interval necrosis and decrease in the size of right-sided level 2 lymph node. No evidence of new lymphadenopathy.2.Residual tumor at C1 -- C2 level on current exam measures 22 x 27 x 40 mm.3.suspected small intra-osseus lytic metastatic lesions at C5 and C7. Questionable other lytic changes in the cervical spine. If further evaluation is desired dedicated pre-and post enhanced MRI of spine is recommended.


Instruction: Generate impression based on findings.

Input: Reason: concern for R knee ligamentous/tendinous injury; unable to do weight bearing History: as above Exam is limited secondary to patient motion.MENISCI: Lateral meniscus: There is a tiny focus of intermediate signal intensity within the inner half of the posterior horn of the lateral meniscus extending to the tibial articular surface, compatible with a small undersurface tear. The remainder of the lateral meniscus is within normal limits.Medial meniscus: Increased signal along the undersurface of the posterior horn of the medial meniscus suggests fraying. Furthermore, there is attenuation of the body of the medial meniscus that may reflect chronic attritional tearing, however, we see no findings to suggest an unstable meniscal tear.ARTICULAR CARTILAGE AND BONE: Examination of the articular cartilage is limited by patient motion. There is focal degeneration of the articular cartilage of the far medial facet of the patella as well as focal degeneration of the femoral trochlea centrally. There is subjective thinning of the articular cartilage of the medial tibiofemoral compartment. Focal depression of the articular surface of the lateral femoral condyle anterior to the meniscus with underlying bone edema may represent an impaction fracture. There is also edema in the lateral aspect of the posterior tibial plateau as well as edema within the medial aspect of the medial tibial plateau.LIGAMENTS: The distal fibers of the anterior collateral ligament appear taut and normal in signal; however, the proximal fibers appear slightly thickened with increased signal intensity, which may reflect sprain/partial thickness tear, particularly in light of the lateral compartment marrow edema pattern suggestive of contusions. The posterior cruciate ligament is within normal limits. The medial collateral ligament is intact, however, a lobulated fluid signal intensity collection superficial to the medial collateral ligament complex (measuring approximately 3 x 1 cm in transverse and 4 cm in craniocaudal dimension) may represent a ganglion or parameniscal cyst. The lateral collateral ligament complex is within normal limits.EXTENSOR MECHANISM: The quadriceps tendon appears within normal limits. There is thickening and increased signal intensity of the distal fibers of the patellar tendon with what appears to be extrusion of mucoid material into the overlying subcutaneous fat; we suspect this reflects severe chronic degeneration of the tendon, although could conceivably be due to prior injury.ADDITIONAL

Output: 1.Edema within the distal femur and proximal tibial as described above suggestive of bone contusions and a possible small impaction fracture along the lateral femoral condyle.2.Mild thickening and increased signal intensity of the proximal fibers of the anterior collateral ligament may represent a partial tear.3.Thickening and increased signal intensity of the distal patellar tendon suggests severe mucoid degeneration, although could conceivably be secondary to prior trauma.4.Large joint effusion and evidence of synovitis. 5.A lobulated fluid collection medial to the knee joint may represent a ganglion or parameniscal cyst. 6.Undersurface tearing/fraying of the bilateral menisci.7.Other findings as described above.


Instruction: Generate impression based on findings.

Input: History of multifocal hepatocellular carcinoma status post TACE RFA ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology. Post ablation cavity in segment 6 measuring approximately 3.7 x 1.7 cm (series 12/26). Best seen on arterial phase imaging is a 1.5 x 1.4 cm arterial enhancing lesion (series 11/34) along the caudal and medial aspect of the ablation cavity suspicious for residual and/or recurrent hepatocellular carcinoma.Post ablation cavity in segment 5 measuring approximately 3.5 x 2.3 cm (series 12/30). Thick arterial enhancing along the anterolateral aspect of the ablation cavity measuring approximately 1.8 x 1.1 cm (series 11/32).Post ablation cavity in segment 3 measuring approximately 2.2 x 0.8 cm (series 12/29). No evidence of marginal recurrent or residual disease.Stable punctate arterially enhancing focus in segment 8 measuring 0.9 x 0.7 cm (series 11/24).Stable porta hepatis lymph nodes.No intra or extrahepatic biliary ductal dilatation.Contracted gallbladder with nonspecific gallbladder wall thickening.SPLEEN: Splenomegaly measuring 17.9 cm in craniocaudal length with numerous cirrhotic nodules.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small splenorenal shunt.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Stable vertebral body enhancing punctate focus (series 11/50).OTHER: No significant abnormality noted.

