Instruction: Generate impression based on findings.

Input: Female, 28 years old, with low back pain. Spinal alignment is anatomic. Vertebral body morphology is normal. No areas of concerning marrow replacement or marrow edema are seen.The visualized spinal cord, conus and nerve roots of the cauda equina are unremarkable.The intervertebral disks are normal in height and signal characteristics. At most, there may be mild bulging of the L5-S1 disk. No significant spinal canal or neuroforaminal stenosis is detected.

Output: No specific findings are seen to account for the patient's low-back pain.


Instruction: Generate impression based on findings.

Input: 9-year-old male patient with history of knee injury. MENISCI: The lateral and medial menisci are intact.ARTICULAR CARTILAGE AND BONE: No focal chondral defect.LIGAMENTS: The anterior cruciate ligament, posterior cruciate alignment, medial collateral ligament, lateral collateral ligament complex, and patellar retinacula are intact.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: Findings compatible with a Morel Lavallee lesion in the medial left knee.


Instruction: Generate impression based on findings.

Input: Right face and arm weakness/numbness, evaluate for stroke There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears unremarkable. There is no abnormal intracranial enhancement. There is a partially empty sella. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. No evidence of intracranial hemorrhage, mass, or acute infarct. 2. A partially empty sella can be a manifestation of pseudotumor cerebri. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Reason: Pt with bordeline resectable HOP cancer. Pt has been on Folfirinox. Had restaging Ct Scan on 4/28/15.. Pt has a segment 7 liver lesion. Please evalaute prior to a whipple surgery History: weight loss. ABDOMEN:LIVER, BILIARY TRACT: Common bile duct stent in place. No intrahepatic or extrahepatic biliary ductal dilatation. Previously identified segment 7 subcentimeter lesion is seen on image 35, series #8. The lesion measures 3 mm in diameter. There is a second similar lesion in segment 7, best seen on image #29, series #8 measuring 3 mm. These lesions are best seen on pre and postcontrast T1-weighted images. These are too small to accurately characterize, however, they do not demonstrate rim enhancement. SPLEEN: No significant abnormality noted.PANCREAS: Hypoenhancing pancreatic head mass is unchanged, measuring approximately 4.1 x 3.3 cm (series 106 image 55). Abutment of the portal vein and SMV again noted. No pancreatic ductal dilatation. Enlarged portacaval lymph node is unchanged, measuring 1.7 x 1.4 cm (series 10 image 151). The mass invades the antrum.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Stable pancreatic head mass invading the stomach compatible with history of pancreatic cancer and regional lymphadenopathy.2.Two subcentimeter lesions measuring 3 mm in segment 7 of the liver. They cannot be accurately characterized, however, no evidence of peripheral rim enhancement to make them suspicious for metastatic disease.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 87-year-old female patient with low back pain, radiation to thighs, compression fracture of L1. Five lumbar type vertebral bodies are presumed to be present. There is a compression deformity of the L1 vertebral body with approximately 50% loss of height with corresponding low T1 signal and increased signal on STIR imaging compatible with edema. There is multilevel degenerative disc disease with disc desiccation and loss of the disc space most predominantly affecting L3/L4 and L4/L5. There is no significant spondylolisthesis. The conus medullaris is normal in position, terminating at the level of L1/L2.Multilevel degenerative changes are seen, as described below:T12-L1: There is 6 mm of retropulsion of bone into the spinal canal secondary to compression fracture without significant central canal stenosis or spinal cord or neural foraminal stenosis.L1-L2: No significant spinal canal or neuroforaminal stenosis.L2-L3: Bilateral ligamentum flavum hypertrophy without significant spinal canal or neuroforaminal stenosis. L3-L4: Bilateral ligamentum flavum hypertrophy and moderate disc bulge contribute to mild spinal canal stenosis and mild bilateral neural foraminal stenosis. L4-L5: Bilateral ligamentum flavum hypertrophy and moderate disc bulge contribute to mild spinal canal stenosis and mild bilateral neural foraminal stenosis.L5-S1: No spinal spinal canal or neural foraminal stenosis.

Output: 1. Subacute compression deformity of the L1 vertebral body with 6 mm of retropulsion, but no spinal conus medullaris compression.2. Multilevel spondylitic changes of the lumbar spine, particularly at L3/L4 and L4/L5 with mild spinal canal and neural foraminal stenosis. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 47-year-old BRCA mutation carrier presents for MRI screening study. History of bilateral breast cancer status post right lumpectomy in 2003 for invasive ductal carcinoma and left lumpectomy in May 2012 for invasive ductal carcinoma. Patient received radiation and chemotherapy. Family history of breast cancer in two sisters, maternal grandmother, maternal aunt and cousin. No current breast related complaints. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.Stable post-surgical changes in both breasts, and stable fibroadenolipoma in the left breast.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Cognitive decline, please assess for volume loss, CVD: memory loss. There is disproportionate prominence of the third and lateral ventricles with a substantial CSF flow jet within the third ventricle. There appears to be a rounded subcentimeter area of CSF signal in the right anterior portion of the third ventricle that appears to be sharply demarcated from the CSF flow artifact. In addition, there is disproportionate volume loss affecting the medial temporal lobes bilaterally. There is mild periventricular white matter T2 hyperintensity. There is a relatively hypoenhancing lesion in the right pituitary lobe that measures up to 14 mm in craniocaudal dimension, without evidence of mass effect upon the optic apparatus. There is no evidence of intracranial hemorrhage or acute cerebral infarction. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. Findings suggestive of Alzheimer's disease perhaps with superimposed normal pressure hydrocephalus.2. A lesion in the pituitary gland likely represents a macroadenoma.3. An apparent rounded subcentimeter area of CSF signal in the right anterior portion of the third ventricle that appears to be sharply demarcated from the CSF flow artifact, may be an artifact itself versus an arachnoid cyst or colloid cyst. If necessary, follow up with DRIVE or FIESTA sequences through this region may be useful for further elucidation.4. No evidence of acute intracranial hemorrhage or acute cerebral infraction.Discussed with Dr. Mastrianni at 1:30 PM on 3/26/15.


Instruction: Generate impression based on findings.

Input: 36-year-old female status post bleach ingestion, aspiration, ARDS, prolonged intubation, sedation, paralysis. Now awake, extubated, alert with right-sided upper and lower extremity weakness. Anticoagulated for PE. Please evaluate for ischemic change. There is no evidence of intracranial hemorrhage, mass or edema. Focus of hypodensity within the left internal capsule and thalamus suspicious for acute ischemia. MRI is recommended for further evaluation, if clinically warranted.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized mastoid air cells are normally pneumatized. Bilateral maxillary sinuses demonstrate layering fluid which may be due to acute sinus disease. The remainder of the paranasal sinuses are normally pneumatized.

Output: Hypodensity within the right thalamic and internal capsule region suspicious for stroke. MRI is recommended for further evaluation, if clinically warranted.


Instruction: Generate impression based on findings.

Input: Deviated nasal septum. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma, cerebellum, brainstem, and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is slight deviation of the nasal septum to the left. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. No evidence of acute intracranial hemorrhage, mass, or acute infarct.2. Slight deviation of the nasal septum to the left.


Instruction: Generate impression based on findings.

Input: 21 year old male with a diagnosis of Von Hippel-Lindau disease; history of 6 small asymptomatic brain hemangioblastomas, evaluate for growth and new lesions. BrainAgain visible are changes of a prior suboccipital craniotomy. There are at least three new suspicious areas of nodularity compared to the prior exam, although there was extensive motion degradation on the prior exam, limiting direct comparison. Just medial to a previously seen lesion in the right paramedian cerebellum is a smaller lesion which is now more conspicuous and not definitively present prior to Jan 2015 (series 4500, image 52). An additional new punctate left mid-superior cerebellar lesion is seen (series 4500, image 54). Finally there is suspicion of a new punctate left medial superior cerebellar peduncle lesion (series 4500, image 53).The enhancing nodule along the midline dorsal medulla at the level of the foramen magnum, measures 6 x 6 mm and is unchanged in size compared to the prior exam but has had a gradual increase in size since the baseline exam from 9/10/2012. The additional previously described small enhancing nodules in the bilateral cerebellar hemispheres are again seen. No lesions within the supratentorial brain are appreciated. No evidence of acute ischemia or hemorrhage. The ventricles and basal cisterns are normal in size and configuration. The expected intracranial vascular flow voids are present.Interval development of diffuse paranasal sinus mucosal thickening and opacification most prominently involving the bilateral maxillary and sphenoid sinuses as well as the ethmoid air cells. There is mild mucosal thickening involving the frontal sinuses and scattered mastoid air cell opacities bilaterally. The calvarium and extracranial soft tissues are grossly unremarkable.Cervical spine: Redemonstration of an intramedullary lesion in the posterior cervical cord at the C4 level which measures 9 mm in maximum dimension and is not significantly changed. There is equivocal slight cranial extent of the surrounding upper cervical spine STIR hyperintense edema, on axial images more along the right aspect of the central cord. Otherwise, the edema pattern is not significantly changed.The vertebral body and intervertebral disc heights are maintained. Straightening of the cervical lordosis is seen, alignment is otherwise maintained. No suspicious bone marrow signal abnormalities. No new cervical cord lesion. No disc bulges, neural foraminal stenosis, or spinal canal stenoses in the cervical spine. Thoracic spine:Redemonstrated are enhancing lesions in the right posterior cord at the T4 level measures 7 mm, unchanged. An additional lesion in the right posterior cord at the T6 level measures 6 mm, and is unchanged on re-measurement compared to the prior exam. These lesions are associated with mild cord edema appearing similar to prior.There is stable mild straightening of the thoracic spine. Mild endplate irregularity which was also previously present from T9 through L1 with mild wedging deformities of the T10 and 11 vertebral bodies are unchanged. No evidence of acute fracture. There is no significant disc bulge, spinal canal stenosis, or neuroforaminal narrowing. Lumbar Spine:The lumbar spine alignment is anatomic, and the vertebral body and intravertebral disc heights are maintained. No bone marrow signal abnormalities. No enhancing masses are noted in the conus or cauda equina. There is no significant disc bulge, spinal canal stenosis, or neuroforaminal narrowing. The paraspinal soft tissues and partially visible intra-abdominal contents are unremarkable.

