Instruction: Generate impression based on findings.

Input: 6-year-old male with history of osteomyelitis status post antibiotics for 7 weeks. Again demonstrated are surgical changes relating to previous debridement of the first phalanx involving the distal metatarsal. Foci of susceptibility artifact indicate postsurgical calcification/blood product. There remains decreased T1 signal in the distal most aspect of the lateral portion of the remaining portions of the first metatarsal with associated T2 signal abnormality and overlying soft tissue ulceration/sinus tract. These findings are compatible with osteomyelitis. Further, there is additional minimally increased signal in the heads of the second and third metatarsals, likely reactive edema and unchanged from prior examination. There is no osteolysis of the second or third metatarsals.The diffuse soft tissue edema, particularly about the plantar musculature and retinaculum is not significantly changed in comparison to prior examination.

Output: Not significantly changed findings related to osteomyelitis of the distal aspect of the first metatarsal.


Instruction: Generate impression based on findings.

Input: Pituitary lesion with vision changes that developed during pregnancy. The pituitary gland has decreased in size, measuring up to 12 mm in craniocaudal dimension, previously 22 mm. In addition, there is now only a residual streaky area of non-enhancement in the mid portion of the gland. The pituitary gland nearly abuts, but no longer exerts mass effect upon the optic apparatus. The pituitary infundibulum and posterior pituitary bright spot are intact. There is mid mucosal thickening in the right maxillary sinus. The imaged portions of the brain are unremarkable.

Output: Interval decrease in size of the pituitary gland, with what may represent the sequela of necrosis, such as Sheehan syndrome, versus apoplexy.


Instruction: Generate impression based on findings.

Input: Compression of brain [G93.5] / Syringomyelia and syringobulbia [G95.0], Reason for Study: ^Reason: Chiari malformation decompression with syrinx, 6 month follow up History: 6 month follow up Fluid collection on the suboccipital craniectomy site has been decreased in size since prior scan (AP:22mm, RL:19mm, CC:35.4mm).Syrinx cavity is seen from the level of C34 to T4 level. Prominent segment of the cavity were seen at the level of C5 (AP:2mm x RL:4mm) and C67 level (AP:2.7mm x RL:3.4mm)There is vertebral body hemangioma at the level of T8, no change since prior scan.There is normal cervical lordosis. The cranial-cervical junction is normal. There is normal thoracic kyphosis and lumbar lordosis. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The remained cord signal is normal. The conus medullaris terminates at the level of L1-2.

Output: 1. Interval decreased size of suboccipital craniectomy site fluid collection.2. Cervico thoracic syrinx is again seen, no change since prior scan in its extent.


Instruction: Generate impression based on findings.

Input: 22-year-old female with lifelong, probable slow flow/venous malformation of the lower leg, increasing pain. There is proliferation of fatty tissue along the anteromedial aspect of the subcutaneous tissues of the leg. There is an extensive network of abnormal vasculature with variable degrees of enhancement surrounding an enlarged greater saphenous vein that begins approximately 6 cm below the knee joint and extends distally over a total length of 27 cm. The network of vessels appears to communicate with the posterior tibial vessels via a vessel that extends between the soleus and flexor digitorum longus muscle. There may also be communication with the distal peroneal vessels just above the ankle joint. More distally, the malformation extends deep to the tendons of the posterior tibialis and flexor digitorum longus, between the distal tibial metadiaphysis and flexor hallucis longus muscle, with fatty infiltration of the distal fibers of the posterior tibialis muscle which may represent a steal phenomenon. A component of this malformation also appears to extend within the anterolateral subcutaneous fat of the leg as well. The tibia and fibula appear normal.

Output: Vascular malformation as described above.


Instruction: Generate impression based on findings.

Input: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are no areas of abnormal parenchymal signal. There is mild asymmetry to the lateral ventricles with the right being larger than left and a slight medial outpouching of the right lateral ventricle results in mild mass effect on the right fornix. The hippocampi are symmetric and normal in appearance. There is no evidence of structural abnormality. The midline structures and craniocervical junction are within normal limits. There is no midline shift or herniation. The major cerebral flow voids are intact.