Output: 1.Post ablation changes of the liver with arterial enhancing foci adjacent to segment 5 and segment 6 ablation cavities. The lesion adjacent to segment 6 ablation cavity has significantly increased in size.2.Stable nonspecific enhancing subcentimeter focus in segment 8.


Instruction: Generate impression based on findings.

Input: 62 year-old female with non-secretory pituitary macroadenoma s/p XRT. Redemonstrated is a enhancing pituitary mass that again measures 17 AP x 24 RL x 24 SI mm, unchanged in size or shape. As before, there is stable extension of the mass into the left cavernous sinus without compromise of the left cavernous carotid artery lumen. There is also unchanged mass effect upon the optic apparatus. There is unchanged thinning of the dorsum sella, but no extension of the mass into the prepontine cistern.

Output: No significant interval change of the pituitary macroadenoma with associated extension into the left cavernous sinus and mass effect upon the optic apparatus.


Instruction: Generate impression based on findings.

Input: Persistent headache after motor vehicle accident with a possible traumatic brain injury. There is no evidence of acute ischemic or hemorrhagic lesion on the scan.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: Normal brain MRI.


Instruction: Generate impression based on findings.

Input: 68-year-old man with history of colorectal cancer status post resection, please evaluate for metastases. ABDOMEN:LIVER, BILIARY TRACT: Multiple T2 hyperintense, mild enhancing lesions are again seen throughout the liver. The largest of these is in the caudate (series 14, image 17) and measures 22 x 18 mm. Additional lesions are seen in segments 4B and 8.There is mild biliary ductal dilatation in the left lateral lobe of the liver.SPLEEN: The spleen is normal.PANCREAS: The pancreas is normal.ADRENAL GLANDS: The adrenal glands are normal.KIDNEYS, URETERS: Bilateral cysts are noted, otherwise the kidneys are normal and enhance symmetrically.RETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: There is mild dependent soft tissue edema. Postoperative changes are noted in the anterior mid abdomen.OTHER: There is volume loss in the right lung, possibly postoperative.

Output: 1.Multiple hepatic lesions compatible with metastases.2.Intrahepatic left lobe biliary dilatation, stable from prior exams.


Instruction: Generate impression based on findings.

Input: Possible pineal mass: headache, dizziness. There is a pineal gland cyst that measures up to 6 mm in diameter. There is no evidence of intracranial hemorrhage or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: A pineal gland cyst that measures up to 6 mm in diameter, which likely represents benign cystic degeneration. Otherwise, no evidence of intracranial hemorrhage, ventriculomegaly, or acute infarct.


Instruction: Generate impression based on findings.

Input: Clinical question: Stable versus worsening hemorrhage. Signs and symptoms: Altered mental status. Nonenhanced brain MRI:No evidence of restricted diffusion on diffusion-weighted series.Metallic artifact representing an aneurysm clip in the right sylvian fissure obscures the detail at this level. Mild parenchymal T2 hyperintensity suggestive of region of encephalomalacia in the right inferior frontal remain similar to prior exam.A small focus of FLAIR hyperintensity edema and containing a small amount of hemorrhage in the cortex and subcortical white matter of right frontal lobe under a craniotomy flap is again identified and with suggestion of subtle interval decreased edema/improvement.There is also interval significant decrease to near complete resolution of the scattered foci of subarachnoid hemorrhage since prior exam.Ventricular system remain within normal size and without deviation of midline.Cortical sulci and the CSF cisterns remain widely patent and unremarkable similar to prior exam.Patchy opacification of bilateral mastoid air cells similar to prior study.Interval resolution of sphenoid sinus disease since prior exam.

Output: 1.No acute intracranial process and negative diffusion weighted series.2.Interval improvement of postoperative changes of right sided craniotomy.3.Significant interval decrease to near complete resolution of the scattered subarachnoid hemorrhage since prior exam.4.Interval decreased focus of T2 hyperintensity/edema in the right frontal cortex and subcortical white matter with hemorrhagic changes.5.Stable ventricular system and with maintained midline.


Instruction: Generate impression based on findings.

