Instruction: Generate impression based on findings.

Input: The patient is a 44-year-old male who presents for a pulmonary vein CT prior to planned atrial fibrillation ablation by catheter-based pulmonary vein isolation. The quality of the study is suboptimal. There is a relatively low contrast opacification of the left atrium pulmonary veins. Within the limits of this study the pulmonary vein dimensions are as follows:Left superior pulmonary vein: 19.3 x 12.8mmleft inferior pulmonary vein 11.4 x 20.1 mmright superior pulmonary vein 26.6 x 17.2 mmright inferior pulmonary vein 19.5 x 15.6 mmLeft atrial volume 123 cc

Output: 1. Increased left atrial volume. 2. Mildly enlarged pulmonary vein diameter. 3. Poor opacification of the left atrium and pulmonary veins.Interpretation of the lungs and other soft tissues of the thorax and upper abdomen will be included in the radiologist report.


Instruction: Generate impression based on findings.

Input: Left breast cancer at 9:00 position about 2 to 3 cm from the nipple with possible satellite lesion at 7:00 position, MRI for further evaluation There is heterogeneous amount of fibroglandular tissuein both breasts.Mild parenchymal enhancement is noted bilaterally.Left breast:Spiculated enhancing mass in the left breast 9:00 position which corresponds to biopsy-proven cancer with a clip artifact within it measures 16 x 20 x 31 mm (AP X ML X CC). Located posterior to it by 6 mm is a an oval lobulated mass showing heterogeneous progressive enhancement that measures 20 x 12 x 8 mm, at approximately 7:30 to 8:00 position of the left breast. Based on the morphology and enhancement characteristics, this lesion could represent a benign fibroadenoma. Multiple small satellite lesions are identified extending posteriorly and laterally with associated non mass enhancement. The lateral anterior focus of enhancement located at 2:00 position measures 5 x 4 x 3 mm. The posterior-most and lateral spiculated mass located at 4:00 position of the left breast measures 9 x 6 x 8 mm (AP X ML X CC). The left nipple also shows abnormal enhancement that measures 11 x 12 x 10 mm however similar intense enhancement is also seen in the right nipple. These could be seen due to inverted nipple however given the intensity of enhancement and irregular shape of the lesion, neoplastic process cannot be excluded.Total extent of the left nipple, biopsy-proven cancer at 9:00 position and the farthest lateral satellite lesions is approximately 88 x 63 mm (AP X ML). Eccentric thickening of 2 left lower axillary lymph nodes, could be reactive given the recent biopsy however further evaluation with ultrasound is recommended.Right breast: Right nipple also demonstrates intense enhancement with irregular shape which could be seen due to inverted nipple however additional MR directed ultrasound is recommended to confirm benignity.No abnormal area of enhancement identified in the right breast. Normal morphology right axillary lymph nodes were identified.

Output: 1. Biopsy-proven cancer in the left breast 9:00 position with additional satellite lesions suggestive of multicentric disease. MR directed ultrasound to identify satellite lesions farthest from the index cancer for example left breast 4:00, left nipple and left breast 2:00 are recommended. The lobulated oval mass posterior to the index mass has most likely benign characteristics.2. Eccentric thickening of 2 left lower axillary lymph nodes for which MR directed ultrasound is recommended.3. Enhancing right nipple which is very similar to the enhancement characteristics of the left nipple. Differential includes inverted nipple bilaterally versus additional satellite lesion.BIRADS: 6 - Known cancer.RECOMMENDATION: E - Additional Mammo/Ultrasound Workup Required.


Instruction: Generate impression based on findings.

Input: Malignant neoplasm of prostate [C61] / Secondary malignant neoplasm of bone [C79.51], Reason for Study: There is interval increase in thickness of the left frontal extra axial lesion just underneath of the left frontal sclerotic skull lesion. The lesion shows some mass effects toward underlying brain parenchyme. The lesion is measured about 43.8mm (AP) x 7.3mm (RL) x 7mm (CC). Considering the patient's clinical history and overlying sclerotic skull lesion, this lesion is likely represent metastatic dural and extradural lesion.There is no other abnormal enhancement.There is no evidence of acute ischemic or hemorrhagic lesion on this scan.Known left frontal sclerotic skull lesion remains stable in terms of size and MR signal characteristics.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Ectatic changes of intracranial arterial system especially vertebrobasilar system indicating atherosclerotic changes such as dolichoectasia. No significant interval change since prior scan. If indicated brain MRA can be considered for further evaluation of intracranial arterial system.The paranasal sinuses and mastoid air cells are clear.

Output: 1. Interval increase in size of left frontal extradural enhancing lesion underneath the known left frontal sclerotic metastatic lesion. 2. Stable left frontal sclerotic skull lesion since prior scan.3. Atherosclerotic changes of intracranial arterial system especially dolichoectatic change of vertebrobasilar system, unchanged since prior scan.


Instruction: Generate impression based on findings.

Input: Right leg weakness. Evaluate for new MS lesions. Brain: There are multiple, greater than 10, foci of T2/FLAIR hyperintensity involving the bilateral periventricular and subcortical white matter with appearance and distribution of the lesions compatible with known demyelinating disease. Infratentorial lesions such as lesion involving the left middle cerebellar peduncle is also suspected as well as in the left lateral aspect of the pons at the nerve root entry zone of the left trigeminal nerve. Few lesions with T1 hypointensity are also noted. Brain parenchymal volume is preserved for age. No abnormal enhancing lesions within the brain are appreciated. No intracranial mass effect, extra-axial collections, or hydrocephalus. Calvarium and extracranial soft tissues are grossly unremarkable.Cervical spine: There are multiple T2 hyperintense lesions in the cervical cord consistent with known demyelinating disease. The most prominent of these is seen involving the right lateral aspect of the cord and extends from the C2-C3 level to the C3-C4 level. Additional tiny lesions are seen at the left ventral base of C2 level and right ventral C2-C3 level on both the axial T2 and T2* mFFE sequences. No abnormal enhancement is definitively appreciated. Apparent areas of high signal on the axial post gadolinium sequence, which is motion degraded, such as at the right C2-C3 level, axial post gadolinium image 29, are favored to be artifactual. No abnormal enhancement on the sagittal sequence is appreciated.Vertebral body heights and alignment are maintained. Degenerative changes are seen including multilevel disc desiccation and small bulge at the C5-C6 level. There is no significant spinal canal stenosis at any level. There is uncovertebral hypertrophy and facet arthropathy with resulting moderate to severe right C3-C4 and right C4-C5 neural foraminal narrowing as well as milder changes at additional levels. There is a right thyroid nodule.

Output: 1. Multiple supra- and infratentorial lesions in the brain with distribution and morphology compatible with known demyelinating disease. No abnormal enhancement. 2. Multiple lesions within the cervical cord are also noted, most prominent at the right lateral aspect of the cord extending from the C2-C3 to the C3-C4 levels. No abnormal enhancement in the cervical cord is definitively appreciated within the limits of the motion degradation.3. An addendum can be made to this report if prior studies are made available for comparison.


Instruction: Generate impression based on findings.

Input: Nasopharyngeal cancer. There is an ill-defined right lateral nasopharyngeal recess mass that measures up to approximately 20 mm. The tumor abuts the right internal carotid artery, without encasement or evidence of perivascular spread. There is no evidence of tumor invasion of the skull base or intracranial extension. Indeed, the cavernous sinuses are intact. There is a partially necrotic right level 2B lymph node that measures 7 mm in short axis. There is also a mildly prominent and slightly heterogeneous right lateral retropharyngeal lymph node that measures 5 mm in short axis. The other cervical lymph nodes are unremarkable. There are right mastoid air cell effusions, likely related to mass effect upon the Eustachian tube orifice. There is a small right maxillary sinus retention cyst. The orbits are intact. The salivary glands are unremarkable. There is mild multilevel degenerative cervical spondylosis.

Output: 1. Right nasopharyngeal tumor measuring up to 20 mm without evidence of perivascular spread, invasion of the skull base or intracranial extension. 2. A partially necrotic right level 2B lymph node that measures 7 mm in short axis is compatible with metastatic disease. In addition, a mildly prominent right lateral retropharyngeal lymph node that measures 5 mm in short axis may also represent metastatic disease. The other cervical lymph nodes are unremarkable.


Instruction: Generate impression based on findings.