Output: Mild asymmetry to the lateral ventricles with the right being larger than left and a slight medial outpouching of the right lateral ventricle resulting in mild mass effect on the right fornix. This finding is of uncertain clinical significance and may simply reflect altered CSF flow dynamics. The exam is otherwise unremarkable.


Instruction: Generate impression based on findings.

Input: 34 yo F with HIV on HAART, depression, new onset HFrEF, tachycardia and chest pain. Referred for cardiac MRI to rule out infiltrative vs ischemic disease vs myocarditis.MEDICATIONS: abacavir, dolutegravir, lamivudine, albuterol, captopril, ASA, diphenhydramine, nystatin, fluticasone, furosemide, nicotine patch. First Pass PerfusionDuring hyperemia, no perfusion defects were present. Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable.Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 17%, the LV end diastolic volume index is 150 ml/m2 (normal range: 65+/-11), the LVEDV is 253 ml (normal range 109+/-23), the LV end systolic volume index is 124 ml/m2 (normal range 18+/-5), the LVESV is 209 ml (normal range 31+/-10), the LV mass index is 65 g/m2, and the LV mass is 110 g. There is global hypokinesis. The native T1 myocardial relaxation time is <1100 ms suggestive of absence of underlying fibrosis, infiltration or inflammation.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 48%, the RV end diastolic volume index is 66 ml/m2 (normal range 69+/-14), the RVEDV is 111 ml (normal range 110+/-24), the RV end systolic volume index is 34 ml/m2 (normal range 22+/-8), and the RVESV is 58 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is trivial aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is at least mild 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.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC drain normally into the right atrium. PericardiumThere is a trivial pericardial effusion.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. No perfusion defects/ "ischemia" present during hyperemia.2. No late gadolinium enhancement. No prior myocardial infarction. The entire myocardium is viable.3. Severely dilated LV with severely reduced global systolic function (LVEF 17 %).4. Normal RV size with mildly reduced systolic function (RVEF 48%).I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Left sided stroke: Right hemiparesis. Brain MRI: There are areas of gyriform restricted diffusion and high T2 signal in the left parietal lobe adjacent to an underlying area of encephalomalacia, with associated cortical laminar necrosis and probable chronic microhemorrhages. There are also punctate foci of cortical and subcortical restricted diffusion and high T2 signal in the left frontal lobe. There is a background of mild scattered cerebral white matter T2 hyperintensity without restricted diffusion, which may represent chronic small vessel ischemic disease. There is no evidence of intracranial hemorrhage or mass. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Brain MRA: There is lack of flow-related enhancement of the imaged portions of the left internal carotid artery. There is reconstitution of flow in the left middle and anterior cerebral arteries at the circle of WIllis. The right vertebral artery appears to terminate as the PICA. There is a fetal right PCOM. The other cerebral arteries are unremarkable and there is no evidence of saccular aneurysms. Neck MRA: There is lack of enhancement through the left internal carotid artery. There is mild narrowing of the origin of the right internal carotid artery. The right vertebral artery is diminutive. The other portions of the major cervical arteries are intact.

Output: 1. Acute areas of infarction involving the left parietal and frontal lobes, mainly in a watershed distribution superimposed upon a chronic left parietal lobe infarct. 2. Significant steno-occlusive disease at the origin of the left internal carotid artery.


Instruction: Generate impression based on findings.