Input: Female, 51 years old, with pain in the neck and left trapezius area. Straightening of the cervical lordosis is likely positional. Sagittal alignment is otherwise unremarkable. Vertebral body heights are preserved. No evidence of marrow replacement or edema is seen. The visualized spinal cord demonstrates normal signal intensity throughout. No epidural lesions are suspected.C2-3: No spinal canal stenosis or neuroforaminal narrowing. C3-4: Minimal posterior disc-osteophyte complex formation with a small superimposed central superior extrusion. No significant spinal canal or foraminal stenosis. C4-5: No spinal canal stenosis or neuroforaminal narrowing. C5-6: Mild posterior disc-osteophyte complex formation. No spinal canal or foraminal stenosis. C6-7: Posterior disc-osteophyte complex formation with perhaps a small superimposed central superior extrusion. Mild spinal canal stenosis with perhaps minimal flattening of the ventral cord. No evidence of significant foraminal narrowing. C7-T1: No spinal canal stenosis or neuroforaminal narrowing.

Output: Relatively mild degenerative findings are seen which at most result in mild stenosis spinal canal at C6-7. The neural foramina are not significantly compromised.


Instruction: Generate impression based on findings.

Input: Diagnosis: Spinal stenosis, lumbar regionClinical question: assess for progression of lumbar stenosisSigns and Symptoms: severe radicular pain, claudication Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall height. The conus medullaris on sagittal imaging is grossly intact. There is mild dextrocurvature to the lumbar spine.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is a mild right far lateral disc protrusion present at this level. There is mild ligamentum flavum hypertrophy present.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is loss of disc space height and disc desiccation at this level. There is mild to moderate degree of bilateral facet and ligamentum flavum hypertrophy at this level. There is a left far lateral disc protrusion at this level. There is effacement of the fat surrounding the left-sided exiting nerve root at this level resulting in some mild encroachment of the left-sided exiting nerve root within the neural foramen. Overall there is no significant change when compared to the prior exam.At L3-4 there is redemonstration of marked bilateral facet hypertrophy associated with anterior subluxation of L3 on L4 which is stable compared to the prior exam. There is uncovering of the disc with some disc material extending into the neural foramina. There is loss of disc space height and disc desiccation at this level. There is compression of the thecal sac with partial effacement of the spinal fluid within the thecal sac, flattening of the thecal sac and partial effacement of the fat surrounding the exiting nerve roots within the neural foramina. Overall there is moderate to severe spinal stenosis at this level which has not changed significantly compared to the previous exam. There is mild right lateral translation of L3 on L4.At L2-3 there is redemonstration of anterior subluxation of L2 on L3, loss of disc space height, disc desiccation and uncovering of disc material. There is marked bilateral facet hypertrophy at this level. There is compression of the thecal sac with near complete effacement of the spinal fluid within the thecal sac, flattening of the thecal sac. Overall there is marked spinal stenosis at this level which has not changed significantly compared to the previous exam. Overall there is no significant change compared with previous exam.At L1-2 there is no significant compromise to spinal canal or neural foramina. There is loss of disc space height, disc desiccation and diffuse disc bulge at this level

Output: 1.There are multilevel degenerative changes present in the lumbar spine with subluxations at L2-3 and L3-4 and severe spinal stenosis at L2-3 and moderate to severe spinal stenosis at L3-4 . There is encroachment of exiting nerve roots within the right neural foramen at L4-5. This has not progressed substantially compared to the March exam.


Instruction: Generate impression based on findings.

Input: Right knee pain, rule out occult injury. MENISCI: Mild intrasubstance signal within the posterior horn of the medial meniscus, likely degenerative. No meniscal tear.ARTICULAR CARTILAGE AND BONE: Small subchondral cyst along the anterior portion of the medial tibial plateau without associated chondral defect. Bone marrow signal is otherwise normal. No chondral defects or fracture.LIGAMENTS: ACL, PCL, MCL and LCL are intact. EXTENSOR MECHANISM: Quadriceps and patellar tendons are intact.ADDITIONAL

Output: Mild nonspecific soft tissue edema anteriorly and other findings as described. No tear.


Instruction: Generate impression based on findings.