Input: 65 year old male with history of MVP repair ('00), HTN, atrial fibrillation s/p ablation in '07, frequent PVCs. Referral for cardiac MRI to look for late gadolinium enhancement. Left VentricleThe left ventricle is moderately dilated with normal systolic function. There is no LV hypertrophy. The overall LV ejection fraction is 59%. The LVEDV is 243 ml (normal range 142+/-34), the LV end diastolic volume index is 116 ml/m2 (normal range: 74+/-15), the LVESV is 99 ml (normal range 47+/-19) and the LV end systolic volume index is 47 ml/m2 (normal range 25+/-9). Sigmoid septum. There are no regional wall motion abnormalities present. There is a small area of late gadolinium enhancement in a subendocardial pattern in the basal lateral wall, just beneath the mitral annulus, to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.The native T1 myocardial relaxation time is within normal limits suggestive of absence of underlying diffuse fibrosis or infiltration.There is no myocardial iron overload. There is no LV thrombus. Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is mildly dilated with normal systolic function. The overall RV ejection fraction is 49%. The RVEDV is 206 ml (normal range 142+/-31), RV end diastolic volume index is 99 ml/m2 (normal range 82+/-16), the RVESV is 106 ml (normal range 54+/-17), and the RV end systolic volume index is 51 ml/m2 (normal range 31+/-9).Right AtriumThe right atrium is mildly dilated.Aortic ValveThe aortic valve is trileaflet, opens widely and there is no significant aortic regurgitation.Mitral ValveCOnsistent with prior MV repair. There is at least mild-moderate MR.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is dilated at the sinuses of valsalva (SOV 4.5 cm). Remaining aortic root appears normal.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Prior mitral valve re[air with at least mild-moderate MR.2. The left ventricle is moderately dilated with normal systolic function. The overall LV ejection fraction is 59%. 4. There are no regional wall motion abnormalities present. There is a small area of late gadolinium enhancement in a subendocardial pattern in the basal lateral wall, just beneath the mitral annulus. The native T1 myocardial relaxation time is within normal limits suggestive of absence of underlying diffuse fibrosis or infiltration. 5. Dilated at the sinuses of valsalva (SOV 4.5 cm). Remaining aortic root appeared normal.6. The right ventricle is mildly dilated with normal systolic function. The overall RV ejection fraction is 49%. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 7-year-old male patient with right thigh pain x1 month with negative x-rays and no history of trauma. ARTICULAR CARTILAGE AND BONE: There is no abnormal cortical or medullary signal intensity or enhancement.SOFT TISSUES: The muscles and tendons are intact. ADDITIONAL

Output: Normal examination without findings to account for patient's pain.


Instruction: Generate impression based on findings.

Input: Clinical question: 56-year-old male with altered mental status, history of CVA, now with mental status change and focal left-sided weakness. Please evaluate for subacute stroke/other intracranial process. Signs and symptoms: Left-sided weakness, slurred speech. Non-infused CT of brain:Examination redemonstrates an old right basal ganglia lacunar infarct.No evidence of new detectable ischemic stroke, hemorrhage, edema, mass effect or midline shift.Cortical sulci, ventricular system and all CSF cisterns remain similar to prior study and within normal limits. Considering provided clinical data an MRI examination would be most helpful for detection of early acute stroke.Calvarium is intact.Limited real paranasal sinuses demonstrate minimal right maxillary chronic sinusitis.Mastoid air cells and middle ear cavities are pneumatized.

Output: 1.No definite acute detectable new ischemic stroke or hemorrhage.2.Stable previously described findings of right sided lacunar infarct.3.Overall stable exam.


Instruction: Generate impression based on findings.

Input: Knee pain. Question of meniscal injury. MENISCI: There is blunting of the posterior horn of the medial meniscus compatible with a radial tear. The lateral meniscus is intact. ARTICULAR CARTILAGE AND BONE: There is full thickness articular cartilage loss of the medial facet of the patella measuring approximately 12 mm in the transverse dimension with underlying subchondral reactive edema. There is significant thinning of the articular cartilage of the median eminence of the patella and medial aspect of the lateral facet with underlying subchondral reactive edema. There is near full thickness to full thickness degeneration and heterogeneity of the trochlear groove and lateral femoral trochlea with underlying reactive bone edema. There is thinning of the articular cartilage of the anterior and weightbearing portion of the medial femoral condyle with superficial delamination between the meniscal horns. There is thinning of the weightbearing portion of the lateral femoral condyle articular cartilage along with focal fissures along the posterior condyle. There is edema within the medial tibial plateau. LIGAMENTS: The collateral and cruciate ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1. Small radial tear of the posterior horn of the medial meniscus. 2. Chondromalacia as described above.3. Large Baker's cyst.


Instruction: Generate impression based on findings.

Input: Knee pain MENISCI: There is mild irregularity of the free edge of the posterior horn of the lateral meniscus which may indicate mild fraying but we see no discrete meniscal tear.ARTICULAR CARTILAGE AND BONE: There is moderate osteoarthritis of the knee with multiple tricompartmental partial and full-thickness cartilage defects and degeneration. A prominent subchondral cyst is noted in the femoral trochlea centrally underlying a full-thickness cartilage defect. Additional edema type signal is noted within the lateral femoral condyle and medial tibial condyle which is favored to be degenerative in nature. There are tricompartmental osteophytes.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Moderate tricompartmental osteoarthritis with perhaps mild fraying of the posterior horn of the lateral meniscus without discrete meniscal tear.


Instruction: Generate impression based on findings.

Input: Diagnosis: Unspecified ptosis of eyelidClinical question: intermittent left ptosis, especially rule out pathology of CN3 tractSigns and Symptoms: intermittent ptosis of the left upper eyelid MRI of the brainNo diffusion weighted abnormalities are appreciated.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.A small extra-axial fluid collection is present just inferior to the left cerebellar hemisphere measuring 7 x 10 mm in coronal dimensions and most likely represents a small arachnoid cyst. Follows spinal fluid on all pulse sequences. It is not associated with diffusion restriction.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is small. The posterior communicating arteries are identified and are small. The posterior communicating arteries are associated with small infundibula. The left vertebral artery is larger than the right vertebral artery.

Output: 1.No evidence for cerebrovascular occlusive disease.2.No evidence for intracranial aneurysm.3.No evidence for acute ischemic cerebral infarction.4.Findings are compatible with a small arachnoid cyst adjacent to the left cerebellar hemisphere.


Instruction: Generate impression based on findings.

Input: Reason: is there any tumor near the right buttock or sacrum? Please define the margins of the plexiform neurofibroma of the left buttock. History: woman with NF1 complaining of pain in the buttock when she sits. She says it is in the right buttock but she has a left sided plexiform. Is there anything else? Note is made of a 5.1 x 1.4 x 4.1 cm focus of enhancing increased signal abnormality along the left gluteal crease with associated reticulation in the surrounding subcutaneous fat (image 31; series 14). This lesion appears to extend to and abut the 6 o'clock position of the anus and the possibility of perianal fistula formation cannot be completely excluded. No enhancing foci signal abnormality are identified within the right buttock to suggest a neurofibroma as clinically questioned. No additional enhancing mass lesions are identified. The imaged musculature of the pelvis is unremarkable. There is a small amount of fluid within the hips without evidence of a large effusion there is a small amount of peritrochanteric inflammation along the left greater trochanter which is likely of no clinical significance. Note is made of bilateral subcentimeter adnexal cysts/follicles.

Output: 5.1 cm focus of enhancing signal abnormality along the left gluteal crease, which is nonspecific, but consistent with the stated history of a neurofibroma. Alternatively, this could also represent perianal fistula formation or postsurgical granulation tissue in the correct clinical context. There is no evidence of neurofibroma formation within the right buttock, as clinically questioned.


Instruction: Generate impression based on findings.

Input: 58-year-old male with history of prostate cancer status post radical prostatectomy 9 years ago now with rising PSA. Evaluate for recurrent disease. PELVIS:PROSTATE: Status post prostatectomy. There is patchy poorly defined low T2 signal adjacent to the bladder neck junction. There is no definite associated abnormality on the postcontrast and diffusion sequences. Within this region are also small cystic foci of uncertain significance.Seminal Vesicles: Surgically absent.BLADDER: No significant abnormality noted.LYMPH NODES: Scattered normal-sized pelvic lymph nodes. No pelvic or abdominal lymphadenopathy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Ill-defined soft tissue thickening at the bladder neck junction as described. While this may represent normal postoperative appearance/scarring, recurrent disease is not entirely excluded. No evidence of metastatic disease elsewhere in the pelvis.


Instruction: Generate impression based on findings.

Input: Multiple sclerosis [G35], Reason for Study: ^Reason: eval for new MS lesions History: fever, abd pain, chest pain There is no evidence of acute ischemic or hemorrhagic lesion on the scan.There are several FLAIR high signal intensity lesions on bilateral periventricular white matter and suspicious on the right medial thalamus without evidence of surrounding edema. These lesions can suggest possible demyelinating disease such as multiple sclerosis, however, could also be non specific.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: Mainly periventricular white matter FLAIR high signal intensity lesions as described above. Differential diagnosis include demyelinating disease such as multiple sclerosis, however, the MR findings are non specific.


Instruction: Generate impression based on findings.

Input: 79-year-old male with altered mental status on anticoagulation. Evaluate for intraventricular hemorrhage. Minimal hypoattenuation in the periventricular white matter is consistent with chronic small vessel ischemic disease.There is no evidence of intracranial hemorrhage, mass or edema. 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: 1. No acute intracranial abnormality.2. Minimal small vessel ischemic disease in the periventricular white matter.


Instruction: Generate impression based on findings.