Output: 1.At least three new suspicious areas of nodularity in the cerebellum compared to the prior exam, although note that the prior exam was limited by motion.2.Dorsal medullary nodule stable from recent comparisons although progressed since baseline exam.3.The additional previously characterized enhancing lesions in the bilateral cerebellar hemispheres, cervical spinal cord, and thoracic spinal cord are unchanged.4.There is equivocal slight cranial extension of the upper cervical spinal cord edema more along the right aspect of the cord, versus artifact, which would warrant close attention on follow up exams. The remainder of the edema pattern in the cerebellum and elsewhere in the spine is stable.5.Findings indicating acute pan-sinusitis, new since the prior exam. Please correlate clinically.


Instruction: Generate impression based on findings.

Input: persistent symptom of dizziness, history of seizure and VP shunt. No evidence of acute ischemic or hemorrhagic lesion on this scan.VP shunt inserted via right posterior temporal lobe and the tip is located right lateral ventricle frontal horn area. Especially on the right temporal approached through the right parietal white matter, VP shunt track shows high signal intensity on FLAIR indicating localized encephalomalcia through the VP shunt track.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, 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.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal distal ICAs, MCAs, and ACAs.Acom artery is patent but bilateral Pcom arteries are not seen. Vertebrobasilar system appears to be normal.There is no evidence of intracranial arterial aneurysm or arterial luminal stenosis.3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The vertebral artery origins are normal. There is normal flow enhancement through the bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion on this scan.2. Ventriculostomy tube through the right posterior temporal lobe via parietal white matter and located in the right lateral ventricle. No significant interval change since prior exam.3. Normal brain MRA and neck MRA.


Instruction: Generate impression based on findings.

Input: 64-year-old female patient status post Whipple for IPMN in April 2014. Evaluate for recurrence or metastatic disease. ABDOMEN:LIVER, BILIARY TRACT: Postoperative changes from Whipple procedure again noted. No intrahepatic or extrahepatic biliary ductal dilatation. No focal suspicious hepatic lesions. Hepatic stenosis.SPLEEN: No significant abnormality noted.PANCREAS: Again seen are postoperative changes from Whipple procedure and resection of IPMN in uncinate process. There are subcentimeter pancreatic cyst in body and tail (series 8 images 20 and 18), appearing similar compared to prior examination. No pancreatic ductal dilatation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral subcentimeter renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postsurgical changes from Whipple's procedure.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Postoperative changes from Whipple procedure and resection of uncinate processes IPMN. No evidence of recurrent disease.2.Subcentimeter cystic foci in the residual body and tail of the pancreas are stable and likely reflect small IPMNs.


Instruction: Generate impression based on findings.

Input: Female 46 years old; Reason: right wrist possible TFCC degenerative tear LIGAMENTS: The scapholunate and triquetrolunate ligaments are intact. TRIANGULAR FIBROCARTILAGE COMPLEX: No significant abnormality noted. the TFCC is intact.TENDONS: No significant abnormality noted. BONES: A small degenerative cyst is noted in the distal ulna. Otherwise, no significant abnormality noted. The bone marrow signal is normal.ADDITIONAL

Output: Intact triangular fibrocartilage complex. No specific findings to account for the patient's presentation.


Instruction: Generate impression based on findings.

Input: Multiple myeloma SKULL: No significant abnormality noted.CERVICAL SPINE: Moderate osteoarthritic changes of the mid cervical spine extending from C3 through C7 with relative sparing of C4-5. Other than straightening, no distinct superimposed osseous abnormality to support myeloma. Soft tissues unremarkableTHORACIC SPINE: No significant abnormality noted. LUMBAR SPINE: Mild osteoarthritic changes without suspicious myelomatous lesionsRIBS: No significant abnormality noted.PELVIS: No significant abnormality noted.UPPER EXTREMITY: No significant abnormality noted.LOWER EXTREMITY: No suspicious findings to support myelomatous involvement. Mild cortical thickening and deformity of both left and right tibia suggesting congenital abnormality and/or possibly old stress reaction. Specifically this finding does not support MGUS and comparison with prior outside imaging if available would be helpful. (The prior MRI does not extend cranial enough to evaluate this mid diaphyseal region).

Output: Scattered mild to moderate osteoarthritic changes largely involving the cervical spine, no superimposed additional findings to support myelomatous lesions.


Instruction: Generate impression based on findings.

Input: Brain MRI: The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. Cervical spine MRI: Alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign. The cervical and upper thoracic cord are normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable. There are no osseous dysplasias or stenoses.

Output: Negative brain and cervical spine MRI without contrast. Specifically, there are no MRI findings to explain the patient's head and neck pain.


Instruction: Generate impression based on findings.

Input: 68 year-old male. PSC, abnormal MRI. Assess ? obstructing lesion. ABDOMEN:LUNG BASES: Enlarged right cardiophrenic lymph node, unchanged. LIVER, BILIARY TRACT: Cirrhotic nodular liver morphology. Disproportionate atrophy of the left hepatic lobe relative to the right. Beaded ductal dilatation of the bilobar intrahepatic ducts consistent with PSC, unchanged.Mildly hypointense lesion in the left hepatic lobe adjacent to a dilated duct noted on 11/2014 MRI measures 1.7 x 0.8 cm (series 15, image 145), previously 1.6 x 0.8; this lesion is isointense to hepatic parenchyma on delayed phase images and is favored to be a perfusion abnormality. No new suspicious hepatic mass is identified.Esophageal and small perigastric varices, unchanged.SPLEEN: Splenomegaly measuring 14 cm. Small splenules noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter right renal hemorrhagic cyst.RETROPERITONEUM, LYMPH NODES: Mildly enlarged periportal lymph nodes, unchanged. BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: A small amount of abdominal ascites.

Output: 1.Intrahepatic beaded biliary ductal dilatation, unchanged.2.Stable hypointense lesion adjacent to dilated ducts in the left hepatic lobe, likely a perfusion abnormality. No suspicious hepatic mass.


Instruction: Generate impression based on findings.

Input: 48 year old male with HFrEF due to non ischemic dilated cardiomyopathy, persistent atrial fibrillation. MRI to evaluate function. Left VentricleThe left ventricle is dilated with reduced systolic function. The overall LV ejection fraction is 29%. The LVEDV is 222 ml (normal range 142+/-34), the LV end diastolic volume index is 109 ml/m2 (normal range: 74+/-15), the LVESV is 161 ml (normal range 47+/-19) and the LV end systolic volume index is 79 ml/m2 (normal range 25+/-9). 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. There is [no ]LV thrombus. Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is dilated with reduced systolic function. The overall RV ejection fraction is 29%. The RVEDV is 228 ml (normal range 142+/-31), RV end diastolic volume index is 112 ml/m2 (normal range 82+/-16), the RVESV is 160 ml (normal range 54+/-17), and the RV end systolic volume index is 78 ml/m2 (normal range 31+/-9).Right AtriumThe right atrium is moderately dilated.Aortic ValveThe aortic valve is trileaflet, 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 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. Moderately dilated left ventricle with reduced systolic function (LVEF 28%)2. Moderately dilated right ventricle with reduced systolic function (RVEF 29%)3. No LV thrombus4. No evidence for delayed enhancementSee extra cardiac findings.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 39 years, Female, Cavernoma, please evaluate, compare to outside images if available in PACS. There is a 9 x 8 x 8 mm (AP x transverse x craniocaudal dimensions, measured on the axial and coronal T2-weighted sequence) heterogeneous T2 hyperintense lesion involving the left frontal subcortical white matter with a rim of susceptibility most consistent with cavernous malformation. No surrounding edema to suggest recent hemorrhage. There is a small adjacent developmental venous anomaly. Remainder of the brain parenchyma is unremarkable. No restricted diffusion to suggest acute ischemia. No evidence of intracranial mass-effect. The ventricles are within normal limits in size and configuration. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: 1. 9 x 8 x 8 mm left frontal lobe lesion is most consistent with a cavernous malformation. There is an adjacent developmental venous anomaly. 2. Remainder of the brain parenchyma is unremarkable with no additional lesions.