Input: Clinical question: Persistent nausea without clear etiology. Rule out mass/neural cause. Signs and symptoms: Nausea Nonenhanced head CT:Examination demonstrates several periventricular and subcortical nonspecific foci of low attenuation of white matter. As was noted on prior MRI examination these findings are suggestive of demyelinating disease. There is no evidence of hemorrhage, edema, mass-effect, midline shift or hydrocephalus.The cortical sulci and ventricular system remain normal for patient stated age.Calvarium is intact. Visualized paranasal sinuses, mastoid air cells and middle ear cavities are unremarkable.

Output: 1.Periventricular and subcortical white matter low-attenuation and white matter consistent with patient's known multiple sclerosis.2.No evidence of acute intracranial hemorrhage, edema, mass-effect, midline shift or hydrocephalus.


Instruction: Generate impression based on findings.

Input: Headache and left ear tinnitus. Additional patient history includes systemic lupus erythematosus and optic neuritis. There is no evidence of intracranial hemorrhage, mass effect, or acute infarct. There are scattered foci of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter and along the undersurface of the corpus callosum, which are better appreciated on prior sagittal FLAIR imaging. No new lesions within the brainstem or elsewhere in the brain. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable. There is a right lens implant.

Output: 1.Unchanged nonspecific white matter lesions in the supratentorial brain. Differential diagnosis again includes prior inflammation, demyelination, or ischemia.2. No new brainstem lesion is identified. Please note if high-resolution imaging of the eighth cranial nerves is warranted, dedicated MRI of the internal auditory canals can be obtained.


Instruction: Generate impression based on findings.

Input: Headache. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are a few scattered foci of T2 hyperintensity in the cerebral white matter, particularly on the left side. There is an enlarged perivascular space in the left basal ganglia that measures up to 10 mm. The brain parenchyma otherwise appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is a punctate left temporomandibular joint synovial cyst.

Output: 1. No evidence of intracranial hemorrhage, mass, or acute infarct. 2. A few scattered foci of T2 hyperintensity in the cerebral white matter, particularly on the left side are nonspecific, but may represent chronic small vessel ischemic disease.3. An enlarged perivascular space in the left basal ganglia measures up to 10 mm. 4. Punctate left temporomandibular joint synovial cyst, which may be associated with degenerative disease.


Instruction: Generate impression based on findings.

Input: Reason: r/o acute stroke History: r sided sensory deficits MRI of the brainThere is a punctate focus of diffusion restriction present along the right thalamus.There is a moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Additional FLAIR and T2 hyperintense punctate lesions are present along the basal ganglia and brainstem.There are numerous punctate foci of susceptibility along the posterior fossa structures and basal gangila with much lesser involvement of the subcortical white matter.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate air fluid level in the left maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.Incidental note is made of partial empty sella.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. The posterior communicating arteries are intact. The vertebral arteries are similar in size.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. The LCCA originates from the innominate artery.The vertebral artery origins are tortuous. There is 40% narrowing at the origin of th right vertebral artery. There is no significant stenosis along the course of the vertebral arteries.

Output: 1.There is a punctate focus of acute infarction along the left superior thalamus.2.Innumerable microhemorrhages are present in a pattern suggestive of hypertension.3.Older lacunar infarcts are present in the basal ganglia, brainstem and thalamus.4.Periventricular and subcortical white matter changes of a moderate degree are nonspecific. At this age they are most likely vascular related. 5.No evidence for intracranial cerebrovascular arterial stenosis6.No evidence for significant extracranial cerebrovascular occlusive disease. There is 40% narrowing at the origin of the right vertebral artery.


Instruction: Generate impression based on findings.

Input: Following a discussion of the procedure with the patient and/or family, including its risks, benefits, alternatives and steps to prevent infection, informed written consent was obtained and documented in the patient's chart. The time-out form was completed to confirm patient identity and side/type of procedure. All operators present for the case performed standard preprocedural prep including hand washing and sterile gloves. The patient was prepped and draped in the usual aseptic fashion. Local anesthesia over the target area was obtained by 1% lidocaine.Targeted ultrasound examination demonstrates a heterogeneous but predominantly hypoechoic mass along the posterior aspect of the left scapula corresponding to the findings on recent MRI examination. There is associated increased vascularity on Doppler interrogation. Using ultrasound guidance a 18-gauge Achieve core biopsy needle was advanced into the lesion. 4 core needle biopsy specimens were obtained. 2 specimens were placed in RPMI solution. 2 specimens were placed in 10% formalin. Touch preparations were performed and handed to cytopathology to confirm specimen adequacy.The core biopsy specimens in formalin were hand carried to the Surgical Pathology lab. The specimens in RPMI solution were handed to cytopathology.The patient tolerated the procedure well without immediate complication. Routine post procedure instructions were communicated to the patient.ESTIMATED BLOOD LOSS: Less than 5cc. An adhesive bandage was placed on the patient’s skin.