Input: 45 year old man with known bicuspid aortic valve, mild aortic regurgitation and ascending aortic dilatation referred for cardiac MRI to evaluate cardiac volume and aortic dimensions. Left VentricleThe left ventricle is mildly dilated with normal systolic function. The overall LV ejection fraction is 62%, the LV end diastolic volume index is 108 ml/m2 (normal range: 74+/-15), the LVEDV is 199 ml (normal range 142+/-34), the LV end systolic volume index is 41 ml/m2 (normal range 25+/-9), the LVESV is 76 ml (normal range 47+/-19). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is moderately dilated with normal systolic function. The overall RV ejection fraction is 53, the RV end diastolic volume index is 137/m2 (normal range 82+/-16), the RVEDV is 252l (normal range 142+/-31), the RV end systolic volume index is 65ml/m2 (normal range 31+/-9), and the RVESV is 120l (normal range 54+/-17).Right AtriumThe right atrium appears mildly dilated.Aortic ValveThe aortic valve opens widely and is bicuspid with fusion of the right and left cusps. There is minimal aortic regurgitation on this study by qualitative and quantitative evaluation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. Ao sizeSOV 36 x 41 mmAsc 44 x 46 mmArch (mid) 28 x 28 mmDesc 21 x 23 mmPulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Mildly dilated left ventricle with normal systolic function (EF 62%). There is no late gadolinium enhancement to suggest the presence of an underlying infiltrative, inflammatory or fibrotic process. 2. Moderately dilated right ventricle with normal systolic function (EF 3. Bicuspid aortic valve with no significant aortic regurgitation.4. Dilated ascending aorta as reported above. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Spinal stenosis, cervical region [M48.02], Reason for Study: ^Reason: Evaluate for cervicals stenosis History: R sided neck pain radiating down arm The cervical spine alignment appears to be slightly straightened. Cervical spinal cord signal intensity remains normal.There are multiple T2 high and T1 low signal intensity nodules within thyroid gland. If clinically indicated, further imaging evaluation with ultrasound examination can be considered.The cranial-cervical junction is normal. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The cord signal is normal. Degenerative changes are specified by the intervertebral level as follows: C2-C3: Minimal bulging of disc. No neuroforaminal narrowing or spinal stenosis. C3-C4: Diffuse bulging of disc which abuts thecal sac. No neuroforaminal narrowing or spinal stenosis. C4-C5: Diffuse bulging of disc which abuts thecal sac with bilateral ligamentum flavum results minimal to mild spinal canal stenosis. C5-C6: Diffuse bulging of disc which abuts thecal sac with bilateral ligamentum flavum results minimal to mild spinal canal stenosis.C6-C7: Diffuse bulging of disc which abuts thecal sac. There is broad-based disc protrusion towards left side neuroforamen results mild to moderate neuroforaminal stenosis. C7-T1: Diffuse bulging of disc toward the right side neuroforamen with facet joint hypertrophy results mild to moderate right neuroforaminal stenosis. T12-L1: no neuroforaminal narrowing or spinal stenosis.

Output: 1. Multilevel various degree spinal canal stenosis including C45 and C56.2. Various degree neuroforaminal stenosis involving left C67 and right C7T1.


Instruction: Generate impression based on findings.

Input: 17 year-old female status post fall with double vision and headache, loss of consciousness and blood from left ear canal. There is no evidence of intracranial mass or edema. A small focus of high density presumably represents an extra-axial fluid collection adjacent to the frontoparietal cortex, (images 12 and 13). Focus of soft tissue density overlying the left parietal occiput likely represents a hematoma without underlying fracture.These focal findings suspicious for a small subdural hematoma would be better evaluated with an MRI.Low-density focal widening of the right lateral sylvian fissure may represent an arachnoid cyst (image 7).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: 1. Small focus of hyperdensity, as described above, may represent a subdural hematoma which would be better evaluated with MRI.2. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Evaluate for spinal or foraminal stenosis. History of L4-5 spondylolisthesis, LLE radiculopathy, left thoracic flank pain Thoracic:Thoracic vertebral body heights are maintained. Alignment is maintained. No significant spinal canal or neural foraminal stenosis is seen. Bone marrow signal is benign with no suspicious lesions. There is a large cervicothoracic syrinx with the superior limit at the C1-C2 level which was seen on recent brain MRI. Inferiorly, syrinx terminates at the T10-T11 level. Syrinx measures up to 9 x 11 mm in the axial plane at the upper thoracic level where there is significant cord expansion. Prior brain MRI demonstrates findings of Chiari 1.Mild degenerative changes are seen in the thoracic spine with loss of disk height at multiple levels. Minimal disk bulges are seen at T5-T6, T6-T7, and T7-T8 without significant associated spinal canal or neural foramina stenosis.Lumbar:Five lumbar type vertebral bodies are present. Vertebral body heights are within normal limits. There is grade 1 anterolisthesis of L4 on L5. Alignment is otherwise within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position at the L1 level.Multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: Minimal disc bulge and dorsal annular fissure. No spinal canal or neural foraminal stenosis.L3-L4: Minimal disc bulge. No spinal canal or neural foraminal stenosis.L4-L5: There is disk desiccation with mild T2 hyperintensity in the disk and at the interspinous level. There is mild anterolisthesis, disc uncovering with left foraminal disc protrusion, ligamentum flavum thickening and moderate facet arthropathy. There is moderate left foraminal narrowing with suspected impingement of the left L4 nerve root. There is minimal spinal canal and minimal right foraminal narrowing.L5-S1: Minimal disc bulge eccentric to the right. No significant spinal canal or neural foraminal stenosis. Mild bilateral facet arthropathy.Paraspinous soft tissues are within normal limits.

Output: 1. Large cervicothoracic syrinx extending from the C1-2 level (as seen on recent brain MRI) to the T10-T11 level. Of note, recent brain brain MRI demonstrates findings of Chiari 1.2. Grade 1 anterolisthesis and facet arthropathy at L4-5. There is a left foraminal disc protrusion at this level resulting in moderate left foraminal narrowing with suspected impingement of the left L4 nerve root. 3. Mild degenerative changes in the remainder of the thoracic and lumbar spine as detailed above.


Instruction: Generate impression based on findings.

Input: Male, 49 years old, with progressive weakness of the left hand. Assess for Hirayama disease. The normal cervical lordosis is reversed with a slight anterior angulation of C2 and C3 relative to the lower cervical spine.Vertebral body heights are preserved. No areas of pathologic marrow edema or replacement are seen. Evidence of prior bilateral laminectomy is seen from C3 through C6.Cord atrophy is evident centered at C4 and C5 with a focus of frank cord T2 hyperintensity on the right at C4-5. Secondary to laminectomy, the thecal sac is well expanded between C3 and C6 on neutral imaging. With flexion, there is no change in the caliber of the thecal sac which remains well-expanded through the decompressed region, nor is it significantly changed above or below. With extension, however, there is a significant decrease in the caliber of the thecal sac with the spinal cord appearing mildly compressed between the dorsal dural surface and the vertebral bodies from C3 to C5.The following level specific findings are observed on neutral imaging:C2-3: No spinal canal stenosis or neuroforaminal narrowing. C3-4: Posterior canal decompression. Mild posterior disc-osteophyte complex formation resulting in mild bilateral foraminal narrowing. C4-5: Posterior canal decompression. Mild posterior disc-osteophyte complex formation resulting in mild bilateral foraminal narrowing. C5-6: Posterior canal decompression. Mild posterior disc-osteophyte complex formation resulting in moderate right and severe left foraminal narrowing. C6-7: Posterior canal decompression. Posterior disc-osteophyte complex formation asymmetric to the left. Moderate left foraminal narrowing. C7-T1: Posterior disc-osteophyte complex formation asymmetric to the left. No significant spinal canal stenosis. Mild bilateral foraminal narrowing.

Output: 1.Evidence of laminectomy for spinal canal decompression is seen from C3 through C6. 2.Spinal cord atrophy and signal abnormality are demonstrated at the C4 and C5 levels. The thecal sac is well expanded in this region on both the neutral and flexion views. On extension views, however, a significant decrease in the caliber of the thecal sac is seen with some degree of cord impingement suspected between the posterior dural wall and the vertebral bodies. While this is paradoxical to what is typically seen on flexion and extension imaging in Hirayama disease, the possibility certainly exists that there is some component of chronic positional cord impingement at play.3.Relatively mild degenerative disc disease is seen without significant spinal canal stenosis as assessed in the neutral position. Scattered foraminal narrowing is noted, and it does tend to be more severe on the left.


Instruction: Generate impression based on findings.

Input: Daily abdominal pain after eating. Terminal ileal inflammation seen intraoperatively during MALS release. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology, size, signal intensity and enhancement without biliary ductal dilatation, focal lesion or vascular abnormality. Status post cholecystectomy. No extrahepatic biliary ductal dilatation.SPLEEN: The spleen is normal in morphology and size without a discrete lesion. PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is wall thickening and hyperenhancement of at least 5 cm of the terminal ileum suggesting compatible with acute inflammation. There is surrounding inflammation involving approximately 5 x 5.6 cm (series 13/59) and fibrofatty proliferation. There is a mild tethering of the surrounding small bowel loops, enteroenteric fistulization cannot be excluded. There is no proximal bowel dilatation. No loculated fluid collection.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Suspected acute inflammatory bowel disease involving at least 5 cm of the terminal ileum with surrounding phlegmonous inflammation and mild tethering of the surrounding small bowel loops without definite fistulous communication but which cannot be entirely excluded. No loculated fluid collection.


Instruction: Generate impression based on findings.

Input: Right shoulder pain ROTATOR CUFF: There is full-thickness tearing of the supraspinatus tendon with retraction to the level of the glenoid. Partial thickness tearing the superior fibers of the infraspinatus is noted which is superimposed upon severe tendinosis. Severe tendinosis of the subscapularis tendon is also evident. There is associated severe atrophy of the supraspinatus muscle with moderate atrophy of the subscapularis and infraspinatus.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is degenerative signal within the anterior superior labrum without evidence of full-thickness defect.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: 1. Full-thickness tear of the supraspinatus tendon with retraction to the level of the glenoid.2. Partial-thickness tearing of the superior fibers of the infraspinatus superimposed upon severe tendinosis.3. Severe tendinosis of the subscapularis tendon.4. Severe atrophy of the supraspinatus and infraspinatus muscles.5. Small joint effusion and synovitis with multiple probable calcified loose bodies within the posterior joint space.


Instruction: Generate impression based on findings.