Instruction: Generate impression based on findings.

Input: Hallucinations. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is scattered cerebral white matter T2 hyperintensity bilaterally, with T2 shine-through and gyriform T1 hyperintensity and enhancement in the right frontal corona radiata and anterior insula on DWI. There is mild cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There are small maxillary sinus retention cysts bilaterally. There is degenerative spondylosis in the imaged portions of the cervical spine.

Output: No evidence of intracranial hemorrhage, mass, or acute infarct. Subacute infarct in the right peri-sylvian region superimposed on a background of scattered cerebral white matter T2 hyperintensity bilaterally may represent subacute to chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: 59-year-old male for evaluation for prostate cancer, elevated PSA. PELVIS:PROSTATE:Prostate Size: 6.4 x 5.8 x 4.5 cm.Peripheral Zone: There is a 8 x 4 mm ill-defined, wedge-shaped T2 hypointense lesion with corresponding restricted diffusion and no early focal enhancement in the right mid gland peripheral zone (series 801, image 15)Central Gland: Severe degree of prostatic hypertrophy.Seminal Vesicles: No significant abnormality.Extracapsular Extension: Not present.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Ill-defined wedge-shaped T2 hypointense lesion in the right mid gland peripheral zone as described above is indeterminate.2.Severe degree benign prostatic hypertrophy.


Instruction: Generate impression based on findings.

Input: Patient is a 41 year old male with history of hypertension, diabetes who presented to an OSH with a NSTEMI. Coronary angiogram showed no significant epicardial coronary artery disease. Cardiac MRI done to evaluate function, structure, and presence of fibrosis. Left VentricleThe left ventricle is moderately enlarged with severely reduced systolic function. The overall LV ejection fraction is 21%, the LV end diastolic volume index is 129 ml/m2 (normal range: 74+/-15), the LVEDV is 238 ml (normal range 142+/-34), the LV end systolic volume index is 102 ml/m2 (normal range 25+/-9), the LVESV is 253 ml (normal range 47+/-19), the LV mass index is 96 g/m2 (normal range 85+/-15), and the LV mass is 238 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.No intracardiac thrombus.Left AtriumThe left atrium is moderately to severely increased. Right VentricleThe right ventricle is mildly dilated with severely reduced systolic function. The overall RV ejection fraction is 20%, the RV end diastolic volume index is 124 ml/m2 (normal range 82+/-16), the RVEDV is 308 ml (normal range 142+/-31), the RV end systolic volume index is 99 ml/m2 (normal range 31+/-9), and the RVESV is 246 ml (normal range 54+/-17).Right AtriumThe right atrium is moderately dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is trace tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is a small pericardial effusion.Extracardiac FindingsThere are several serpiginous structures at the esophageal hiatus suspicious for small vascular structures. No evidence of cirrhosis, which makes esophageal varices less likely. Correlation to patient's history and liver enzymes recommended.

Output: 1. The left ventricle is moderately enlarged with severely reduced systolic function (LVEF 21%)2. The right ventricle is mildly dilated with severely reduced systolic function (RVEF 20%)3. There is no definite late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Diagnosis: Dizziness and giddinessClinical question: Eval vasculature in stroke wuSigns and Symptoms: vertigo MRI of the brainNo diffusion weighted abnormalities are appreciated.There are multiple punctate foci of signal hypointensity scattered in the brainstem, thalami and basal ganglia as well as the deep gray nuclei of the cerebellum. Additionally there are a couple periventricular punctate foci of susceptibility as well as one in the left inferior frontal gyrus.There are punctate foci of T2 signal hyperintensity without FLAIR hyperintensity in the areas where there is susceptibility effect.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. 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 medium size. The posterior communicating arteries are intact. The vertebral arteries are similar in size.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries.

Output: 1.Multiple microhemorrhages are present in the brain as detailed above which are in a pattern suggestive of hypertension.2.No evidence for intracranial cerebrovascular occlusive disease.3.No evidence for extracranial cerebrovascular occlusive disease.4.No evidence for acute ischemic cerebral infarction5.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: History of primary sclerosing cholangitis. Evaluate for suspicious lesion or dominant stricture. ABDOMEN:LIVER, BILIARY TRACT: The liver measures 23 cm in the craniocaudal dimension, similar to the prior. There is atrophy of the left lateral hepatic segment with compensatory hypertrophy of the right hepatic lobe.Normally distended gallbladder.Demonstrated again is a long smooth stricture involving the common bile duct extending for 3.5 cm with mild proximal dilatation up to 8 mm (series 901/1), similar to the prior. There is mild narrowing just distal to Klatskin's point and mild scattered foci of intrahepatic biliary ductal dilatation and narrowing, similar to prior. There is no significant contiguous intrahepatic biliary ductal dilatation. No discrete suspicious enhancing lesion is noted of the liver parenchyma or involving the common bile duct strictures.The vessels are patent.SPLEEN: The spleen measures 10.7 cm in length without a focal lesion. It is normal in signal intensity.PANCREAS: The pancreas is normal in morphology, signal intensity and enhancement. The main pancreatic duct is normal in caliber with normal variant ductal anatomy.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Right lower quadrant ostomy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Stable examination with findings compatible with primary sclerosing cholangitis with stable distal common bile duct stricture and mild upstream dilatation. No suspicious focal lesion or new dominant stricture.


Instruction: Generate impression based on findings.

Input: Diagnosis: DiplopiaClinical question: Evaluate for ischemic strokeSigns and Symptoms: Horizontal diplopia A couple punctate foci of diffusion restriction are present in the right cerebellar hemisphere.There are a couple of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. These are probably of little clinical significance.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.There are a couple right cerebellar microinfarcts present.


Instruction: Generate impression based on findings.

Input: Clinical question: Mass signs and symptoms: Headaches Non-enhanced CT of brain:There is no evidence of intracranial hemorrhage, edema, mass, mass effect, midline shift or hydrocephalus.Cortical sulci and ventricular system are within normal range for patient's stated age of 43. There is subtle crowding of the cerebellar tonsils at the level of foramen magnum concerning for mild ectopia of the cerebellar tonsils. Please correlate with history and follow-up with an MRI.Calvarium is intact. Limited view of paranasal sinuses and mastoid air cells are unremarkable.

Output: 1.No evidence of acute intracranial process.2.Minimally ectopic cerebellar tonsils.


Instruction: Generate impression based on findings.

Input: 57 years Male (DOB:2/23/1959)Reason: fluid sample from extracranial fluid collection for help with directed antibiotic therapy History: post surgical fluid collectionDIET RESTRICTION: NPO after midnight. Must have radiologist approval.PROVIDER/ATTENDING NAME: LAWRENCE J GOTTLIEB LAWRENCE J GOTTLIEB Serial CT images obtained during the biopsy procedure demonstrate the needle placement within the left neck mass. Following needle removal images obtained that demonstrate no complications .

Output: CT-guided aspiration biopsy of left temporal bone surgical site lesion. A total of 4 samples were obtained and sent for microbiologic analysis.


Instruction: Generate impression based on findings.

Input: 30 years Female (DOB: 4/12/1986)Reason: chiari malformation , pseudotumor cerebri, shunt, new headaches, evaluate for changes, please do with csf flow study. History: new headaches, neck pain, eval for changesPROVIDER NAME: DAVID M. FRIM DAVID M. FRIM MRI brain:The cerebellar tonsils are low-lying extending through the foramen magnum by approximately 5 mm. Is unchanged since the prior exam. CSF flow study displays normal biphasic flow.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal lesions are identified in the cervical spine.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: There are low lying cerebellar tonsils present. There is no evidence for ventriculomegaly or syrinx. CSF flow pattern on flow study appears nonobstructive.


Instruction: Generate impression based on findings.