Output: Ultrasound guided biopsy of left scapular mass.


Instruction: Generate impression based on findings.

Input: 35-year-old female with pain on walking. Knee "gives away." Evaluate for torn meniscus or ligament. MENISCI: Lateral and medial menisci are intact.ARTICULAR CARTILAGE AND BONE: There is bone marrow edema within the anterior aspect of the lateral tibial plateau as well as subchondral edema within the lateral aspect of the lateral femoral condyle which likely represents bone contusion. There is a poorly defined, band-like focus of low signal intensity within the subchondral lateral femoral condyle which may represent a small, nondisplaced subchondral fracture, but this is equivocal. Overlying cartilage appears intact as well as the articular cartilage of the knee.LIGAMENTS: The ACL is intact. The PCL is intact. The MCL is intact. The LCL is intact. There is mild edema within the fat deep to the iliotibial band which likely represents direct contusion. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: Edema within the lateral femoral condyle and lateral tibial plateau suggests bone contusion with a small, equivocal subchondral fracture of the lateral femoral condyle and other findings as above. We see no meniscal or ligamentous injury.


Instruction: Generate impression based on findings.

Input: R sided tingling, evaluate for TIA MRA of the brain: Normal flow voids through the anterior circulations. There is attenuation of flow-related enhancement of the left proximal P2 segment. There is also focal irregularity of the proximal left posterior communicating artery. Right posterior communicating artery is not well visualized. No evidence of aneurysm.MRA of the neck: Limited evaluation of the arch. Normal flow-voids are seen in the visualized bilateral carotids and vertebral arteries. Bilateral carotid arteries are tortuous. Left vertebral artery is dominant. There is diminutive right V4 segment distal to the PICA origin. Right vertebral artery origin is not well visualized. Origins of the bilateral carotids and left vertebral artery appear patent. No significant steno-occlusive disease.MRI of the cervical spine: There are grade 1 anterolistheses of C3 over C4 and C7 over T1. Vertebral body heights are maintained. There ise multilevel disc desiccation and loss of height. There is developmental narrowing of the spinal canal. There is a lesion with sclerotic margin in the upper odontoid process, which may represent a degenerative cyst or other benign lesion. There appears to be a hemangioma or focal fat deposition at the C6 vertebral body. Otherwise bone marrow signal is unremarkable. Cervical medullary junction is unremarkable with normal position of the cerebral tonsils. Approximately 1.5 cm T2 heterogeneous right thyroid nodule with T2 hypointensity suggestive of blood products and/or calcification. C2-3: There is central disc protrusion and facet arthropathy without significant spinal canal stenosis or foraminal narrowing.C3-4: There is mild uncovering of the disc. There is disc osteophyte complex and uncovertebral arthropathy, right greater than left. There is mild-to-moderate spinal canal stenosis and bilateral moderate to severe foraminal narrowing.C4-5: Disc osteophyte complex with moderate central canal stenosis. There is uncovertebral arthropathy, right greater than left, with moderate-to-severe right and moderate left foraminal narrowing.C5-6: Bilateral uncovertebral arthropathy with moderate-to-severe left and moderate right foraminal narrowing. Disc osteophyte complex with mild-to-moderate central canal stenosis.C6-7: Left uncovertebral arthropathy with mild left foraminal narrowing. No significant spinal canal stenosis or right foraminal narrowing.C7-T1: There is mild uncovering of the disc. No significant spinal canal stenosis or foraminal narrowing.T1-2: Central disc protrusion noted on sagittal view without significant spinal canal stenosis.

Output: 1. Attenuation of flow related enhancement in the proximal left P2 segment, consistent with atherosclerotic disease. Otherwise no significant steno-occlusive disease or aneurysm of the intracranial or cervical vasculature.2. Developmental narrowing of the cervical spinal canal with superimposed degenerative changes most prominent at C3-4, C4-5, and C5-6 levels as above, including moderate-severe foraminal narrowings.3. Approximately 1.5 cm right thyroid nodule with blood products and/or mineralization. Ultrasound may be obtained for further evaluation if clinical concern.