Input: 72-year-old female patient status post Whipple in May 2009 for an IPMN and history of pancreatic cyst. Surveillance imaging. ABDOMEN:LIVER, BILIARY TRACT: Postsurgical changes of a Whipple procedure.SPLEEN: No significant abnormality noted.PANCREAS: Postsurgical changes of a Whipple procedure. There is a 7 x 3 mm cystic, nonenhancing focus within the pancreatic body which appears to communicate with the main pancreatic duct and likely represents a sidebranch IPMN, not definitively visualized on the prior examination (image 41, series 10). An additional cystic lesion within the pancreatic tail compatible with a sidebranch IPM is also slightly larger in size. Stable branching prominence of the pancreatic duct within the distal pancreatic tail.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Renal cyst is unchanged.RETROPERITONEUM, LYMPH NODES: Stable size of a reference porta hepatis lymph node measuring 1.4 x 1.2 cm (image 15, series 5), previously 1.4 x 1.2 cm. Scattered prominent lymph nodes in the retroperitoneum are also stable to mildly increased in size.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Post-surgical sequela within the ventral abdominal wall. OTHER: No significant abnormality noted.

Output: 1.Enlarging cystic lesions without suspicious features within the pancreas likely represent multiple sidebranch IPMNs.2.Mildly enlarged retroperitoneal lymph nodes may be reactive in etiology.


Instruction: Generate impression based on findings.

Input: Reason: Evaluate for common bile duct blockage, see HIDA scan 12/6 History: abdominal pain, N/V Postcontrast images mildly limited by patient motion and acquisition timing.ABDOMEN:LIVER, BILIARY TRACT: Liver demonstrates loss of signal on out of phase images compatible with hepatic steatosis. No suspicious focal lesions, though evaluation mildly mildly limited by timing of post contrast sequences.Cholelithiasis including stones in the gallbladder neck. Diffuse gallbladder wall thickening compatible with acute cholecystitis. No associated intra or extrahepatic biliary ductal dilatation. No choledocholithiasis is seen.SPLEEN: No significant abnormality noted.PANCREAS: Background parenchymal signal intensity within normal limits. No pancreatic duct dilation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right lower pole subcentimeter cyst. No hydronephrosis. Kidneys enhance symmetrically.RETROPERITONEUM, LYMPH NODES: On the inferior-most images, there is mild ectasia of the infrarenal aorta measuring up to 2.6 cm with associated crescentic area of intermediate signal along the wall most likely representing mural thrombus on this nondedicated study. The aorta measures up to 2.6 cm in diameter at this level.BOWEL, MESENTERY: Mild colonic diverticulosis.BONES, SOFT TISSUES: Degenerative changes affect the spine.OTHER: No significant abnormality noted.

Output: 1.Findings compatible with acute cholecystitis without evidence of biliary ductal dilatation or choledocholithiasis.2.Hepatic steatosis.3.Incompletely imaged mild infrarenal aortic ectasia with presumed associated mural thrombus.


Instruction: Generate impression based on findings.

Input: 53 year old female with worsening creatinine. Evaluate for any parenchymal abnormalities, nephrolithiasis or hydronephrosis. ABDOMEN:LIVER, BILIARY TRACT: Gallstones without evidence of acute cholecystitis. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Note is made of multiple subcentimeter foci of fluid signal intensity, particularly involving the cortex, which are too small to characterize, but likely represent simple cysts. There is a focus of increased T1 signal abnormality in inferior pole of the right kidney, which likely represents a complex/hemorrhagic cyst. No focal mass lesions are identified. The right kidney measures 9.9 cm in length. The left kidney measures 9.3 cm in length.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. No focal mass lesion, renal calculus or hydronephrosis is identified within the confines of a noncontrast examination.2. Gallstones without evidence of acute cholecystitis.


Instruction: Generate impression based on findings.

Input: Male, 55 years old, acute weakness status post T11 laminectomy. Findings are demonstrated relating to laminectomy at T11-12 and intraspinal lesion resection. There remains a patch of T2 hypointense material between the dura and the left dorsal surface of the spinal cord at the T11 level, similar to prior. This tissue may itself enhance to a mild degree, but it is contiguous with enhancement within the adjacent cord which has expanded superiorly and now extends to the level of the T10-11 disk. T2 hyperintense cord swelling has also progressed, now extending up to the T6 level, previously only to T9.Six lumbar type vertebrae are demonstrated when counting from above. Again seen is evidence of posterior instrumented fusion at L3-4 with bilateral pedicle screws and an interbody spacer, as well as anterior instrumented fusion from through the sacrum with interbody spacers. Laminectomy has been performed at L4 and L5 with expansion of the spinal canal at this region. Surgical findings have not significantly changed.Trace retrolisthesis of L3 relative to L4. Trace anterolisthesis of S1 relative to S2. Vertebral body heights are preserved. No concerning marrow signal abnormalities are detected.L1-2: Facet hypertrophy and minimal bulging disk. No significant interval changes.L2-3: Disk bulge and small central disk extrusion. Prominence of the dorsal epidural fat. Moderate spinal canal stenosis. Moderate foraminal narrowing. No significant interval changes.L3-4: Facet hypertrophy. Minimal disk bulging and osteophyte spurring. Mild spinal canal narrowing. Moderate to severe foraminal narrowing. No significant interval changes.L4-5 and L5-L6: Postoperative findings. No significant disk herniation, spinal canal stenosis or neuroforaminal narrowing.L6-S1: No significant spinal canal or neuroforaminal stenosis.

Output: Postoperative findings are redemonstrated consistent with prior laminectomy and lesion resection from the lower thoracic spine. T2 hypointense material between the dura and spinal cord at the operative level persists and may reflect scarring or blood products. Enhancement within the adjacent spinal cord has, however, progressed and now extends further in the superior direction. Associated cord edema has also progressed.There has been no significant interval change in the appearance of extensive postoperative findings in the lumbar spine.


Instruction: Generate impression based on findings.

Input: 17-year-old male with right knee pain for 2 weeks. MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: Fracture of the lateral femoral condyle along the lateral trochlear groove. There are 2 unstable fracture fragments adjacent to the fracture with an additional loose fracture fragment within the suprapatellar space laterally which measures 1.8 x 0.5 x 0.9 cm.LIGAMENTS: Cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: Extensor mechanism is intact. ADDITIONAL

Output: Fracture of the lateral femoral condyle with loose fracture fragment within the joint.


Instruction: Generate impression based on findings.

Input: Evaluate for retropharyngeal abscess. Patient is status post tracheostomy with signs of abscess on endoscopy. Neck CT:Again noted is bone and disk space destruction consistent with diskitis - osteomyelitis at C5, C6, and C7 levels as reported on recent CT study. Kyphotic angulation at the level of diskitis - osteomyelitis, with uncovering of bilateral C5 - C6 facet joints are again noted. Again noted are postsurgical changes of laminectomy. A thin layer of epidural abscess is again seen along the posterior longitudinal ligament of the cervical spine as described on prior MRI of cervical spine.There is significant heterogeneous soft tissue thickening involving the prevertebral space, retropharyngeal space and pharyngeal mucosal space, extending from the level of C2 - C3 to C7 - T1 level, superior to the tracheostomy tube placement. There is air tracking in the prevertebral space. Given the presence of osteomyelitis - diskitis, this probably represents acute inflammatory changes and phlegmon. However, there is no discrete fluid collection to suggest retropharyngeal abscess. Presence of soft tissue mass in hypopharynx representing tumor recurrence cannot be excluded.There is left pleural effusion. There are emphysematous changes in the lung apices.There is bony erosion of anterior left paramedian region of the left maxillary alveolus. This is unchanged.

Output: 1. Diskitis - osteomyelitis involving C5, C6, and C7 levels with kyphotic angulation of the cervical spine and uncovering / subluxation of the bilateral C5-C6 facet joints.2. Small residual epidural abcess in cervical spine.3. Heterogeneous soft tissue thickening involving the hypopharynx, extending from pharyngeal mucosal space to retropharyngeal space, with air tracking in the prevertebral space, likely representing a combination of inflammatory soft tissue edema and phlegmon. No evidence of discrete abscess in retropharyngeal space. Presence of recurrent tumor in the hypopharynx cannot be excluded based on imaging appearance.4. Left pleural effusion.


Instruction: Generate impression based on findings.

Input: Newly diagnosed oral tongue squamous cell carcinoma: right middle tongue tumor, leukoplakia on right buccal mucosa, odynophagia, otalgia, unintentional weight loss. There is an infiltrative mass in the right oral tongue with extension into the root of the tongue, into the base of tongue, and across the midline. The mass measures up to approximately 5.5 cm. There is a partially cystic right level 2A lymph node that measures 10 x 13mm in axial cross-section. Other lymph nodes in the neck are not particularly enlarged, although a few left suprahyoid lymph nodes appear to be slightly heterogeneous. The salivary glands are unremarkable. There is a fluid level in the right maxillary sinus. There is multilevel degenerative spondylosis. The orbits are unremarkable.

Output: 1. Findings compatible with invasive squamous cell carcinoma the right oral tongue with extension into the root of the tongue, into the base of tongue, and across the midline. 2. A partially cystic right level 2A lymph node likely represents metastatic disease. Other lymph nodes in the neck are not particularly enlarged, although a few left suprahyoid lymph nodes appear to be slightly heterogeneous, which is nonspecific. 3. Findings suggestive of acute sinusitis.


Instruction: Generate impression based on findings.