Input: 63 years, Female, found down, unknown fall or cervical spine injury. Seizures. Hyperdense left occipital lesion on CT. Brain: There is an approximately 22 x 15 x 26 mm intraparenchymal hematoma in the left posterior paramedian parietal lobe with T1 and T2 hyperintensity compatible with subacute age. There is surrounding edema and local mass effect including partial effacement of the trigone of the left lateral ventricle. There is no midline shift or herniation. No abnormal enhancement associated with the hematoma is appreciated, although follow-up after resolution of these relatively acute blood products would be helpful. No restricted diffusion to suggest acute ischemia. No abnormal parenchymal or meningeal enhancement elsewhere in the brain. No hydrocephalus.There is evidence of chronic hemorrhage with slitlike encephalomalacia involving the right posterior lateral putamen and external capsule. There is also an additional focus of hemosiderin staining involving the right subinsular white matter slightly more anteriorly. Additional punctate microhemorrhage is present in the right frontal lobe slightly more superiorly.Several foci and patchy areas of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter as well as the pons, which are nonspecific, but compatible with moderate chronic small vessel ischemic disease. There is extensive opacification throughout the paranasal sinuses. There is also extensive bilateral mastoid air cell opacification, left greater than right. Calvarium and extra cranial soft tissues are grossly unremarkable.Cervical Spine: Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. There is some loss of cervical lordosis which may be in part positional. There is also trace retrolisthesis of C4 on C5. Alignment is otherwise grossly maintained. Bone marrow signal is benign.There is abnormal T2 signal in the cervical cord at the C3-C4 level just below the discs space favored to represent myelomalacia although component of edema is not entirely excluded. There is longitudinal low T2 signal involving the right lateral aspect of the cord at the which extends from the upper C3 to the upper C4 level likely representing chronic hemorrhage. No surrounding edema or cord swelling to suggest that this is recent.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: There is a disc osteophyte complex including a left paracentral disc extrusion which along with ligamentum flavum thickening contributes to moderate to severe spinal canal stenosis at this level. There is abnormal, likely associated, T2 cord signal abnormality just inferior to this level. There is also moderate bilateral neural foraminal stenosis related to uncovertebral hypertrophy.C4-5: Disc osteophyte complex and uncovertebral hypertrophy contribute to mild spinal canal stenosis. There is also uncovertebral hypertrophy with moderate right and mild left neural foraminal stenosis.C5-6: No significant compromise to the spinal canal. Uncovertebral hypertrophy results in moderate right neural foraminal stenosis. Left neural foramen is patent. C6-7: No significant compromise to the spinal canal or neural foramina.C7-T1: No significant compromise to the spinal canal or neural foramina.No findings to suggest ligamentous injury in the cervical spine. Paraspinous soft tissues are grossly unremarkable.

Output: 1. Subacute intraparenchymal hematoma in the left parietal lobe. No underlying mass is appreciated, although follow-up once the relatively acute blood products resolve would be helpful.2. Three additional foci of chronic hemorrhage are seen in the right frontal lobe and right subinsular white matter/putamen.3. Moderate chronic small vessel ischemic disease.4. Degenerative changes in the cervical spine including moderate to severe spinal canal stenosis at the C3-C4 level which is primarily related to left paracentral disc extrusion. There is associated T2 signal abnormality favored to represent myelomalacia, although component of edema is not entirely excluded.5. Longitudinal low T2 signal involving the right lateral aspect of the cervical cord from the upper C3 to the upper C4 level suspected to represent a chronic hemorrhage. No associated mass or cord swelling.


Instruction: Generate impression based on findings.

Input: Female, 57 years old, with progressive lower extremity weakness, unable to ambulate, history of brain metastases. No evidence of cord compression is seen. No marrow replacing lesions are detected to suggest the presence of metastatic disease. Mild disc osteophyte formation is evident in the cervical spine without high-grade stenosis. A Schmorl's node deformity is demonstrated at T10-11. Mild disc bulging is seen at lower lumbar levels again without significant spinal canal stenosis. Mild foraminal narrowing is demonstrated bilaterally at L3-4.

Output: 1.No evidence of cord compression or any other significant spinal canal compromise.2.No evidence of metastatic disease within the limitations of a noncontrast examination.


Instruction: Generate impression based on findings.

Input: 59-year-old female with right hip pain, soft tissue injury. ACETABULAR LABRUM: There is a probable small tear of the anterior/superior labrum.ARTICULAR CARTILAGE AND BONE: Mild osteoarthritis affects the right hip joint, including joint space narrowing and subchondral cyst formation.SOFT TISSUES: There is complete avulsion of the right semimembranosus tendon from the ischial tuberosity, with associated retraction and thickening. A large fluid collection extends along the medial aspect of the retracted semimembranosus tendon, from the level of the ischial tuberosity, inferiorly, and out of the field-of-view, likely representing a large hematoma. There is significant fatty atrophy of the bilateral gluteus muscles, as well as the right vastus lateralis.ADDITIONAL

Output: 1.Avulsion and retraction of the right semimembranosus tendon.2.Large associated hematoma, which extends out of field-of-view.3.Mild osteoarthritis of the right hip joint.4.Probable small tear of the anterior/superior labrum.


Instruction: Generate impression based on findings.

Input: 74-year-old male with renal cell carcinoma needing restaging examination. ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesions. Low T2 signal of the liver, suggestive of iron deposition. Reference enhancing nodule along the anterior peritoneum just anterior to the left hepatic lobe measuring 2.6 x 1.9 cm, unchanged (series 11/43).SPLEEN: Reference rim-enhancing intrasplenic lesion measures 4.5 x 3.8 cm, previously 2.9 x 2.2 cm (series 11/36); this lesion has increased in size due to increased central cystic component/necrosis. Reference rim-enhancing posterior perisplenic lesion measures 1.6 x 2.3 cm, unchanged (series 11/58).Decreased size of enhancing lateral perisplenic nodule (series 11/43).PANCREAS: No significant abnormality noted.ADRENAL GLANDS:Reference enhancing nodule in the superior aspect of the left nephrectomy bed measures 2 x 0.8 cm, previously 2.7 x 1.9 cm (and decreased in size (series 11/54).KIDNEYS, URETERS: Status post left nephrectomy. Reference amorphous soft tissue in the left nephrectomy bed currently measuring up to 3.2 x 2.1 cm, unchanged series 11/60). Again, this tissue likely represent postsurgical scarring given its stability.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY:Postsurgical changes from left colectomy with right lower quadrant colostomy. Reference left lateral body wall rim-enhancing lesion located in the superior left paracolic gutter measures 4.5 x 2.4 cm, previously 4.5 x 3.1 cm and mildly decreased in size (series 11/79). BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Multiple enhancing metastases in the upper abdomen are stable to decreased in size since prior study. No new sites of disease.


Instruction: Generate impression based on findings.

Input: : eval labrum History: hip pain Incidental note of iatrogenic air in the joint.ACETABULAR LABRUM: There is a partial undersurface tear of the anterior-superior labrum best seen on the radial images.ARTICULAR CARTILAGE AND BONE: No significant abnormality noted.SOFT TISSUES: No significant abnormality noted. ADDITIONAL

Output: Partial undersurface tear of the anterior superior labrum best seen on the radial images.


Instruction: Generate impression based on findings.

Input: Chiari malformation decompression/VP shunt: headaches, neck pain, and back pain. Brain: There are postoperative findings related to Chiari decompression. There is deformity of the inferior cerebellum, which appears to contact the overlying dura. There appears to be deficiency of flow across the neo-foramen magnum, although this may be in part be artifactual. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears unremarkable, aside from minimal scattered foci of nonspecific T2 hyperintensity. There is a right transfrontal ventricular catheter that terminates in the region of the left foramen of Monro. The ventricular system is not dilated. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable.Spine: There are postoperative findings in the posterior lower cervical spine. There is straightening of the cervical spine alignment in the sagittal plane. The rest of the vertebral column alignment is within normal limits. There is mild degenerative spondylosis at multiple levels of the cervical spine, lower thoracic spine, and at L5-S1, with up to slight spinal canal stenosis. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable, aside from degenerative endplate signal alterations in the lower thoracic spine. The spinal cord displays normal signal and morphology and the conus medullaris is appropriately situated at the L1 level. The paravertebral soft tissues are unremarkable.

Output: 1. Postoperative findings related to Chiari decompression with evidence of adhesions involving the inferior cerebellum with what appears to be associated diminished cerebrospinal fluid flow in this region.2. No evidence of syringohydromyelia or hydrocephalus.


Instruction: Generate impression based on findings.

Input: Known prostate cancer. Biopsy 7/16/2015 reveals left lateral base, lateral mid, and lateral apex prostatic adenocarcinoma. Gleason score 7 (3+4). Diffusion-weighted images are uninterpretable due to artifact and patient will be called back for additional images without endorectal coil.

Output: Diffusion-weighted images are uninterpretable due to artifact and patient will be called back for additional images without endorectal coil.


Instruction: Generate impression based on findings.

Input: Knee pain MENISCI: The previously described horizontal tearing of the posterior horn of the medial meniscus is no longer evident. There is no otherwise no evidence of a discrete of medial or lateral meniscal tear.ARTICULAR CARTILAGE AND BONE: A new full-thickness defect of the articular cartilage of the medial condyle is noted measuring approximately 1.1 cm. The previously underlying marrow edema in the medial femoral condyle has resolved.The articular cartilage of the remaining medial, lateral, and patellofemoral compartments is otherwise preserved. A small focus of low T1/high T2 marrow signal is noted within the femoral trochlea centrally which may reflect the area of prior intervention.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. New full-thickness defect of the articular cartilage of the medial femoral condyle measuring approximately 1.1 cm.2. No evidence of discrete meniscal tear.3. Large Baker's cyst, similar to the prior exam.


Instruction: Generate impression based on findings.