Input: History of right distal femur replacement for osteosarcoma. Knee pain with cystic mass over anteromedial knee. Evaluation of the knee and surrounding soft tissues is markedly limited by metallic susceptibility artifact arising from the patient's longstem total knee arthroplasty endoprosthesis device. There is a mass within the subcutaneous fat along the anteromedial aspect of the proximal tibial metaphysis, immediately medial to the anterior tibial tubercle. This extraosseous mass is approximately 3.5 x 3 cm in transverse dimension and 3.5 cm in craniocaudal dimension. This mass is of predominantly low signal intensity on T1-weighted images, high signal intensity on T2-weighted images, and shows peripheral enhancement following gadolinium administration. There is mild edema in the adjacent subcutaneous fat. The mass permeates the adjacent tibial cortex, extending into the medullary space anterior to the stem of the prosthesis. This intramedullary component of the mass is slightly more heterogeneous on T2-weighted images, and of intermediate signal intensity on T1-weighted images, showing little enhancement following gadolinium administration other than along the its periphery. This intramedullary process also extends posteromedially along the stem of the tibial component forming an additional lobule that shows peripheral enhancement following gadolinium administration. Overall, the intraosseous component is approximately 4.5 x 3 cm in transverse dimension and approximately 4 cm in craniocaudal dimension. Additionally, there is a subcentimeter focus of abnormal signal intensity within the lateral tibial plateau; I'm uncertain whether not this represents the same process.More proximally, evaluation of the soft tissues is extremely limited by susceptibility artifact. However, there is intermediate signal intensity on T1-weighted images and high signal intensity on the T2-weighted images in Hoffa's fat pad which could conceivably reflect an extension of the aforementioned process along the anterior margin of the endoprosthesis construct. More proximally, there is abnormal signal intensity along the medial aspect of the condylar portion of the femoral component that is of similar signal intensity to the aforementioned process and shows both nodular and rim enhancement following gadolinium administration. Accurate measurement of this component of the process is difficult but I suspect that it is approximately 4 x 1 cm in transverse dimension and 3 cm in craniocaudal dimension.

Output: Soft tissue mass along the anteromedial aspect of the proximal tibial metaphysis that extends into the proximal tibia, and possibly superiorly into Hoffa's fat pad and along the medial aspect of the condylar portion of the femoral component. Although there is relatively minimal enhancement of this mass, I cannot exclude recurrence of osteosarcoma given the relatively aggressive nature of the extension of this process. Alternatively, this may reflect infection or a peculiar foreign body/particle reaction.


Instruction: Generate impression based on findings.

Input: Reason: Thumb-CMC and MCP pain-possible UCL injury History: pain and injury There is a tear of the ulnar collateral ligament from its attachment to the base of the proximal phalanx of the thumb. There is mass-like low signal intensity along the ulnar aspect of the first metatarsal head, underlying the adductor aponeurosis, suggestive of a Stener lesion. There is mild edema within the surrounding soft tissues about the first MTP joint as well as a small amount of fluid within the joint. The proximal phalanx of the thumb appears to be slightly volarly subluxed. The radial collateral ligament appears intact. The basilar joint is normal. There is a small cyst within the capitate which is probably of no clinical significance.

Output: Ulnar collateral ligament tear with probable Stener lesion.


Instruction: Generate impression based on findings.

Input: There is redemonstration of extensive diffuse patchy increased T2/FLAIR signal within the periventricular and, to a lesser degree, subcortical white matter as well as the brainstem and cerebellar peduncles without significant interval change. Many of the foci of increased T2/FLAIR signal also demonstrate decreased T1 signal, not significantly changed. No abnormal intracranial enhancement is identified. There is moderate diffuse volume loss affecting the cerebrum and cerebellum appearing similar to prior. The corpus callosum is again thin. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull and scalp soft tissues are unremarkable. There is mild mucosal thickening within the paranasal sinuses and a small mucous retention cyst within the right maxillary sinus.

Output: 1.Stable white matter signal abnormality without enhancement consistent with multiple sclerosis. Overall, moderate T1 and moderate-severe T2 burden of disease2.Moderate diffuse brain volume loss greater than expected for patient's stated age, consistent with history of MS.


Instruction: Generate impression based on findings.

Input: Right knee instability The examination is limited by metallic artifact from an intramedullary rod in the proximal tibia.MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: There is perhaps mild thinning of the articular cartilage of the medial compartment but there are no full-thickness cartilage defects identified.LIGAMENTS: No significant abnormality noted. Specifically, the ACL is intact.EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: No evidence of internal derangement of the knee. Specifically, the ACL is intact.


Instruction: Generate impression based on findings.