Input: Ms. Feld is a 54-year-old female with family history of ovarian cancer in mother and breast cancer in maternal grandmother. BRCA1 positive. There is scattered fibroglandular tissue in both breasts. Minimal parenchymal enhancement is noted bilaterally. Very few foci of enhancement are seen in both breasts, stable over multiple prior exams.No abnormal enhancement is seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Female, 66 years old, with low back pain bilateral in the buttocks and hip pain worse on the right. Assess for worsening of lumbar stenosis. A mild levoscoliosis of the lumber spine is demonstrated. A trace retrolisthesis of L2 relative to L3, and a grade 1 anterolisthesis of L4 relative to L5 are unchanged.Findings are seen consistent with posterior spinal fusion from L4 through S1.Endplate irregularity and signal abnormality at L2-3 have progressed moderately. Endplate irregularity at L4-5 and L5-S1 have not changed. Otherwise, no evidence of significant marrow signal abnormality is seen.The visualized spinal cord and conus are within normal limits. Details of the cauda equina will be discussed by level as follows:T12-L1: Left facet hypertrophy. Mild bulging disk. No significant generalized spinal canal stenosis. Mild left foraminal narrowing. No significant interval changes.L1-2: Mild facet hypertrophy and ligamentum flavum thickening. Mild bulging disk. No significant generalized spinal canal stenosis. Mild left foraminal narrowing. No significant interval changes.L2-3: Moderate facet hypertrophy and ligamentum flavum thickening. Moderate bulging disk. Superimposed right foraminal and far lateral protrusion, the far lateral component of which has increased in size. Superimposed left paracentral inferiorly directed extrusion which is unchanged. Moderate to severe generalized spinal canal stenosis with crowding of the cauda equina, unchanged. Severe bilateral foraminal narrowing, unchanged. L3-4: Mild facet hypertrophy. Minimal bulging disk. No significant generalized spinal canal stenosis. Moderate bilateral foraminal narrowing. No significant interval changes.L4-5: Moderate facet hypertrophy. Disk uncovering and disk bulging, asymmetric to the right. No significant generalized spinal canal stenosis. Assessment of the foramina is compromised by metallic artifact. Otherwise, no significant interval changes.L5-S1: Facet hypertrophy. Moderate bulging disk with a superimposed right foraminal protrusion. No significant generalized spinal canal stenosis. Assessment of the foramen is somewhat compromised by metallic artifact, but severe bilateral foraminal narrowing is suspected and probably hasn't significantly changed. No other significant interval changes.

Output: 1. Redemonstration of postoperative findings compatible with posterior spinal fusion from L4 through S1.2. Progression of endplate degeneration at L2-3. Disk bulging and a superimposed left paracentral extrusion at this level are unchanged. A right far lateral extrusion at this level has increased in size. Moderate to severe generalized spinal canal stenosis and severe bilateral foraminal stenoses are unchanged.3. Degenerative findings at other levels are not significantly changed.


Instruction: Generate impression based on findings.

Input: Diagnosis: Radiculopathy, lumbar regionClinical question: Evaluate for disc herniation or spinal stenosis at L1-L2 or L2-L3 in patient with recurrent right back and hip painSigns and Symptoms: right lower back and right hip pain Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is a moderate degree of facet hypertrophy at this level associated with some ligamentum flavum hypertrophy. This was also present on the prior exam.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is a mild degree of facet and ligamentum flavum hypertrophy at this level which was also present on the prior examAt L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: No compromise to lumbar spinal canal or neural foramina. There are mild degenerative changes present in the lower lumbar spine which have not changed substantially since the prior exam.


Instruction: Generate impression based on findings.

Input: Multiple myeloma patient on clinical drug trial with increasing hip pain, specifically left-sided lately. Evaluate for further degenerative changes versus myeloma lesions. The vertebral column alignment is within normal limits. There is significant central compression spanning nearly the full height of the L4 vertebral body centrally, but less severely laterally, similar to PET/CT of 1/2/2015. The disc space heights are preserved. The vertebral bone marrow signal is mildly heterogeneous, but without discrete lesion. There is no significant spinal canal stenosis. The distal spinal cord and conus are within normal limits with the conus terminating at the L2 level. There is no abnormal enhancement. The paravertebral soft tissues are unremarkable. There are small bilateral renal cysts.T12-L1: No significant disc bulge, spinal canal or foraminal stenosis. L1-L2: Tiny right paracentral disc protrusion, bilateral facet degeneration and thickening of the ligamentum flavum. No significant spinal canal or foraminal stenosis. L2-L3: Mild disc bulge asymmetric to the left, bilateral facet degeneration and thickening of the ligamentum flavum, contributing to mild left foraminal narrowing. No significant spinal canal stenosis. L3-L4: Disc bulge, bilateral facet degeneration and thickening of the ligamentum flavum, contributing to mild indentation of the ventral thecal sac and mild bilateral foraminal stenosis. No significant spinal canal stenosis. L4-L5: Mild disc bulge, bilateral facet degeneration and thickening of the ligamentum flavum, contributing to mild bilateral foraminal narrowing. No significant spinal canal stenosis. L5-S1: Disc bulge with annular fissure, bilateral facet degeneration and thickening of the ligamentum flavum, contributing to mild right and mild to moderate left foraminal stenosis. No significant spinal canal stenosis.

Output: 1. No significant interval change in the L4 compression fracture compared to the PET/CT of 1/2/2015. 2. No evidence of myelomatous disease.3. Mild to moderate degenerative changes of the lumbar spine as described above, most prominent at L3-4, with mild indentation of the ventral thecal sac and mild bilateral foraminal stenosis. No significant spinal canal stenosis.


Instruction: Generate impression based on findings.

Input: Female, 13 years old, with high-grade glioma status post relapse, currently on bevacizumab. Again seen are the sequelae of treated tumor within the left parietal operculum. Encephalomalacia with hemosiderin staining, wispy T1 hyperintensity and minimal if any superimposed enhancement is unchanged. Ill-defined T2 hyperintensity surrounding this lesion has not significantly expanded.Also redemonstrated is evidence of treated recurrent tumor in the left frontal lobe. The parenchyma here is also mildly encephalomalacic with stable ill-defined T2 hyperintensity in the white matter.New from the prior examination is an area of subcortical T2 hyperintensity involving the paramedian left superior frontal gyrus (image 21 series 501). This lesion is nonenhancing and shows no evidence of restricted diffusion. No convincing elevated rCBV is seen, though the area is difficult to evaluate with the presence of sulcal vascularity.T2 hyperintensity within the left genu of corpus callosum is unchanged. Ill-defined nonenhancing signal abnormality spanning the corpus callosum body, however, is more prominent. A few scattered foci of susceptibility within the cerebral hemispheres bilaterally are unchanged and likely reflect the effects of prior therapy. No new enhancing lesions are seen. No evidence of significant new mass effect is detected. Ventricles are stable in size and morphology including ex vacuo dilatation of the left ventricular atrium.

Output: 1.Stable treated disease in the left parietal operculum and left anterior frontal lobe.2.New nonenhancing signal abnormality is evident within the paramedian left superior frontal gyrus, and within the body of the corpus callosum. Findings are nonspecific and could represent treatment-related change, but the pattern is similar to that of the patient's prior instance of progression, and as such, continued disease progression is of concern.


Instruction: Generate impression based on findings.

Input: Status post radical prostatectomy in 2009 now with detectable PSA. PELVIS:PROSTATE: Status post prostatectomy. The cystourethral junction is well-visualized without evidence of recurrence. The prostatectomy bed is unremarkable.BLADDER: No significant abnormality noted.LYMPH NODES: Subcentimeter nonspecific left inguinal lymph nodes. No pathologically enlarged or enhancing pelvic lymph nodes are evident. BONES, SOFT TISSUES: No enhancing osseous lesion of the imaged pelvis.OTHER: No significant abnormality noted.

Output: No specific findings of recurrence in the prostatectomy bed or pelvis is identified.


Instruction: Generate impression based on findings.

Input: 82-year-old female with a history of a left distal internal carotid artery aneurysm presents with a headache.82-year-old female (DOB: 7/31/1934)Reason: Headache. History: Intracranial aneurysm.PROVIDER/ATTENDING NAME: Robert Mulliken. MRI of the brainNo diffusion weighted abnormalities are appreciated.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. The CSF spaces are appropriate for the patient's stated age with no midline shift. 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:No significant change in the left posterior communicating region internal carotid artery aneurysm which measures up to 4 mm in size (series 301, image 85). No new intracranial aneurysm is identified.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 greater in size than the right. Loss of signal in the distal left vertebral artery is likely artifactual. There is no evidence for cerebrovascular occlusion.The anterior communicating artery is intact. The posterior communicating arteries are intact.

Output: 1. No significant change in 4 mm left posterior communicating region internal carotid artery aneurysm.2. There is no evidence for acute ischemic cerebral infarction or hemorrhage.3. There is no evidence for extracranial or intracranial cerebrovascular occlusive disease.4. Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: Female 50 years old Reason: abnormal mri, monitoring pancreatic mass, History: none ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. Numerous peribiliary cysts are present. There is slightly increased in size and number. There is a central cyst measuring 3 cm which compresses the central ducts with increasing intrahepatic biliary ductal dilatation from prior. Extrahepatic common bile duct is normal in caliber. No definite solid hepatic lesions.SPLEEN: No significant abnormality noted.PANCREAS: There are multiple pancreatic cystic lesions. The largest within the tail measuring 16mm previously , 18 mm. The lesion near the pancreatic head is also not significantly changed.No definite communication can be demonstrated with the adjacent pancreatic duct.ADRENAL GLANDS: Adrenal gland is nodular.KIDNEYS, URETERS: Multiple small bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Severe enlargement of the main pulmonary artery.