Input: Clinical question: 83-year-old male with multiple myeloma. Presents with low back pain. Rule out bony disease. Evaluate for degenerative disk disease. Signs and symptoms: Moderate to severe low back pain. Constipation. Nonenhanced CT of lumbar spine girl inaxial 3 -mm continuous CT images of the entire lumbosacral spine were obtained. Sagittal and coronal 2-D reformatted images were also obtained.Examination demonstrates severely osteopenic lumbosacral vertebral column. The alignment of the vertebral column is within normal limits. Partially visualized lower T10 vertebrae demonstrate extensive lytic changes which considering patient's history likely represents multiple myeloma. The alignment and morphology the vertebral column from T11 through L5 remains within normal. No evidence of a destructive bony lesion is identified.There is a large irregularly-shaped lytic lesion in the vertebral body of S1 on the left which is also suspected from a myoma. Very large similar lesions within bilateral iliac wings and the ala of the sacrum and is also present.There is no significant degenerative disk disease on this exam. There is mild to moderate degenerative changes of posterior elements of both facets and ligamentum flavum.There is no definitive bony central canal stenosis. There is highly suspected neural foramina compromise bilaterally at at L4 -- L5 level mild neural foramina compromise at L3 -- L4 is also suspected. No definitive neural foramina compromise at any other level.For more detailed evaluation of degenerative disk disease, central spinal stenosis or neural frontal compromise an MRI examination is recommended. MRI can also better visualized the extent of changes of multiple myeloma which due to very severe osteopenia may be difficult to assess on CT.

Output: 1.Severe osteopenia results in very poor visualization of bony structures of lumbosacral spine.2.There is a destructive lytic lesion in partially visualized vertebral body of T10.3.Large irregularly-shaped lytic lesion is noted involving the vertebral body of S1. Likely secondary to multiple myeloma.4.Extensive lytic changes of the iliac wings bilaterally (left greater than right cortical and central ala (left greater than right) consistent with patient's history of multiple myeloma.5.Mild degenerative disk disease and hypertrophic changes of posterior elements are noted. No evidence of any bony central canal stenosis. Mild compromise of bilateral neural foramina at L4 -- L5 and to a lesser degree at L3 -- L4 level is suspected.


Instruction: Generate impression based on findings.

Input: 47-year-old male with tear of the cartilage or meniscus of the knee. MENISCI: Again seen is extensive tearing of the anterior horn of the lateral meniscus, including a fluid-filled horizontal component. Overall the degree of signal abnormality within the meniscus appears to have increased slightly when compared to the prior study. There is globular signal abnormality within the anterior aspect of the lateral meniscus which likely reflects mucoid degeneration that penetrates the peripheral fibers of the anterior horn, extending into Hoffa's fat pad with parameniscal cyst formation. This is contiguous with band-like low signal intensity which perhaps represents scarring from prior arthroscopy. There is a 4 mm ovoid focus of intermediate signal intensity within the aforementioned parameniscal cyst which may represent a small cartilage fragment. The tip of the posterior horn of the lateral meniscus appears slightly blunted but the posterior horn otherwise appears intact. There is increased signal intensity within the posterior body and horn of the medial meniscus suggestive of mucoid degeneration, but we see no discrete tear.ARTICULAR CARTILAGE AND BONE: The articular cartilage appears normal for age with no large fluid-filled articular cartilage defects. Bone marrow signal intensity is within normal limits. There is a broad-based bony excrescence extending from the medial aspect of the proximal fibula which likely represents a tug lesion at the soleus muscle origin, of doubtful significance.LIGAMENTS: There is mild intermediate signal intensity between the IT band and lateral femoral condyle which may reflect mild inflammation. The cruciate ligaments appear intact. The medial collateral ligament appears intact. Mild increased signal intensity within the proximal fibers of the lateral collateral ligament proper may reflect degeneration.EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Extensive tearing of the anterior horn of the lateral meniscus with parameniscal cyst formation and other findings as described above.


Instruction: Generate impression based on findings.

Input: Male; 58 years old. Reason: assess for excursion of drain History: bilious fluid in pancreatic cyst drain ABDOMEN:LUNG BASES: Moderate left pleural effusion with increased left basilar nonspecific atelectasis/consolidation, for which underlying aspiration or infection cannot be excluded. Small right pleural effusion with mild compressive right basilar subsegmental atelectasis. LIVER, BILIARY TRACT: Postsurgical changes from side-to-side choledochojejunostomy. The anastomosis is widely patent. Minimal biliary tree dilation is seen without evidence of obstructing lesion.SPLEEN: No significant abnormality noted.PANCREAS: Mild likely chronic dilation of the pancreatic duct. No evidence of obstructing mass, but correlation with most recent endoscopic findings is recommended.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Status post cyst gastrostomy and percutaneous catheter placement with two drainage catheters and appearance of left upper quadrant bilobed cystic structure grossly unchanged since prior CT. Mild to moderate nonspecific circumferential bowel wall thickening of the transverse duodenum, which may be at least partially attributable to underdistention.BONES, SOFT TISSUES: Body wall anasarca.

Output: 1.Postsurgical changes from choledochojejunostomy with widely patent anastomosis. Minimal biliary tree dilation without evidence of obstructing lesion.2.Nonspecific bowel wall thickening of the transverse duodenum, which may be causing partial obstruction with gastric reflux of bile, given the patient's clinical history of bilious fluid from gastrostomy tube.3.Catheter placement and essentially stable left upper quadrant bilobed cystic structure.4.Stable mild and likely chronic pancreatic ductal dilation without evidence of obstructing mass, but correlation with most recent endoscopic findings is recommended.


Instruction: Generate impression based on findings.

Input: Shoulder pain ROTATOR CUFF: There is a minimal amount of increased signal intensity of the distal supraspinatus tendon reflecting minimal tendinosis. Otherwise the rotator cuff tendons are unremarkable.SUPRASPINATUS OUTLET: There is a mild amount of acromioclavicular arthrosis.GLENOHUMERAL JOINT AND GLENOID LABRUM: No significant abnormality noted.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: 1. Minimal tendinosis of the supraspinatus. Otherwise there is no evidence of rotator cuff or labral tear.2. Mild synovitis and acromioclavicular arthrosis.


Instruction: Generate impression based on findings.

Input: History pituitary mass, status post surgery. There is no appreciable interval change in the 9 x 10 x 8 mm non-enhancing high T2 and intermediate T1 signal signal lesion within the right anterolateral aspect of the sella, which displaces the normal pituitary tissue posteriorly. The lesion protrudes slightly into the medial compartment of the right cavernous sinuses and abuts the supraclinoid portion of the right internal carotid artery. There is no mass effect upon the optic apparatus. The pituitary infundibulum is intact, but displaced to the left. The posterior pituitary bright spot is intact.

Output: Unchanged cystic pituitary lesion that measures up to 10 mm.


Instruction: Generate impression based on findings.

Input: History of bilateral breast cancers and bilateral lumpectomies. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.No suspicious enhancement is seen in either breast. There is stable post-surgical volume loss and scarring in each breasts lumpectomy bed. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Female, 45 years old, with history of TIA in January 2016, now with worsening right-sided weakness, and pain at T9-10, thoracic spine with pressure, possible autoimmune picture. MRI brain:No restricted diffusion is seen. No evidence of parenchymal edema or mass effect is detected. A 2 mm nonspecific focus of T2 hyperintensity is seen within the left superior frontal gyrus. Otherwise, no abnormal parenchymal signal is seen. There are no findings to suggest acute intracranial hemorrhage or any abnormal extra-axial fluid collection. The ventricular system is normal in size and morphology.MRA brain:MRA images are degraded by motion artifact. Within this limitation, no high-grade stenosis is suspected though many areas of the intracranial vessels are not well assessed. The area of the ACOM artery is not well visualized. The PCOM arteries are not clearly seen. The left vertebral artery is dominant. The proximal basilar artery may be fenestrated.MRA neck:No significant stenosis of the carotid vessels is detected by NASCET criteria. Likewise, no significant stenosis of the vertebral vessels is suspected, though evaluation is limited by motion artifact.Thoracic spine MRI:Image quality is degraded by motion artifact. Within this limitation, the following observations are made. Alignment is anatomic. Vertebral body morphology and signal characteristics are within normal limits. No pathologic marrow enhancement is seen.The spinal cord shows normal signal intensity and morphology throughout. No abnormal parenchymal or leptomeningeal enhancement is detected. No epidural abnormalities are present.The intervertebral disc spaces are preserved. No significant disc bulge or herniation is seen. No spinal canal or foraminal stenosis is noted.

Output: 1.Unremarkable evaluation of the brain with no acute abnormality and no specific findings to account for the reported symptoms.2.Within the limitation of motion degradation, MRA images of the brain and neck are unremarkable.3.Within the limitation of motion degradation, MRI of the thoracic spine is unremarkable.


Instruction: Generate impression based on findings.

Input: Melanoma. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable.

Output: No evidence of intracranial metastases.


Instruction: Generate impression based on findings.