Input: Facial weakness [R29.810], Reason for Study: ^Reason: L facial droop History: L facial droop Brain MRIThere is restricted diffusion on the right side basal ganglia and right caudate nucleus head. These lesions are mixed with T2/FLAIR high signal intensity lesions thus indicating acute/subacute ischemic infarct.On gradient echo images, especially on the lateral aspect of the lesion show subtle susceptibility artifacts indicating possible hemorrhagic transformation. However, this lesion shows in close proximity to the brain show right side middle thalamic vein, thus could represent venous flow related artifacts.There is linear subcortical FLAIR high signal intensity lesions on the right side inferior parietal lobule (series 1101, image 23) without showing restricted diffusion which indicate age indeterminate likely chronic ischemic infarction.Subtle increased signal intensity of the right central sulcus on FLAIR (series 1101, image 26). However, since this finding is not associated with restricted diffusion or evidence of hemorrhage but shows prominent tubular structure on Gradient echo (series 1001, image 90), this finding could represent an artifacts related to relatively slow cortical venous flow. 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. The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate complete occlusion of the right MCA at the point of right internal carotid artery intracranial bifurcation. An enteric indicating artery is patent bilateral posterior communicating artery are also patent.Vertebrobasilar system as well as left internal carotid artery, left MCA and bilateral anterior cerebral arteries appear to be normal.

Output: 1. Constellation of above findings indicate right MCA complete occlusion related multistage ischemic infarctions with acute ischemic infarction involving right basal ganglia.2. Possibility of focal hemorrhagic transformation cannot completely excluded especially lateral aspect of the acute ischemic infarction.3. Cortical venous slow flow and chronic subcortical ischemic infarction may indicate possible low perfusion status. Thus, if clinically indicated, CT perfusion study can be considered for further physiologic imaging evaluation.


Instruction: Generate impression based on findings.

Input: Reason: evaluate for medial meniscus and acl tears History: pain, effusion, clicking. Metallic artifact within the proximal tibia related to bullet fragments.MENISCI: Complete loss of the anterior body and horn of the lateral meniscus. The posterior horn of the lateral meniscus is intact.Globular intrasubstance signal involving the undersurface of the anterior body and the free edge of the anterior horn of the medial meniscus likely due to degeneration overlying the prior tibial plateau fracture.ARTICULAR CARTILAGE AND BONE: Thinning of the articular cartilage anteriorly along the medial tibiofemoral compartment. Near complete loss of articular cartilage anteriorly along the lateral tibiofemoral compartment. Deformity and postsurgical changes of the proximal tibia compatible with prior tibial plateau fracture.LIGAMENTS: The cruciate and collateral ligaments are intact.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: Complete loss of the anterior body and anterior horn of the lateral meniscus. Degeneration of the undersurface of the anterior body and anterior horn of the medial meniscus. Associated cartilage loss. These findings likely are related to patient's prior tibial plateau fracture.


Instruction: Generate impression based on findings.

Input: Clinical question: Rule out vessels and hemorrhage. Signs and symptoms: As above. Nonenhanced brain MRI:The examination demonstrates a previously known large new right thalamic acute hematoma measuring at 27 x 35mm in transaxial dimension. There is surrounding vasogenic edema and resultant mass effect on the third ventricle however without evidence of midline shift. There is dissection of hemorrhage into the ventricular system as was noted on prior study and without significant change. There is mild dilatation of the supratentorial ventricular system (right greater than left without significant change since prior study. A left frontal approach ventricular catheter with the tip in the body of right lateral ventricle similar to prior exam is again noted.Additionally examination demonstrate multiple small foci of flair hyperintensity in bilateral subcortical and periventricular white matter as well as right basal ganglia consistent with chronic small vessel ischemic strokes.Small foci of hemorrhagic encephalomalacia in the left anterior frontal and a smaller in the right anterior frontal lobes as noted on prior exam.Nonenhanced brain MRA:Examination demonstrate no evidence of vascularity within the right thalamic hemorrhage or in the surrounding brain parenchyma to suggest a vascular malformation.Bilateral internal carotid arteries remain widely patent across the skull base and in their supraclinoid segments.Bilateral anterior and middle cerebral arteries are patent. There is a tiny vascular outpouching along the superior aspect of the right M1 segment of middle cerebral artery is present and is suggestive of a tiny infundibulum. Less likely possibility of a small aneurysm cannot be entirely excluded however. Distal branches of bilateral anterior and middle cerebral arteries are unremarkable. There is no detectable abdomen AP at the level anterior communicating artery. Bilateral two arteries, bilateral pica branches, basilar artery and all of its branches are visualized and unremarkable.