Output: 1.Mild progressive increase in the mild intrahepatic biliary ductal dilatation.2.Near stable size measurements of the cystic pancreatic tail lesion.


Instruction: Generate impression based on findings.

Input: There is no evidence of tumors. There is diffuse fatty bone marrow. The cervical spine is in normal alignment. The vertebral body heights are well-maintained. The spinal cord is of normal caliber and signal. At C2-C3, there is no evidence for neural foraminal or spinal stenosis. At C3-C4, there is a small posterior disc osteophyte complex causing mild effacement of the ventral thecal sac without neuroforaminal or spinal canal stenosis. At C4-C5, there is a right paracentral posterior disc osteophyte complex causing moderate right and mild left neuroforaminal stenosis. There is mass effect on the right lateral anterior spinal cord without intrinsic cord signal abnormality. At C5-C6, there is loss of intervertebral disc space with a small posterior disc osteophyte complex, as well as hypertrophy of the ligamentum flavum causing moderate left and mild right neuroforaminal stenosis, as well as mild spinal canal stenosis. At C6-C7, there is loss of intervertebral disc space with a posterior disc osteophyte complex and hypertrophy of the ligamentum flavum causing considerable spinal stenosis at this level without associated cord signal abnormality.C7-T1, there is no evidence for neural foraminal or spinal stenosis.THORACIC SPINE

Output: 1. No gross evidence of multiple myeloma involving the cervical, thoracic, or lumbar spine, although assessment is somewhat limited without intravenous contrast. However, an incompletely imaged left iliac bone mass is compatible with multiple myeloma. Please refer to the separate pelvis MRI report for additional details.2. Multilevel degenerative changes of the cervical spine as well as lumbar spine, with severe spinal stenosis at C6-C7 and moderate spinal stenosis at L3-L4.


Instruction: Generate impression based on findings.

Input: Cirrhosis and ascites. Evaluate for tumor versus bland portal vein thrombus. Outside hospital biopsy revealing hepatocellular carcinoma. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology with left and caudate lobe hypertrophy with a nodular contour.A discrete nodule adjacent to the IVC measures 3.4 x 3.1 cm and demonstrates faint arterial enhancement, washout and capsule formation compatible with hepatocellular carcinoma. Otherwise, the liver is diffusely heterogeneous. No additional discrete arterial enhancing lesion is seen on post contrast images however there are multiple discrete washing out lesions on portal venous and delayed phase imaging involving both the right and left hepatic lobe. Additional some of these lesions have faint T2 weighted hyperintensity, loss of signal on out-of-phase imaging and suggestion of capsule formation. There is a filling defect in the anterior division of the right portal vein. Although there is no vessel expansion or definite enhancement of the thrombus given the suspected extensive disease, tumor thrombus is nevertheless not entirely excluded.Trace perihepatic fluid.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: Lobular right cardiophrenic lymph node measuring 1.3 cm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Cirrhosis with heterogeneous liver appearance. Suspected infiltrative HCC involving the right hepatic lobe and multiple satellite lesions in the left hepatic lobe given the degree of heterogeneity and several well-defined lesions seen on delayed phase imaging with associated faint T2-weighted hyperintensity, intracellular fat and suggestion of capsule formation - although not strictly meeting imaging criteria for HCC; multiple regenerative nodules is possible but less likely. There is a lesion adjacent to the IVC which meets imaging criteria for HCC. Correlate with site of and findings from patient's outside biopsy.2. Thrombus within the anterior division of the right portal vein. No vessel expansion or definite enhancement of the thrombus favors bland thrombus. In the setting of diffuse infiltrative HCC, tumor thrombus is not entirely excluded.


Instruction: Generate impression based on findings.

Input: 55 years Female (DOB:12/27/1960)Reason: back pain History: back painPROVIDER/ATTENDING NAME: DAVID M DICKERSON DAVID M DICKERSON 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 disc desiccation at L3-4 and L4-5.The patient status post lumbar spine surgery with pedicle screws at L5 and S1 associated with interconnecting rods. There is a disc prosthesis present at L5-S1 eccentric to the right side.At L5-S1 there is mild anterior subluxation of L5 on S1. There is disc desiccation and a mild disc bulge at this level. The neural foramina are obscured by metal artifact at this level. There appears to be some encroachment of the right-sided exiting nerve roots.At L4-5 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.The patient is status post L5-S1 surgery with posterior and anterior fusion. There is mild anterior subluxation of L5 on S1 and possible encroachment of the right-sided exiting nerve roots within the neural foramen. The neural foramina are not well evaluated this level due to metal artifact.


Instruction: Generate impression based on findings.

Input: 68 year old female with abdominal pain. Evaluate for colitis, diverticulitis, appendicitis. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Left adrenal mass measures 3 cm in diameter. This may be further characterized with noncontrast CT or MRI examination, if indicated.KIDNEYS, URETERS: Fat stranding surrounding the right kidney. Focal decreased areas of attenuation, especially in the right upper pole and left upper pole regions are most consistent with pyelonephritis. Multiple punctate nonobstructing right renal calculus. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative changes in the lumbosacral spine and pelvis.OTHER: No significant abnormality noted.

Output: Nonenhancing lesions of the renal parenchyma bilaterally are most compatible with pyelonephritis. No hydronephrosis. Nonobstructing right nephrolithiasis. 3-cm diameter left adrenal mass.


Instruction: Generate impression based on findings.

Input: Female, 58 years old, with metastatic lung cancer, surveillance imaging. At the site of the previous small enhancing lesion along the right superior frontal sulcus, only a focus of susceptibility is now evident. No residual enhancement is seen. A nonspecific enhancing focus within the left frontal bone is unchanged.No new pathologic intracranial enhancement is seen. No evidence of parenchymal edema, mass effect or diffusion restriction is detected. Scattered small foci of FLAIR hyperintensity within the cerebral hemispheres are nonspecific and unchanged. Ventricular size and morphology remain within normal limits.

Output: Since the prior examination, enhancement related to the lesion along the right superior frontal sulcus has resolved. There is a small focus of susceptibility at this location. No new intracranial metastases are detected. An enhancing focus within the left frontal lobe is unchanged and nonspecific.


Instruction: Generate impression based on findings.

Input: Male 53 years old Reason: Rectal cancer please assess and evaluae extent of disease prior to start of therapy History: As above Overall image quality: ExcellentPELVIS:PROSTATE/SEMINAL VESICLES: Tumor abuts the posterior aspect of the prostate with loss of normal fat plane. No gross invasion is evident.BLADDER: No significant abnormality noted. LYMPH NODES: Lymph nodes in the perirectal space, within the mesorectal fascia: Scattered small lymph nodes, largest is 5 x 4 mm (series 13, image 25)Lymph nodes outside the mesorectal fascia: Bilateral pelvic sidewall mildly enlarged lymph nodes, on the right there is a node that is 10 x 9 mm (series 11, image 303).BOWEL, MESENTERY: Rectal Tumor:Size: 4.4 x 2.8 x 5.4 cm (image 25/series 7 and image 23/series 6)Tumor appearance on T2-weighted images: Lobulated T2 intermediate signal intensity mass.Tumor location: Lower-third(For lower rectal tumors):Distance of the lower edge of the tumor to the anal verge (lower edge of the anal canal): 3.9 cm.Distance of the lower edge of the tumor to the pelvic floor (relationship of the tumor to the anal sphincter complex): Tumor extends down to the anus at the level of the puborectalis muscle with suspicion for invasion through the external sphincteric complex on the right at the 10 o'clock position (series 6, image 29)Circumference of the rectum involved: Anterior to left rectal wall (10 o'clock to 4 o'clock position).Relationship and proximity of the tumor to adjacent structures (prostate, seminal vesicles): Abuts the posterior aspect of the prostate (series 6, image 25) without evidence of gross invasion.MRI T-stage: T3Tumor Distance to Mesorectal Fascia: Extends to the mesorectal fascia anteriorly and abuts the posterior prostate (image 25/series 6).BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Stage T3 lower rectal cancer extending to the anus with suspicion of invasion of the external sphincteric complex.2. Mildly enlarged extramesorectal lymph nodes, suspicious for local metastases. Additional lymph nodes as described above.


Instruction: Generate impression based on findings.

Input: Pelvic pain for 2 months. Retrocervical mass on outside hospital CT. PELVIS:UTERUS, ADNEXA: The uterus measures 6.7 x 8.2 cm. There are 2 well-defined T2 and T1 weighted hypointense masses dorsal to the uterine body with likely vessels extending from the uterus most suggestive of subserosal fibroids. The largest measures 5.3 x 4.7 cm centered in the rectouterine pouch. The other lesion measures 2.3 x 1.6 cm extending from the left uterine body. Both of these demonstrate gradual avid enhancement.The endometrium/endometrial canal is normal in thickness. Endomyometrium/junctional zone is well-defined and is normal in thickness.The left and right ovary are normal in morphology containing multiple small physiologic follicles.Small nabothian in cysts.A tampon is noted.BLADDER: Normally distended bladder without focal abnormality.LYMPH NODES: Small inguinal and external iliac lymph nodes are likely reactive.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Left lower quadrant subcutaneous fat iatrogenic port-like device.OTHER: No significant abnormality noted.

Output: 1.Two lesions in the pelvic cul-de-sac likely represent subserosal fibroids, the largest of which measures 5.3 x 4.7 cm.2.No additional abnormality.


Instruction: Generate impression based on findings.