Instruction: Generate impression based on findings.

Input: Reason: Diffuse Large B cell lymphoma- now with worsening right shoulder pain History: as above. ROTATOR CUFF: There is complete rupture of the supraspinatus tendon with retraction to the level of the glenohumeral joint. There is moderate fatty atrophy of the supraspinatus muscle. There is extension of this tear to involve much of the infraspinatus tendon although a few of the posterior fibers of the tendon appear to reach the greater tuberosity. The teres minor and subscapularis muscles and tendons appear intact.SUPRASPINATUS OUTLET: There is fluid within the subacromial subdeltoid bursa confirming a full-thickness tear. Moderate osteoarthritis affects the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is heterogeneity and intermediate signal intensity within the anterior, posterior, and superior labrum likely representing degeneration and degenerative tearing. Mild osteoarthritis affects the glenohumeral joint. Note is made of a high riding humeral head.BICEPS TENDON: There is thickening and intermediate signal intensity of the intra-articular portion of the tendon of the long head of the biceps indicating tendinosis. The tendon itself appears intact. ADDITIONAL

Output: 1. Bone marrow signal abnormality within the proximal humerus and coracoid consistent with the patient's history of lymphoma, within the limitations of this noncontrast examination. There is also serpentine signal abnormality within the proximal humerus which may reflect a component of osteonecrosis.2. Massive rotator cuff tear involving the supraspinatus and infraspinatus tendons with retraction as described above.3. Osteoarthritis of the shoulder. Other findings as described 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.The alignment of the vertebral column throughout the spine remains normal.


Instruction: Generate impression based on findings.

Input: Female, 81 years old. Nonhealing wound, drainage, hyperpigmentation There is ulceration of the soft tissues along the lateral aspect of the lower leg. There is thickening and enhancement of the adjacent skin suggesting inflammation. There is diffuse reticulation of the subcutaneous fat indicating edema with relatively mild enhancement. There is mild edema of the muscles of the leg, particularly the peroneal musculature with minimal if any enhancement. There is also fatty infiltration of the posterior musculature of the lower leg. We see no rim-enhancing fluid collection to indicate an abscess. Evaluation of the proximal tibia and surrounding soft tissues is limited by metal susceptibility artifact from the patient's knee hardware, but marrow signal is otherwise normal without evidence of osteomyelitis. Note is made of subcutaneous edema affecting the right leg as seen on large field of view images.

Output: Soft tissue ulceration and edema without evidence of abscess or osteomyelitis.


Instruction: Generate impression based on findings.

Input: Reason: 69-year-old female with h/o ileocolonic Crohn's disease, s/p multiple SBR with short bowel, admitted with diarrhea and weight loss. Please evaluate for active Crohn's disease. ABDOMEN:LUNG BASES: Left pleural effusion and atelectasis/consolidation at the left lung base appearing similar to recent chest radiograph.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Large hiatal hernia.Postsurgical changes from an ileocecectomy. Overall there is a paucity of distal small bowel loops related to prior ileal resection. The residual small bowel is well-distended with oral contrast. The neoterminal ileum is clearly identified. The bowel is normal in caliber and wall thickness. There is no abnormal postcontrast enhancement or restricted diffusion. No significant fibrofatty proliferation or mesenteric lymphadenopathy. No fixed luminal narrowing or prestenotic/upstream dilatation. No sinus tract or fistula formation. No significant free fluid or loculated fluid collection.Previously seen inflammatory changes involving the colon are no longer seen.BONES, SOFT TISSUES: Patchy marrow signal intensity, not significantly changed. Areas of increased T1 and T2 signal within the spine compatible with hemangiomas. Multiple compression deformities in the thoracic and lumbar spine are incompletely assessed but appear grossly similar to the prior exam.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: See discussion above.BONES, SOFT TISSUES: Patchy marrow signal intensity is not significantly changed.There is mildly increased enhancement along the anus and adjacent intergluteal cleft, and a perianal fistula at the 12:00 position cannot be excluded (images 63 to 80 series 17).OTHER: Nodular soft tissue signal material immediately anterior to the sacrum which is nonspecific but appears grossly stable since 2006 CT and thus is likely of benign etiology.