Output: 1.Nonenhanced brain MRI demonstrate no evidence of any acute or new finding since prior exam. Acute hematoma in the right thalamus, surrounding vasogenic edema, dissection of hemorrhage into the ventricular system remain all very similar to prior study. Shunted lateral ventricles demonstrate no change in size or position of the left ventricular catheter. Chronic small vessel ischemic strokes and bilateral anterior frontal (left greater than right) encephalomalacia as was noted on prior studies.2.Nonenhanced brain MRA demonstrate no detectable increased vascularity within the right thalamic hemorrhage or its surrounding parenchymal. All major intracranial arteries and their distal branches remain patent. Tiny focus of vascular outpouching along the superior aspect of right MCA is believed to represent an infundibulum. Less likely possibility of a tiny aneurysm cannot be entirely excluded. Unremarkable nonenhanced MRI otherwise.


Instruction: Generate impression based on findings.

Input: Right shoulder pain ROTATOR CUFF: There is a full-thickness, near complete tear of the supraspinatus tendon at its insertion with approximately 1 cm of retraction. There appears to be additional delamination and proximal retraction of the undersurface fibers of the supraspinatus tendon. There is mild fatty atrophy of the supraspinatus muscle along the myotendinous junction but otherwise the muscle is normal. The distal infraspinatus tendon also appears thinned likely representing extension of the aforementioned supraspinatus tear but there is no convincing evidence of a full-thickness infraspinatus tear. The infraspinatus muscle is normal. The teres minor and subscapularis tendons and muscles are intact.SUPRASPINATUS OUTLET: There is minimal osteoarthritis of the acromioclavicular joint. A small amount of fluid is present within the subacromial subdeltoid bursa presumably secondary to the rotator cuff tear described above.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is distortion of the anterior and posterior labrum which may reflect degeneration and chronic tearing. There is also increased signal intensity within the superior labrum suggesting a tear. Separation of the anterior superior labrum may represent additional tearing or conceivably a sublabral foramen. There is a small amount of fluid within the glenohumeral joint but no large joint effusion. A small amount of fluid is also seen anterior to the subscapular recess which may reflect a mild subcoracoid bursitis. Degenerative cysts are noted within the greater tuberosity.BICEPS TENDON: There is questionable longitudinal splitting of the tendon of the long head of the biceps at its anchor but otherwise the biceps tendon is intact.

Output: Rotator cuff tear with other findings as described above.


Instruction: Generate impression based on findings.

Input: Essential (primary) hypertension [I10], Reason for Study: ^Reason: R/O ischemic stroke History: left facial weakness Brain MRIThere is no evidence of acute ischemic or hemorrhagic lesion on the scan.Small susceptibility lesion on the left thalamus indicates either mineralization or chronic hemosiderin deposition.Patch bilateral periventricular white matter T2/flair high signal intensity lesions are nonspecific, most likely indicate nonspecific small vessel ischemic disease.Multifocal lacunar infarcts are seen in bilateral thalami and right basal ganglia.The ventricles, sulci and cisterns are unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate luminal stenosis (or than 50%) at the right MCA M1 segment and right distal ICA cavernous sinus segment. Otherwise no significant luminal stenosis on the left ICA, bilateral ACA and left MCA. Vertebrobasilar system appears to be normal.Neck MRA3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate more than 80% luminal stenosis on the right extracranial internal carotid artery just above the bifurcation.The left carotid bifurcation shows irregularity of the lumen, however, the degree of luminal stenosis is less than 50%.The vertebral artery origins are normal.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. Nonspecific small vessel ischemic disease with multifocal lacunar infarcts.3. Intracranial as well as extracranial significant arterial luminal stenosis on the right side craniofacial arterial system. In particular, or than 80% luminal stenosis of the right extracranial proximal internal carotid artery and more than 50% right MCA M1 segment.


Instruction: Generate impression based on findings.