Input: 58-year-old male. Prostate cancer research exam. Staging exam. PELVIS:PROSTATE:Prostate Size: 3.8 x 4.8 x 4.2 cm.Peripheral Zone: T2 hypointensity and diffusion restriction bilaterally that is diffuse in the base and predominately medial in the mid to the apex of the prostate, consistent with prostate carcinoma. There is also a 9 by 6-mm focus anteriorly on the right side of the urethra at the level of the apex which abuts the capsule anteriorly.Central Gland: No significant abnormality noted.Seminal Vesicles: No evidence of invasion.Extracapsular Extension: Signal abnormality at the base bilaterally contacts greater than 1 cm of the capsule, without any definite evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Prostate carcinoma from the base to the apex bilaterally.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Evaluate ventricle size. Hydrocephalus. There is a large infratentorial cystic mass posterior and superior to the cerebellar hemispheres causing mass effect on the cerebellum and the frontal lobes. The fourth ventricle is enlarged with altered configuration. The lateral and third ventricles appear normal in size. An MRI is recommended for further evaluation.There is no evidence of intracranial hemorrhage. There are questionable foci of hypodensity in the left cerebellar hemisphere of unclear clinical significance.A shunt catheter traverses the right parietal bone and with its tip located in the large cystic infratentorial mass.The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Large cystic mass posterior and superior to the cerebellar hemispheres causing mass effect with enlargement of the fourth ventricle. Shunt catheter tip is within the cystic mass. An MRI is recommended for further evaluation.


Instruction: Generate impression based on findings.

Input: Metastatic breast cancer needs evaluation per IRB 14-0701. There is a heterogeneously enhancing mass in the right perirolandic region that measures up to 25 mm. There is associated vasogenic edema and mild regional mass effect. There is also an area of susceptibility effect within the mass that has a configuration suggestive of an underlying developmental venous anomaly, although this could alternatively represent intratumoral hemorrhage or calcification. There is also enhancing lesions in the left occipital lobe that measures up to 5 mm. There is a background of mild cerebral white matter T2 hyperintensity, which may represent chronic small vessel ischemic disease. There is no evidence of acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable.

Output: Enhancing lesions within the right perirolandic region and left occipital lobe likely represent metastatic disease to the sulci may suggest normal pressure hydrocephalus.


Instruction: Generate impression based on findings.

Input: Demyelinating disease. Paresthesias. Cervical: Examination is significantly motion degraded despite repeating multiple sequences. There is a definite T2 hyperintense lesion in the cord at the right dorsal C2 level. T2 hyperintense lesion also suspected involving the dorsal mid C4 level in the midline as well as a ventral midline C4-C5 lesion seen only on the axial T2 sequence. There is also a questionable midline ventral lesion at the C7-T1 level seen only on the axial T2 sequence. There is also a questionable left ventral C7 lesion seen only on the axial proton density sequence. Cord volume is maintained.Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is grossly maintained aside from mild straightening. Bone marrow signal is benign.Degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: Small left paracentral and foraminal disc osteophyte complex. No significant spinal canal stenosis. Neural foramina are also patent. C4-5: No significant compromise to the spinal canal or neural foramina.C5-6: Small disc extrusion with partial effacement of the ventral thecal sac. Overall no significant spinal canal or neural foraminal stenosis.C6-7: No significant compromise to the spinal canal or neural foramina.C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.Thoracic: Motion degradation on the thoracic sequences limits sensitivity for small lesions. No definite lesion in the thoracic cord is definitively appreciated. Cord volume is maintained. Vertebral body heights and alignment are maintained. Bone marrow signal is benign. There is no significant spinal canal or neural foraminal stenosis at any level.

Output: 1. There is a T2 hyperintense lesion involving the right dorsal C2 level consistent with known demyelinating disease. Multiple additional small lesions are also suspected in the cervical cord, particularly on the axial T2 sequence, as described above but are difficult to confirm due to motion degradation on multiple sequences.2. No lesions in the thoracic cord are definitively appreciated within the limits of motion degradation, which limits sensitivity to small lesions.


Instruction: Generate impression based on findings.

Input: Metastatic base of tongue squamous cell carcinoma, treated with pembrolizumab, palliative RT to left orbit, and started palliative carbo/paclitaxel/cetuximab. The left cerebellar tonsil lesion is now less conspicuous. However, there are now several new and/or more conspicuous, but subcentimeter lesions elsewhere in the bilateral cerebellar hemispheres and right anterior frontal lobe, without discernible vasogenic edema. The left posterior globe lesion is no longer discernible. There is no evidence of acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull and scalp soft tissues are grossly unremarkable. There is a left maxillary sinus retention cyst.

Output: 1. Interval evolution of the subcentimeter left cerebellar tonsil metastasis, likely due to treatment effects. However, there are now several new and/or more conspicuous, but subcentimeter lesions in the bilateral cerebellar hemispheres and right anterior frontal lobe, which may represent additional metastases.2. The left ocular metastasis is no longer discernible.


Instruction: Generate impression based on findings.

Input: 57-year-old male with left pontine hemorrhagic lesion on previous brain MRI, evaluate for interval change Redemonstrated is a small focus of T2 hyperintensity is evident within the left aspect of the pons with associated mild susceptibility artifact. No significant edema or mass effect is seen. These findings are unchanged.Elsewhere in the brain there are several additional scattered small foci of nonspecific T2 hyperintensity within the periventricular and subcortical white matter. No restricted diffusion is seen. No mass effect or parenchymal edema is demonstrated. These foci are stable in appearance.No evidence of acute intracranial hemorrhage or any pathologic extra-axial fluid collection is detected. The ventricles are normal in size and morphology. The major intracranial flow voids are visualized.Bone marrow signal characteristics are unremarkable. Sphenoid sinus mucosal inflammatory findings are again demonstrated.

Output: 1.Stable small lesion within the left aspect of the pons with findings suggestive of associated blood products. The differential diagnosis would include a chronic small vessel stroke, old small hypertensive hemorrhage, or even a small vascular lesion such as a cavernoma. 2.Stable scattered small nonspecific white matter lesions which most likely represent mild chronic microvascular disease.


Instruction: Generate impression based on findings.

Input: Other cervical disc degeneration, unspecified cervical region [M50.30], Reason for Study: ^Reason: Progression of DDD, foraminal stenosis, spinal stenosis History: Cervical radiculopathy in C5-6 distribution The examination was discontinued due to patient's pain.Thus, only T1 and T2 weighted sagittal scans were obtained.At the level of C5-C6 and C6-C7, decreased intervertebral disc heights and diffuse bulging of discs are seen which abuts thecal sac. However, there is no MR evidence of direct compression of the spinal cord. There is also evidence of ligamentum flavum thickening at those levels result mild spinal canal stenosis. Comparing to prior scan, there is no significant interval change since prior scan. The cervical spine appears to be slightly straightened reducing normal lordosis. The cranial-cervical junction is normal. Spinal cord signal intensity is normal.The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The cord signal is normal.

Output: 1. Incomplete cervical spine MRI scan due to patient's pain.2. Degenerative changes are seen at the level of C56 and C67 including diffuse disc bulge and mild spinal canal stenosis. No significant interval change since prior scan.3. Normal spinal cord signal intensity.


Instruction: Generate impression based on findings.

Input: 40-year-old male with a history of a meningioma. Evaluate for interval change to the meningioma. Redemonstrated within the right frontal convexity is a dural based extra-axial homogeneously enhancing mass measuring 10 x 11 mm which is not significantly changed compared to the prior exam from 4/16/2016 where it measured 9 x 11 mm. The differences in measurement are likely secondary to differences in image acquisition technique. For instance, on the prior MRI brain exam, only the central component of the mass was visualized on coronal images, and therefore comparison of CC measurements are inaccurate. There is a small lobulated component which extends into the overlying diploic space. 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: Overall stable right frontal convexity dural based enhancing extra-axial mass, most likely representing a meningioma which minimally extends into the overlying calvarium perhaps along an area of developmentally irregular inner table contour.


Instruction: Generate impression based on findings.

Input: 55-year-old female with low back pain and left hip pain The density and the alignment the vertebral column remains within normal limits. No significant degenerative disk disease is identified. There is however mild degree of degenerative disease at L5 -- S1 level. No evidence of spinal stenosis at any level.No evidence of central spinal stenosis or neural foramina compromise from T12 -- L1 through L3 -- L4 level.L4 -- L5.Minimal degenerative disk disease and hypertrophic changes of posterior elements are noted. Minimal bulge of disk material is present. Laterally within the neural foramina and far laterally there is broad-based bulge of disk material and a more focal area of disk protrusion. This is highly suspected of a large herniated disk. This finding is best appreciated on axial image 57 and 58. Lateral to the disk a prominent soft tissue density (axial image 55) is identified. This finding may represent inflamed and swollen nerve root or a migrated disk fragment laterally. I recommend further evaluation with an MRI examination or a post infusion study to exclude possibility of a mass. There is only minimal compromise of the left neuroforamina secondary to above findings. The right neuroforamina is patent and no central spinal stenosis is detected.L5 -- S1.Moderate degree of degenerative disk disease with a sclerotic changes of endplates are noted. No central spinal stenosis or neural foramina compromise. Mild bulge of disk material is also present.

Output: 1.Suspected large herniated disk at L4 -- L5 laterally and far laterally as detailed.2.Prominent soft tissue density adjacent to the disk at this same location may be represent a swollen nerve root or a mass. Further evaluation with a dedicated post infused MRI or a post infusion CT to exclude presence of the mass is recommended.3.No evidence of central spinal stenosis or neural foramina compromise at any other level.