Output: 1.Paucity of small bowel related to previous resection without evidence of active inflammation within the small and large bowel.2.Increased enhancement along the anus and intergluteal fold, nonspecific; correlation with patient's clinical history and physical exam recommended as a perianal fistula at the 12:00 position cannot be excluded.3.Heterogeneous bone marrow appearing grossly similar to prior. However, if there is clinical concern for metastatic disease, additional imaging such as a nuclear medicine bone scan may be considered as clinically warranted.


Instruction: Generate impression based on findings.

Input: 13-year-old male with NF type II, facial weakness, brain tumor. Evaluate for interval change in vestibular schwannoma and schwannoma the right facial nerve, change in brain tumor. MRI BRAIN: There is evidence of prior right parietal craniotomy. No restricted diffusion to suggest acute ischemia. Gray-white matter differentiation is preserved. No discrete intraparenchymal lesions are identified, however see below regarding lesions within the internal auditory canals and brain stem. The ventricles and sulci are appropriate for patient's age. There is no midline shift or herniation.MRI IAC: Bilateral enhancing lesions within the internal auditory canals are again noted and not significantly changed from prior study. These lesions demonstrate low T1 signal and T2 signal with homogeneous enhancement. The lesion on the right measures 6 mm x 6 mm (series 2701, image 11) and occupies the majority of the intracanalicular portion of the inferior vestibular division and to a lesser degree the superior vestibular division and cochlear division of the vestibulocochlear nerve. The lesion on the left measures 7 mm x 5 mm (series 2701, image 8) and also occupies a similar pattern of the vestibulocochlear divisions although a to lesser extent. The intracanalicular portion of the facial nerves appear to be spared bilaterally. There are postoperative changes of the right petrous bone. In particular, enhancing lesions of the right petrous bone adjacent to the right internal auditory canal and posterior mastoid air cells are likely reflecting postoperative granulation tissue or mixed with residual tumor. Although direct comparison to the prior study dated 8/24/2014 is not entirely possible due to difference in slice thickness, the above findings are overall not significantly change.MRI CERVICAL SPINE: There is interval change in MR characteristics of the medullary lesion. The lesion shows increase in size of the lesion within the spinal cord at the level of the medulla which was relatively homogeneous low T1 and high T2 signal intensity before. The lesion also demonstrates interval increase in size. It is measured 2.5 cm x 1.8 cm x 1.4 cm which was previously 1.4 cm x 1.4 cm x 1.2 cm. Given the signal characteristics and the patient's history of neurofibromatosis type II, this is compatible with a spinal cord ependymoma. Additional smaller enhancing lesion in the spinal cord at the level of C2 measuring up to 9 mm (series 2301, image 10) has also increased in size comparing to prior study with a new additional lesion at the level of C2/C3 disc space spinal cord anterior aspect (series 2501, image 9). These lesions likely represent another ependymomas. Also at the level of C1-2 posterior arch there is a lesion within which arises peripherally overlying the spinal musculature and appears to encase the left side C2 nerve root; a portion of the lesion also abuts the posterior inferior aspect of the left vertebral artery. The lesion is isointense on T1, bright but subtle internal low signal intensities on T2 and demonstrates homogeneous enhancement. This likely represents a neurogenic tumor such as a schwannoma. The lesion is measured 4.0 cm x 2.9 cm x 2.9 cm (series 2501, image 5). This also appears slightly increased in size on the prior study.

Output: 1. Bilateral vestibular schwannomas compatible with patient's known history of Neurofibromatosis II which are not significantly changed in size. Postoperative changes along the petrous bone and posterior mastoid air cells appear similar to prior study; this likely represents postoperative granulation tissue or mixed with residual tumor.2. Medullary ependymoma has increased in size since the prior study with changed MR characteristics (more heterogeneous T2 signal, development of cystic component and inhomogeneous enhancement). 3. Spinal cord ependymoma at the level of C2 has increased in size since prior scan.4. Another spinal cord ependymoma at the level of C2-C3 level mid-anterior aspect of the spinal cord.5. Mass lesion between C1 and C2 posterior arch, located adjacent to the left vertebral artery, likely represents a neurogenic tumor such as schwannoma. This has slightly increased in size since the prior study.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 56-year-old female, evaluate rotator cuff ROTATOR CUFF: There is a partial articular sided tear of the distal supraspinatus tendon without evidence of full thickness component. There is no retraction of the tendon or atrophy of the muscle. The remaining rotator cuff tendons and muscles are intact.SUPRASPINATUS OUTLET: Moderate acromioclavicular joint osteoarthritis..GLENOHUMERAL JOINT AND GLENOID LABRUM: The labrum appears grossly intact. Glenohumeral alignment is within normal limits.BICEPS TENDON: Intact and appropriately situated within the bicipital groove. ADDITIONAL