Input: 44 years Female (DOB:10/10/1971)Reason: evaluate for mets History: hx of CAPROVIDER/ATTENDING NAME: HEMAL M. NAYAK HEMAL M. NAYAK There are multiple foci of diffusion restriction present particularly in the watershed zone between the anterior middle cerebral arteries bilaterally but also along the left superior frontal gyrus and left cuneus and paracentral lobule. Many of these display contrast enhancement following gadolinium administration. Additional small patchy foci of diffusion restriction are present in the cerebellum predominantly in the inferior aspect of the left cerebellar hemisphere but also present in the right cerebellar hemisphere. A couple of these lesions display microhemorrhages.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.Multiple patchy foci of diffusion restriction suggestive of metastatic disease are present diffusely in the brain in the mixed watershed and small embolic pattern of distribution. Many of these are associated with contrast enhancement suggestive of subacute phase. Please note that this reduces the detection rate for metastatic disease. If there is clinical suspicion for metastases a follow-up exam would help assess this further.


Instruction: Generate impression based on findings.

Input: Toe pelvic region and thigh pain. History of of low back pain for years in the right stiffness and foot. For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. There is normal lumbar lordosis. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. The conus medullaris terminates at the L1-L2 level.Degenerative changes are specified by the intervertebral level as follows: T12-L1: no neuroforaminal narrowing or spinal stenosis. L1-L2: no neuroforaminal narrowing or spinal stenosis. L2-L3: no neuroforaminal narrowing or spinal stenosis. L3-L4: no neuroforaminal narrowing or spinal stenosis. L4-L5: Minimal bulging of disc, no neuroforaminal narrowing or spinal stenosis. L5-S1: no neuroforaminal narrowing or spinal stenosis.

Output: Minimal bulging of disc at the level of L4-5 otherwise unremarkable.


Instruction: Generate impression based on findings.

Input: Clinical question to be answered: Evaluate interval change. Signs and symptoms: Worsening mental status. In comparison with the prior examination extensive post operative changes remain stable. Extensive CSF collection under the scalp is redemonstrated. Intracranially no evidence of any new area of hemorrhage. There is however a significant thickening and minimally high density of the cortex of the left hemisphere possibility of petechial hemorrhage within this thickened cortex is suspected. This can be further evaluated by an MRI. Multiple areas of low attenuation (likely edema) within the cortex of the left hemisphere are consistent with areas of cortical stroke. Images at the level of the sylvian fissure on the left demonstrate thrombosed branches of left MCA. This is believed to be secondary to clipping of the feeding pedicles to the AVM.Overall degree of mass effect remains a stable and minimal midline shift demonstrates no interval change. Minimal blood within the dependent portion of the left lateral ventricle is redemonstrated. Minimal blood within the subarachnoid space on the right may be secondary to placement of pressure monitor.

Output: Overall stable CT examination of brain. Please see above comments.


Instruction: Generate impression based on findings.

Input: 5 years, Male, tongue and palate palsy. Rule out abscess, stroke, or other intracranial abnormality. Brain: There is susceptibility artifact related to EEG leads which degrades some of the sequences. Brain parenchyma appears within normal limits. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. No extra-axial collections. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved. Sella and orbits are grossly within normal limits. Mild mucosal thickening is noted in the right maxillary and sphenoid sinuses. Neck: There is prominence of the adenoidal and palatine tonsillar tissue. There is also mild prominence of the bilateral lateral retropharyngeal lymph nodes as well as additional bilateral cervical lymph nodes throughout the neck. For example a right level 2 lymph node measures 11 mm in the short axis. No fluid collections in the neck. No lesions involving the skull base are appreciated. Visualized salivary glands appear unremarkable. Airway is patent. Visualized cervical spine is unremarkable.

Output: 1. Brain MRI appears within normal limits. Specifically no evidence of infarct or intracranial abscess.2. Prominence of the nasopharyngeal and oropharyngeal lymphoid tissue as well as mild prominence of the cervical lymph nodes. These findings are nonspecific and may be reactive. Lymphoproliferative disorder may also be considered in the appropriate clinical setting. No fluid collections or other masses in the neck.


Instruction: Generate impression based on findings.