Input: Back pain. Evaluate for cord compression at L5. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits aside from some loss of lumbar lordosis. The conus medullaris is normal in position.There are multiple T1 hypointense, T2 hyperintense, and enhancing lesions throughout the lumbar spine and visualized pelvis consistent with diffuse osseous metastatic disease. There is diffuse marrow infiltration involving the L5 vertebral body with evidence of pathologic fracture and up to 60% loss of height involving the right aspect of the vertebral body as seen on recent CT from 8/31/2016. There is no significant osseous retropulsion. Marrow infiltration is noted to extend into the posterior elements, right greater than left. There is also abnormal enhancement posterior to the L5 vertebral body likely representing epidural tumor and primarily involving the ventral epidural space from L4-L5 to L5-S1 and extending into the right L5-S1 neural foramen. There is an additional relatively large lesion measuring approximately 2 cm in diameter involving the L4 vertebral body. Relatively large lesions are also involving the left aspect of the sacrum and right iliac bone.Aside from L5, vertebral body heights in the lumbar spine are maintained. Small multilevel Schmorl's nodes are also present involving the superior endplates of the T12 and L2 vertebrae. There are also mild multilevel degenerative changes including small central disc protrusion at the T12-L1 level as well as L4-L5 levels and minimal additional multilevel disc bulges. Degenerative changes also include moderate facet arthropathy at the right L5-S1 level and to a lesser degree left L5-S1 and bilateral L4-L5 levels. There is mild central spinal canal stenosis at the L4-L5 level which is primarily on a degenerative basis. The lumbar spinal canal is otherwise preserved. There is moderate bilateral, right greater than left, L5-S1 neural foraminal stenosis related to combination of L5 pathologic fracture, mild epidural tumor, and degenerative changes. There is also mild left L4-L5 narrowing which is on a degenerative basis.Diffuse osseous metastatic disease is new compared to lumbar spine MRI from 1/22/2010. Compared to more recent PET from 3/14/2016 there also appears to be progression of metastatic disease. The pathologic fracture at L5 also appears new since then although present on recent CT from 8/31/2016.

Output: 1. Diffuse osseous metastatic disease involving the lumbar spine and pelvis including diffuse tumor infiltration of the L5 vertebral body extending into the posterior elements, epidural tumor from L4-L5 to L5-S1, and pathologic fracture at L5. Additional details as above.2. Mild central spinal canal stenosis at the L4-L5 level which is primarily on a degenerative basis. The lumbar spinal canal is otherwise preserved. There is moderate bilateral, right worse than left, L5-S1 neural foraminal stenosis related to combination of L5 pathologic fracture, epidural tumor, and degenerative changes.


Instruction: Generate impression based on findings.

Input: Prostate cancer PELVIS:PROSTATE:Prostate Size: 4.7 x 2.3 x 3.8 cmPeripheral Zone: Punctate T2-weighted hypointensities in the right apex may reflect sites of disease.Central Gland: In the anterior mid-gland there is a 9 x 5 mm T2-weighted hypointensity with restricted diffusion and equivocal early enhancement, suspicious for carcinoma. It abuts and mildly bulges the adjacent anterior capsule, extracapsular extension cannot be excluded.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: See discussion above.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Suspicious T2-weighted punctate hypointensities in the right peripheral zone apex.2. Anterior mid-gland 9 x 5 mm focus is suspicious for carcinoma. It abuts and mildly bulges the adjacent anterior capsule, therefore extracapsular extension cannot be excluded.


Instruction: Generate impression based on findings.

Input: 21-year-old man with history of mixed germ cell tumor of the testis, evaluate for metastatic disease. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in signal and morphology. The gallbladder appears normal and there is no intra or extrahepatic biliary ductal dilatation.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 retroperitoneal lymphadenopathy noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Stable small inguinal lymph nodes.OTHER: No significant abnormality noted.

Output: No evidence of metastatic disease.


Instruction: Generate impression based on findings.

Input: Plasma cell dyscrasia and spinal lesions concerning for myeloma. There is no significant change in the T2 hyperintense enhancing lesions of variable sizes in the C6, T3, T6-10, T12, and L1 through L5 vertebrae. There is multilevel cervical, thoracic, and lumbar degenerative disease with no significant spinal canal stenosis. Aside from multiple small intravertebral disc herniations, the vertebral body heights and alignment are intact. The spinal cord and cauda equina nerve roots are intact. The paravertebral soft tissues are unremarkable.

Output: 1. Multifocal T2 hyperintense, enhancing lesions compatible with myelomatous involvement, without significant interval change or evidence of pathological fractures.2. Multilevel degenerative disease without significant spinal canal stenosis.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Posterior medial ankle pain TENDONS: No significant abnormality noted.LIGAMENTS: No significant abnormality noted.ARTICULAR SURFACES AND BONE: No significant abnormality noted. ADDITIONAL

Output: Normal MRI of the ankle.


Instruction: Generate impression based on findings.

Input: Female, 60 years old, with history of grade 2 oligodendroglioma, off all therapy now, status post RT/PCV. Ill-defined T2 hyperintense signal abnormality involving the left temporal lobe shows no significant change in overall size or geographic extent. Gyriform T1 hyperintensity and susceptibility likely reflect mineralization of the lesion. No evidence of mass effect or clear pathologic enhancement is observed.A nonspecific subcentimeter focus of nonenhancing T2 signal abnormality is unchanged in the right cerebellum. Ill-defined T2 hyperintensity within the left corona radiata and periatrial tissue is similar to the immediate prior examination. No new enhancing lesions are seen. Ventricular size and morphology are unchanged.

Output: Stable findings are seen compatible with treated left temporal lobe tumor. No evidence of local progression is seen. No new intracranial lesions are observed.


Instruction: Generate impression based on findings.

Input: Clinical question: Eval for growth of GBM. Pt is now on TMZ. Signs and Symptoms: GBM. Pre and post enhanced brain MRI:There is interval decreased peritumoral vasogenic edema of right hemisphere with resultant visualization of the cortical sulci and resolution of trace midline shift to the left. Surgical cavity in the high convexity right anterior parietal with thick irregular rim of enhancement also demonstrate significant interval improvement since prior exam. On sagittal postcontrast images the tumor measures approximately at 34 x 30 mm compared to prior study measurements of 37 x 41 mm.Remaining tumor demonstrate interval decreased size, significantly decreased extent of and thickness of enhancement. There are also sections of the cavity wall that demonstrate almost no enhancement. No evidence of new remote foci of flair hyperintensity or abnormal enhancement .

Output: Interval improvement of right hemispheric GBM with overall decreased size with decreased intensity, extend and thickness of enhancement surrounding the surgical cavity. Please see above comments.


Instruction: Generate impression based on findings.

Input: Patellar instability MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: There is a mild amount of bony edema involving the lateral femoral condyle posteriorly. Otherwise no significant abnormality noted.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted. The Insall-Salvati ratio is normal, measuring 1.2.ADDITIONAL

Output: 1. Normal TT to TG distance and Insall Salvati ratio with no evidence of trochlear dysplasia. The MPFL is also intact.2. Mild bony edema involving the lateral femoral condyle posteriorly which may reflect a small contusion. Otherwise no evidence of internal derangement of the knee.


Instruction: Generate impression based on findings.

Input: Pain and clicking. Evaluate for carpal instability. LIGAMENTS: There is spill of contrast from the mid-carpal joint into the radiocarpal joint indicating an intrinsic ligament tear. On the basis of the same day arthrogram, this is most likely due to lunotriquetral ligamentous disruption. TRIANGULAR FIBROCARTILAGE COMPLEX: The TFCC is grossly intact.TENDONS: The tendons are intact. BONES: Bone marrow signal is within normal limits.ADDITIONAL

Output: Findings most likely represent lunotriquetral ligamentous disruption.


Instruction: Generate impression based on findings.

Input: Male, 39 years old, with rapidly growing left neck mass. Dog bite one month ago. Extensive edema is evident within the left neck involving the parotid space, masticator space, submandibular space, sublingual space and floor of mouth, retropharyngeal and pharyngeal spaces. The left-sided submandibular gland is particularly edematous. There is mass effect on the airway with mild effacement and slight rightward deviation. Inflammation appears to track through the submental soft tissues to involve the right neck to a lesser degree than the left.Although there may be tracking fluid within the retropharyngeal space, no definite evidence of a discrete or loculated fluid collection is seen allowing for the absence of IV contrast. On diffusion-weighted images, multiple diffusion restricting lymph nodes are seen which is compatible with inflammation, but no discrete fluid collections are demonstrated.Mild edema is seen within the left ventricular body. Elsewhere, marrow signal characteristics are unremarkable.A right pleural effusion is partially visualized. The vascular flow voids of the visualized neck vessels appear to be preserved compatible with patency.

Output: Extensive cellulitis involving the left neck more than the right including superficial and deep spaces. There is mass effect with partial effacement and rightward deviation of the airway.There may be tracking fluid within the retropharyngeal space, but no definite evidence of a discrete or loculated abscess collection is seen. Although the absence of IV contrast does limit evaluation for abscess, diffusion-weighted imaging at least partially makes up for this shortcoming, and there is no diffusion evidence of an abscess at this time.Marrow edema is seen within the left mandibular body which could represent contiguous inflammation or infection.


Instruction: Generate impression based on findings.

Input: Radicular pain in the left lower extremity Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position.Examination is mildly motion degraded. There is developmental narrowing of the lumbar spinal canal with superimposed mild degenerative changes as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: Disc desiccation with mild bulge, eccentric to the right. No spinal canal or neural foraminal stenosis.L3-L4: Disc desiccation and disc bulge. No spinal canal or neural foraminal stenosis.L4-L5: Disc desiccation with left foraminal annular fissure and small disc protrusion (series 10, image 19). There is contact of the left L5 nerve root in the lateral recess. No significant central spinal canal stenosis or neural foraminal stenosis.L5-S1: No significant disc disease. No spinal canal or neural foraminal stenosis.Paraspinous soft tissues are within normal limits.