Instruction: Generate impression based on findings.

Input: 71 year old man with history of CAD with known occlusion of the RCA, LV dysfunction, previous stroke, hypertension and peripheral arterial disease referred for cardiac MRI to evaluate cardiac function and assess for scar. Left VentricleThe left ventricle is mildly dilated with moderate-severely reduced systolic function. The overall LV ejection fraction is 35%, the LV end diastolic volume index is 114 ml/m2 (normal range: 74+/-15), the LVEDV is 221 ml (normal range 142+/-34), the LV end systolic volume index is 75 ml/m2 (normal range 25+/-9), the LVESV is 145 ml (normal range 47+/-19), the LV mass index is 82 g/m2 (normal range 85+/-15), and the LV mass is 159 g (normal range 164+/-36). There is an irregularity in the basal anterior wall which resembles an outpouching. In this same area there is hypokinesis of the mid anterior wall. The native T1 relaxation time is elevated at 1100ms, which may represent an element of diffuse fibrosis. There is a very small area of late gadolinium enhancement in the apical inferolateral wall which is transmural, and is suggestive of previous infarction. The remainder of the myocardium is viable.Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 53%, the RV end diastolic volume index is 63 ml/m2 (normal range 82+/-16), the RVEDV is 122 ml (normal range 142+/-31), the RV end systolic volume index is 30 ml/m2 (normal range 31+/-9), and the RVESV is 58 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Mildly dilated LV with moderate-severely reduced function (EF 35%). 2. There is an irregularity in the basal anterior wall which resembles an outpouching. In this same area there is hypokinesis of the mid anterior wall.3. There is a very small area of late gadolinium enhancement in the apical inferolateral wall which is transmural, and is suggestive of previous infarction. The remainder of the myocardium is viable.4. Normal size RV with normal systolic function (EF 53%). 5. Mild biatrial dilation. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 61-year-old man with history of pancreatic and hepatic cysts. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in size and morphology. There are numerous simple hepatic cysts again noted and unchanged in size. Of these, a few appear to be hemorrhagic with high T1 signal (13/69), but do not enhance. The large complex cystic lesion with heterogeneous internal T1 and T2 signal (7/36) measures 107 x 98 mm, previously 125 x 115 mm. On postcontrast imaging, there is no internal enhancement. This lesion causes mild local mass effect on the adjacent duodenum and common bile duct, however there is no biliary obstruction or biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: The multiloculated cystic lesion in the tail of the pancreas (500/30) measures 57 x 28 mm, previously 59 x 36 mm. Indication of the pancreatic duct is not clearly visualized. The remaining pancreatic parenchyma appears normal.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Small ventral hernia.OTHER: No significant abnormality noted.

Output: 1.Complex cystic lesion of the liver continues to decrease in size, possibly representing a large complex cyst or biliary hamartoma.2.Multiple additional liver cysts unchanged with benign characteristics.3.Stable cystic lesion in the pancreatic tail, likely a side branch IPMN or a serous cystadenoma.


Instruction: Generate impression based on findings.

Input: Left shoulder pain and limited range of motion The examination is limited by motion artifact.ROTATOR CUFF: There is mild increased signal intensity along the myotendinous junction of the supraspinatus tendon indicating mild tendinosis or strain. There is also mild increased signal intensity along the bursal surface of the distal insertional fibers which may represent mild fraying however we see no discrete rotator cuff tear. The infraspinatus tendon appears normal with small cysts noted in the underlying humeral head which are of doubtful clinical significance. The teres minor tendon and muscle are normal. The subscapularis tendon demonstrates mild undersurface fraying distally without a discrete tear. The subscapularis muscle is normal.SUPRASPINATUS OUTLET: Mild osteoarthritis affects the acromioclavicular joint and a small amount of fluid is noted within the subacromial/subdeltoid bursa which is of questionable clinical significance.GLENOHUMERAL JOINT AND GLENOID LABRUM: Within the limits of this non-arthrographic study, we see no labral tear. A small amount of fluid is noted within the glenohumeral joint but there is no large effusion.BICEPS TENDON: No significant abnormality noted.

Output: 1. Mild rotator cuff tendinosis as described above with questionable mild strain of the supraspinatus tendon. We see no frank rotator cuff tear.2. Mild osteoarthritis of the acromioclavicular joint with other findings described above.


Instruction: Generate impression based on findings.

Input: Male, 83 years old, with apraxic gait. A 4 mm focus of restricted diffusion is seen within the left cerebellum. No other areas of diffusion restriction, edema or mass effect are detected. Confluent and patchy periventricular FLAIR hyperintensity is demonstrated. No evidence of acute intracranial hemorrhage or any abnormal extra-axial fluid collection is seen. A punctate focus of susceptibility along the left lateral ventricular margin may represent chronic microhemorrhage or mineralization. On postcontrast images, no pathologic parenchymal or extra-axial enhancement is observed.

Output: 1.A 4 mm focus of acute ischemia is seen within the left cerebellum. No other acute lesions are identified.2.Findings are seen compatible with moderately advanced small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: 65-year-old female with transaminitis. ABDOMEN:LIVER, BILIARY TRACT: Distended gallbladder containing numerous stones with minimal wall thickening and trace pericholecystic fluid.The distal common bile duct measures 6.6 mm in diameter and is at the upper limits of normal in diameter. No intra or extra hepatic biliary ductal dilatation, and no filling defects identified. Hepatic contour with a subtle nodular appearance and mild widening of the fissures. No evidence for hepatic steatosis. No areas of restricted diffusion.SPLEEN: Borderline splenomegaly measuring 13 cm in craniocaudal length.PANCREAS: Parenchymal atrophy. No pancreatic ductal dilatation.ADRENAL GLANDS: A left adrenal nodule measures 1.7 cm in transverse diameter, and there is no change in size compared to the 1/15/2015 CT exam. No evidence of signal dropout on the out of phase sequence. Normal right adrenal gland.KIDNEYS, URETERS: Bilateral nephrostomy catheters in place. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: Stable small left retroperitoneal lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Partially visualized L4 pedicle screws.OTHER: No significant abnormality noted.

Output: 1.Distended gallbladder containing stones, borderline wall thickening, and trace pericholecystic fluid. Early acute cholecystitis cannot be excluded.2.MR findings suggestive of chronic liver disease. No hepatic steatosis.3.Indeterminate left adrenal nodule, however size stability is noted since the 1/5/2015 CT exam.


Instruction: Generate impression based on findings.

Input: 47-year-old female with a history of bilateral mastectomies with bilateral implant reconstruction for right breast cancer on 12/18/2013 at an outside institution. She underwent revision of reconstructed breasts and implant exchange in 12/16/2014. Currently, she has a palpable concern at lower inner quadrant of the right reconstructed breast. Status post bilateral mastectomies with bilateral retropectoral silicone implants. On T2 weighted images, post-operative scar is present at lower inner quadrant in the right reconstructed breast.No abnormal enhancement is seen in either reconstructed breast, including the area of palpable concern (lower inner quadrant of the right reconstructed breast). No abnormal lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: 28 years, Female, Reason: 28 yo female with cystic mesenteric mass; please evaluate for any abnormalities History: cystic mesenteric mass. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, 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: Mesenteric fluid containing lesion with thin walls is now positioned more inferiorly within the left lower quadrant and measures 6.0 x 2.7 x 8.0 cm (11/45 and 5/9), unchanged in size. There are no solid enhancing components or other suspicious features.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small amount of free fluid in the pelvis is likely physiologic.

Output: Mesenteric cyst without suspicious features, likely a lymphangioma, enteric cyst or other benign mesenteric cystic lesion.


Instruction: Generate impression based on findings.

Input: Left big toe numbness, dorsum. Nerve entrapment? There is mild nonenhancing edema within the subcutaneous fat dorsal to the bases of the third and fourth metatarsals extending into the midfoot, but I see no mass or other findings to that would cause nerve entrapment or otherwise result in the patient's symptoms of dorsal big toe numbness. There is mild enhancement at the insertion of the anterior tibialis tendon on the which may reflect a mild enthesitis, but this is of questionable clinical significance. Mild osteoarthritis affects the first metatarsophalangeal joint, but the great toe is otherwise normal. There is a bipartite medial sesamoid bone beneath the first metatarsal head, a normal variant. Mild osteoarthritis also affects the first tarsometatarsal joint. The lesser toes are unremarkable. I see no findings to suggest a stress fracture. The musculature of the foot is normal.

Output: Minimal dorsal subcutaneous edema, mild osteoarthritis, and possible mild enthesitis at the tibialis anterior insertion, but I see no mass or other specific findings to account for the patient's left big toe numbness.


Instruction: Generate impression based on findings.

Input: H/o unknown primary with widely metastasis. Examination demonstrates diffuse bony destruction in the thoracic and lumbar spine as well as sacrum with loss of vertebral body height in T2, T12, L1 and L2. It appears that the spinal canal narrows at Levels T2 and L1. Please refer to spine MRI for details of cord compression. Specifically, there is bony destruction in the C7, T1-7, T9-L3, and L5 vertebral bodies and sacrum, in which posterior element destruction is seen in the C7-T3, T12-L3 and L5, and rib destruction is seen at levels T1-T3 and T7. Bilateral effusion is also noted.

Output: Diffuse metastatic disease in the thoracic and lumbar spine as detailed above. spinal canal stenosis at levels T2 and L1, please refer to spine MRI for details of cord compression.