Output: Partial partial articular sided tear of the distal supraspinous tendon without retraction or muscle atrophy.


Instruction: Generate impression based on findings.

Input: Advanced lung cancer. Mid back pain for 3 weeks. Evaluate for metastasis. There is diffuse fatty signal in the upper thoracic spine bone marrow related radiation treatment. The remainder of the marrow shows no significant focal lesion, aside from C7-T1 degenerative signal alteration. The vertebral bodies are preserved in height and the spinal canal is preserved. The spinal cord shows normal signal and is not compressed. The left upper lobe lung mass, which has intercostal extension, and an enhancing left pleural effusion are partially imaged. There also appear to be new enlarged retroperitoneal and mediastinal lymph nodes. There are T2-hyperintense nodules in the thyroid gland.

Output: 1.Postradiation changes are present in the upper thoracic spine, but no evidence of thoracic spine metastasis.2.Partially imaged left upper lobe lung mass with associated findings chest wall involvement and pleural effusion. 3.Possible new retroperitoneal and mediastinal lymphadenopathy. However, the MRI is not optimized for the assessment of these areas and a dedicated chest CT may be useful for further evaluation, if clinically warranted.4.Nonspecific thyroid nodules. A thyroid ultrasound may be useful for further evaluation.


Instruction: Generate impression based on findings.

Input: Male, 21 years old, with Crohn's disease, on anti-TNF, with numbness and tingling of the upper and lower extremities. Concern for demyelinating disease. Brain:A thin rim of T2 hyperintensity is evident along the bilateral frontal horns. Posteriorly, the ventricular margins are spared. There may also be a single punctate focus of T2 hyperintensity within the white matter adjacent to the right frontal horn. Otherwise, no focal lesions are seen.No mass effect or parenchymal edema is seen. There are no abnormal extra-axial fluid collections. Slight asymmetry of lateral ventricular size is within the limits of normal variation. The ventricles are otherwise unremarkable. No pathologic intracranial enhancement is seen.Cervical spine:Alignment is anatomic. Vertebral body morphology is within normal limits. No evidence of marrow replacement or marrow edema is seen.The spinal cord demonstrates normal signal intensity and morphology throughout. No focal cord lesions or pathologic cord enhancement are detected.No significant degenerative disease is identified. The spinal canal and the neural foramina are patent.

Output: 1. A thin rim of signal abnormality is seen along the bilateral frontal horns, with perhaps a single punctate focus of T2 hyperintensity in the adjacent white matter on the right. The periventricular signal is somewhat unusual in a patient of this age (though it is seen commonly in older age groups), and it is conspicuous in that it affects the frontal regions preferentially. At this point, the findings are not sufficiently specific to make a diagnosis of demyelinating disease or any other process, and in fact, normal variation would still be in the differential. A follow-up exam may be considered to assess for any evolution of these findings.2. Examination of the cervical spine is within normal limits. No cord lesions are seen which would correlate with the patient's symptoms.


Instruction: Generate impression based on findings.

Input: 45-year-old female with pain and weakness ROTATOR CUFF: There is abnormal signal extending within the undersurface of the distal supraspinatus tendon, indicating an articular sided tear with retraction of the undersurface fibers. Mild associated atrophy and supraspinous muscle is noted. Tendons and muscles of the infraspinatus, teres minor, and subscapularis appear intact.SUPRASPINATUS OUTLET: Mild to moderate acromioclavicular joint osteoarthritis.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is globular abnormal signal within the superior and inferior labrum likely representing diffuse degeneration. Glenohumeral alignment is within normal limits.BICEPS TENDON: Intact and normally situated within the bicipital groove. ADDITIONAL

Output: Partial articular sided tear of the supraspinatus tendon with minimal retraction of the undersurface fibers, as described above.