Output: 1. Left foraminal annular fissure at L4-L5 with small disc protrusion. There is contact and possible impingement of the left L5 nerve root in the lateral recess. No significant central spinal canal stenosis at any level or neural foraminal stenosis.2. Development of narrowing of the lumbar spinal canal.


Instruction: Generate impression based on findings.

Input: Female, 60 years old, status post occipital bone surgery for arachnoid granulation removal, assess for changes. Sequelae of occipital bone surgery are again seen. Patchy enhancement is evident within the overlying scalp soft tissues and within the bony surgical defect. However, these findings are unchanged, and no evidence of any recurrent arachnoid granulation is seen.A nodule of tissue which appears to follow gray matter signal characteristics along the posterior body of the left lateral ventricle is unchanged. Brain parenchymal morphology is otherwise unremarkable. No restricted diffusion is seen. Scattered foci of white matter T2 hyperintensity are redemonstrated appearing similar to the prior examination. No edema or mass effect is detected. No intracranial hemorrhage or any abnormal extra-axial fluid collections are observed. The ventricular system is stable and normal in size.Normal flow related signal is seen within the vasculature of the anterior and posterior intracranial circulation. No significant stenosis or occlusion is detected. No aneurysms are seen. The ACOM artery is not well resolved on this examination. Prominent bilateral PCOM arteries are noted.

Output: 1.Demonstration of postoperative findings in the occipital region which are stable relative to the prior examination. No evidence to suggest a recurrence of the arachnoid granulations is seen.2.Unremarkable MRA of the brain.


Instruction: Generate impression based on findings.

Input: 45-year-old female with multiple sclerosis. There are scattered foci of increased T2 signal within the supratentorial periventricular, pericallosal and subcortical white matter, which overall do not appear significantly changed from the prior examination. However, a single area of increased T2 signal along the atrium of the right lateral ventricle appears to have increased in size from the prior examination (series 801/21). Focus of increased signal in the left anterior frontal lobe was not definitely seen on the prior examination, although this may be related to differences in technique. Several of these lesions show mild correlative T1 hypointensity, including the lesion in the left centrum semiovale along the right ventricular atrium as well as the temporal stem. The other lesions do not demonstrate significant associated T1 hypointensity.There is no evidence of intracranial hemorrhage or acute infarct. There is an unchanged T1 hypointense T2 hyperintense focus in the posterior pituitary suggestive of a Rathke's cleft cyst. There is prominence of the lateral ventricles, particularly the atria, consistent with parenchymal volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. Left maxillary mucus retention cyst. The orbits, skull, and scalp soft tissues are grossly unremarkable.

Output: Suspected increase in size of a T2 hyperintense lesion along the atrium of the right lateral ventricle, but otherwise grossly unchanged findings consistent with supratentorial demyelinating disease.


Instruction: Generate impression based on findings.

Input: NSCLC with brain metastases status post SRS. There has been interval increase in size and number of intracranial metastases. For example, the posterior left fusiform gyrus lesion measures up to 6 mm, previously 3 mm. In addition, there are approximately seven new scattered supratentorial and infratentorial enhancing lesions with mild associated vasogenic edema. For example, a lesion in the region of the left flocculus measures up to 11 mm, a lesion along the left posterior cingulate sulcus measures up to 5 mm, and a lesion in the right superior frontal gyrus measures up to 3 mm. There is no evidence of acute infarct. There are subcentimeter foci of encephalomalacia in the bilateral thalami and adjacent to the left frontal horn of the lateral ventricle. There is also an unchanged background of nonspecific cerebral white matter T2 hyperintensity. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues appear unchanged.

Output: 1. Interval increase in size and number of intracranial metastases.2. Chronic lacunar infarcts and probable chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: C2 lesion, colon cancer with metastases to spine. Six-month follow-up. 7 mL of IV MultiHance was administered, 3 mL discarded. Again seen is T1 shortening involving the C1-C3 vertebral bodies consistent with prior radiation therapy. There is no abnormal edema or enhancement at these levels to suggest residual or recurrent tumor. There remain multiple abnormal foci of enhancement and T2/STIR hyperintensity involving the C3, C4, C5, C6, C7, T1, and T2 vertebral bodies consistent with known metastatic disease. There is mild interval enlargement of the lesions compared to study from 5/28/2015. For example round enhancing lesion involving the C4 vertebral body measuring 9 x 11 mm in the AP and craniocaudal dimensions previously measured 8 x 9 mm. Enhancing C7 spinous process lesion previously measuring 4 mm in the AP dimension, now measures 8 mm. There is also increased marrow infiltration of the left T3 lamina as noted on the sagittal images.Vertebral body heights and alignment are grossly unchanged including straightening and minimal anterolisthesis at the C7-T1 level similar to prior. There remains at least moderate spinal canal stenosis at the C3-C4 level related to prominent disc osteophyte complex and ligamentum flavum thickening and not significantly changed. Minimal enhancement along the anterior dura at this level is likely degenerative in etiology. There is T2 hyperintensity and volume loss consistent with myomalacia at the C3-C4 level also unchanged. Minimal spinal canal stenosis at the C7-T1 level related to disc bulge also appears similar.No evidence of epidural tumor. No abnormal leptomeningeal or intramedullary enhancement.

Output: 1. Posttreatment changes involving the cervical vertebral bodies from C1 to C3 without gross evidence of residual or recurrent tumor at these levels. 2. Continued enlargement of metastatic lesions involving the cervical spine more inferiorly and upper thoracic spine as detailed above. No evidence of pathologic fracture or epidural tumor.3. Moderate spinal canal stenosis at the C3-C4 level on a degenerative basis with cord myelomalacia is unchanged.


Instruction: Generate impression based on findings.

Input: Pilocytic astrocytoma treated with laser ablation. There are postoperative findings related to left transfrontal laser ablation of a hypothalamic region tumor, which measures up to 10 mm. The ventricles are unchanged is size and configuration. The optic apparatus appears grossly intact. There is no evidence of territorial infarction or acute intracranial hemorrhage. There is no midline shift or herniation. The skull and extracranial soft tissues are unchanged.

Output: Postoperative findings related to laser ablation of a hypothalamic region pilocytic astrocytoma, which has not significantly changed in size.


Instruction: Generate impression based on findings.

Input: Female; 31 years old. Reason: PSC/US eval for stricture History: PSC/UC ABDOMEN:LIVER, BILIARY TRACT: Stable mild narrowing and irregularity of the intrahepatic bile ducts, including a focal stenosis of the left hepatic duct at Klatskin's point (series 13/19). Normal caliber of the common bile duct. No dominant stricture is evident. No masses are identified. Hepatic vessels are patent.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Stable narrowing/irregularity of the intrahepatic bile ducts without dominant stricture or mass identified.


Instruction: Generate impression based on findings.

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

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


Instruction: Generate impression based on findings.

Input: Left face and arm sensory deficit. MRI: There is mild scattered T2 hyperintensity in the periventricular and subcortical white matter bilaterally, There is no evidence of acute infarction, intracranial hemorrhage, or mass. There is mild enlargement of the ventricles, which may be somewhat out of proportion to the prominence of the sulci. There are secretions and mucosal thickening in the left maxillary sinus. The skull appears unremarkable. There are bilateral lens implants.MRA: There is no evidence of significant steno-occlusive lesions in the head and neck arteries, aside from minimal irregularity in the bilateral carotid siphons from calcifications. There is no evidence of cerebral aneurysms. There is a mildly prominent pannus posterior to the dens and mild irregularity of the dens itself.

Output: 1. No evidence of acute infarction, intracranial hemorrhage, or mass.2. Enlargement of the ventricles is somewhat out of proportion to the margin of the sulci. This could relate to normal pressure hydrocephalus in the correct clinical setting versus central cerebral volume loss.3. Nonspecific supratentorial white matter abnormality most likely relates to chronic small vessel ischemic disease.4. No evidence of significant steno-occlusive lesions in the head and neck arteries.5. A mildly prominent pannus posterior to the dens and mild irregularity of the dens itself may be degenerative in nature or perhaps the sequela of a prior inflammatory process.


Instruction: Generate impression based on findings.

Input: Male, 28 years old. Medial sided elbow pain s/p fall on 04/15/16. Pain with extension, TTP over medial elbow Exam is limited by suboptimal patient positioning due to patient pain during the exam. Several sequences were repeated.LIGAMENTS: The ligaments are grossly intact.TENDONS: The extensor and flexor tendons are grossly normal. The biceps and brachialis tendons are grossly unremarkable.ARTICULAR SURFACES AND BONE: There is extensive bone marrow edema within the proximal ulna, with a fracture of the coronoid process with minimal volar displacement of a small fracture fragment. Additional bone marrow edema of the radial head/neck is compatible with a contusion. There is a moderate elbow joint effusion. SURROUNDING STRUCTURES: No significant abnormality noted.

Output: 1.Fracture of the coronoid process of the ulna as above.2.Bone contusion of the radial head/neck.


Instruction: Generate impression based on findings.

Input: Low back pain with sports for months. There is facet arthropathy and ligamentum flavum thickening affecting L3 through S1, including mild trace effusions and a subcentimeter right L4-5 synovial cyst. In addition, there is a partial disc dessication and a disc bulge at L5-S1 with mild left and mild to moderate right neural foraminal stenosis. There is also slight disc bulging at L4-5 with minimal bilateral neural foraminal narrowing, The vertebral column alignment is within normal limits. The vertebral body heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology and the cauda equina nerve roots are unremarkable. The paravertebral soft tissues are unremarkable.

Output: 1. No discernible evidence of spondylolysis or spondylolisthesis.2. Degenerative spondylosis in the lower lumbar spine including facet arthropathy and ligamentum flavum thickening affecting L3 through S1, a partial disc dessication and a disc bulge at L5-S1 with mild left and mild to moderate right neural foraminal stenosis, and slight disc bulging at L4-5 with minimal bilateral neural foraminal narrowing,


Instruction: Generate impression based on findings.

Input: Clinical question: Stroke. Signs and symptoms: Stroke. Unenhanced CT of brain:Examination demonstrate findings consistent with a small vessel disease of indeterminate age. No definitive interval change is detected. Focal area of low-attenuation in the left paramedian pons is believed to represent a lacunar infarct of indeterminate age. This finding may have been present on the prior exam. Please correlate with clinical history and follow-up with an MRI.There is no evidence of hemorrhage or acute cortical stroke. Cortical sulci, ventricular system and all CSF cisterns remain within normal for patient stated age.

Output: 1.No evidence of hemorrhage, mass effect or midline shift.2.No definitive acute intracranial stroke.3.Findings consistent with small vessel disease of indeterminate age..


Instruction: Generate impression based on findings.

Input: 42-year-old male with new palpable right breast mass. Family history is positive for breast cancer in mother diagnosed at 60 years of age, as well as in 2 paternal aunts and a great niece. Patient has heterogeneously dense breast parenchyma, and the study is performed under Allenton protocol. Mild background parenchymal enhancement is noted bilaterally.Within the right breast, at the 6:00 position, there is an irregular heterogeneously enhancing mass measuring 3.3 x 2.1 x 1.8 cm. A 5 mm enhancing focus is also present in the medial right breast at the 4:00 position. This latter focus presents the heart internal septations on the T2 image, findings suggestive of a fibroadenoma.No abnormal enhancement is seen in the left breast. No abnormal lymph nodes are identified in either axillary or internal mammary region.

Output: 1. Highly suspicious 6:00 right breast mass, should undergo ultrasound-guided biopsy.2. Nonspecific benign-appearing enhancing focus in the right medial breast, with imaging characteristics suggestive of fibroadenoma. MRI guided ultrasound of the right medial breast recommended, preferably at the time of other 6:00 right breast mass biopsy, for further evaluation.BIRADS: 5 - Highly suggestive of malignancy.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration.


Instruction: Generate impression based on findings.

Input: 43 year old female with left breast 12-1 o'clock cancer with focus seen inferiorly on MRI, possible satellite. A targeted left ultrasound was performed for the MRI area of concern. 1 o'clock index lesion is re-identified. There is no definite solid or cystic mass identified in the expected area of the MRI abnormality in the 2-3 o'clock position.

Output: No definite sonographic correlate found for MRI enhancing focus in the left breast. MRI guided biopsy is recommended. Results and recommendation discussed with the patient and Dr. Jaskowiak.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: 10-year-old male with a history of Crohn's disease with multiple perianal fistulas/abscesses status post removal draining seton presents with increased irritation, induration, and pain. BONE MARROW: No significant abnormality noted.SOFT TISSUES: No abscess or drainable fluid collection is identified. High T2 signal in the soft tissues of the perineum with contrast enhancement likely reflects induration (series 1201, image 77). Hypointense foci adjacent to the rectum (series 401, image 48) with streaking linear high T2 signal (series 401, image 49). JOINTS: No significant abnormality noted.ADDITIONAL

Output: 1. Hypointense foci adjacent to the rectum with streaky linear abnormal signal is suspicious for residual or early recurrent enterocutaneous fistula.2. Abnormal enhancing signal the soft tissues of the perineum likely reflects induration.3. No abscess or drainable fluid collection is identified.


Instruction: Generate impression based on findings.

Input: Clinical question: Ischemia versus others. Signs and symptoms: AMS. Nonenhanced brain MRI:Negative diffusion weighted images.Few nonspecific punctate foci of flair hyperintensity in bilateral cerebral hemispheres demonstrate no appreciable interval change.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination.The signal void of major intracranial arterial branches are identified.Calvarium and soft tissues of the scalp are unremarkable.Unremarkable images through the orbits, paranasal sinuses and mastoid air cells.

Output: 1.No acute or new findings since prior exam.2.Few tiny nonspecific nonspecific foci of flair hyperintensity of cerebral hemispheres and without change since prior exam.3.Unremarkable nonenhanced brain MRI otherwise.


Instruction: Generate impression based on findings.

Input: Male, 69 years old, history of smouldering multiple myeloma, now with new lesions seen on skeletal survey. Assess for additional bony disease. Cervical:No areas of concerning marrow signal replacement, edema or enhancement are seen. Vertebral body morphology is normal. Spinal alignment is anatomic. Spinal cord signal intensity and morphology are within normal limits.Mild facet hypertrophy is seen within the cervical region, most severely affecting C7-T1 on the right. Small central disk osteophyte complexes are also present at C3-4 and C4-5. No high-grade spinal canal or neuroforaminal stenosis is suspected.Thoracic:No areas of concerning marrow signal replacement, edema or enhancement are seen. Vertebral body morphology is normal. Spinal alignment is anatomic. Spinal cord signal intensity and morphology are within normal limits.Scattered facet hypertrophy is seen through the thoracic spine. No significant degenerative disk disease, spinal canal or neuroforaminal stenosis is suspected.Lumbar:No areas of concerning marrow signal replacement, edema or enhancement are seen. Vertebral body morphology is normal allowing for small Schmorl's nodes the superior endplates of L2 and L3. Spinal alignment is anatomic. The visualized conus and cauda equina demonstrate normal signal intensity and morphology.L1-2: Mild facet hypertrophy and ligamentum flavum thickening. No significant spinal canal or neuroforaminal stenosis. L2-3: Moderate facet hypertrophy and ligamentum flavum thickening. Mild bulging disk. Mild generalized spinal canal stenosis. Moderate bilateral foraminal narrowing. L3-4: Moderate facet hypertrophy and ligamentum flavum thickening. Mild bulging disk. Mild generalized spinal canal stenosis. Moderate to severe bilateral foraminal narrowing. L4-5: Moderate facet hypertrophy and ligamentum flavum thickening. Mild bulging disk with a small superimposed central protrusion. No significant spinal canal stenosis. Moderate bilateral foraminal narrowing. L5-S1: Moderate facet hypertrophy. Mild bulging disk with small central annular fissure. No significant spinal canal or neuroforaminal stenosis.

Output: No evidence to suggest myelomatous disease in the spine.


Instruction: Generate impression based on findings.

Input: Female 54 years old Reason: eval for lumbar spine abnormality History: Hx of Von Hippel Lindau w/ new right sided back pain There is mild kyphosis at the thoracolumbar junction. The vertebral body heights are preserved. Minimal disc desiccation and loss of height of L3-4 and L5-S1. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and terminates at the L1-L2 level. There are innumerable, partially visualized cystic lesions replacing the kidneys bilaterally, some with fluid-fluid levels. Partially imaged cystic lesion in the pelvis, likely left adnexa. Multiple (greater than 10) enhancing nodules along the surface of the conus, from T12 to L1, as well as along the cauda equina nerve roots bilaterally (also present on prior MRI from 2012). The relatively larger nodules along the conus surface are similar to the prior exam (up to approximately 5 mm in diameter), but punctate additional lesions appear new or more prominent, which may be related to technique/contrast timing.Interspace observations:T12-L1: There is no significant compromise to spinal canal or neural foramina.L1-L2: There is a small right paracentral protrusion, minimally smaller compared to the prior exam, without significant compromise to spinal canal or neural foramina.L2-L3: Minimal disc bulge without significant compromise to spinal canal or neural foramina. L3-L4: There is no significant compromise to spinal canal or neural foramina.L4-5: There is no significant compromise to spinal canal or neural foramina.L5-S1: There is a minimal central protrusion without significant compromise to spinal canal or neural foramina.

Output: 1.Multiple, greater than 10, enhancing nodules along the surface of the conus and along the bilateral cauda equina nerve roots which are consistent with multiple hemangioblastomas in the setting of vHL. The relatively larger nodules measuring up to 5 mm are similar to prior MRI from 2012 while some of the smaller punctate lesions appear new or more prominent in the interval. The subtle differences may be related to contrast timing although minimal enlargement remains a possibility.2.Minimal degenerative change without significant spinal canal or neural foraminal stenosis at any level.3.Partially visualized cystic lesions of the native kidneys and left adnexa.