Input: Male, 50 years old, history of lumbar ependymoma resection, baseline evaluation. A few scattered small foci of T2 hyperintensity are evident within the cerebral white matter which are nonspecific. No edema or mass effect is detected. There is no evidence of pathologic parenchymal or extra-axial enhancement. Diffusion weighted images are normal.No evidence of acute intracranial hemorrhage or any abnormal extra-axial fluid is seen. The ventricles are normal in size and morphology. The basal cisterns are patent.The bone marrow signal characteristics are within normal limits. No abnormalities of the paranasal sinuses are seen.

Output: No evidence of metastatic disease to the brain.


Instruction: Generate impression based on findings.

Input: History of pancreatic cyst. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology, size, signal intensity and enhancement. No biliary ductal dilatation or vascular abnormality. No focal suspicious liver lesion. Distended gallbladder without cholelithiasis or wall thickening or adjacent inflammatory changes.SPLEEN: No significant abnormality noted.PANCREAS: There are several subcentimeter pancreatic body T2-weighted hyperintense cystic lesions with thin walls and no mural nodularity. The post-contrast images are degraded due to patient motion, but there is no suspected enhancement. These are compatible with side branch IPMNs. The pancreatic duct is normal in caliber.The pancreatic parenchymal T1 weighted signal is decreased suggesting parenchymal dysfunction. Otherwise the parenchyma enhances homogeneously.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Several bilateral simple and septated renal cysts.RETROPERITONEUM, LYMPH NODES: Atherosclerotic disease of the abdominal aorta without aneurysmal dilatation.BOWEL, MESENTERY: No significant abnormality noted. Small umbilical fat-containing hernia.BONES, SOFT TISSUES: No significant abnormality noted. Nonspecific asymmetric patchy heterogeneous bone marrow signal intensity.OTHER: No significant abnormality noted.

Output: 1. Several pancreatic body subcentimeter side-branch IPMNs.2. Nonspecific asymmetric patchy heterogeneous bone marrow signal intensity, may reflect a hematologic dyscrasia.


Instruction: Generate impression based on findings.

Input: 65-year-old female with metastatic pancreas and new pancreatic tail lesion seen on recent CT. ABDOMEN:LIVER, BILIARY TRACT:Hepatic steatosis. No discrete suspicious lesion or pathologic enhancement to suggest metastatic disease.Patent portal and hepatic vasculature. No intrahepatic or extrahepatic biliary ductal dilation.SPLEEN: No significant abnormality noted. Patent splenic vein.PANCREAS:Hypodense lesion seen near the tail of the pancreas on prior CT correlates with a low T2 signal lesion with restricted diffusion and enhancement, compatible with tumor and measuring up to 1.6 x 1.8 cm (series 1203/54), not significantly changed in size since prior CT. The lesion demonstrates central hypoenhancement, likely due to central necrosis. Infiltrative, ill-defined tumor in the region of the pancreatic neck is also not significantly changed in size since prior CT. The pancreatic tail lesion is best seen on diffusion weighted images and appears to connect to the pancreatic neck infiltrative lesion. As a result of this finding, the pancreatic tail lesion is most likely related to increased infiltrative tumor rather than a new or metastatic lesion.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No evidence of peritoneal metastasis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Hypodense lesion seen near the tail the pancreas on prior CT is due to tumor, felt to be likely due to increased size of known infiltrative tumor in the region of the pancreatic neck based on appearance on DWI sequence, metastatic lymph node or new additional metastatic lesion considered less likely.


Instruction: Generate impression based on findings.

Input: Reason: Right shoulder MR arthrogram - evaluate for reinjury of previously repaired rotator cuff. ROTATOR CUFF: There is a full-thickness tear and retraction of the supraspinatus tendon. The infraspinatus and subscapularis muscles are intact. There is a high riding humeral head consistent with the supraspinatus tear.SUPRASPINATUS OUTLET: No gross abnormality.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint and the glenoid labrum are intact.BICEPS TENDON: The significant abnormality of the biceps tendon. ADDITIONAL

Output: Complete tear and retraction of the supraspinatus tendon.


Instruction: Generate impression based on findings.

Input: Pancreatic IPMN. ABDOMEN:LIVER, BILIARY TRACT: Unchanged small right lobe simple cyst. No focal suspicious lesion. No biliary ductal dilatation or vascular abnormality.SPLEEN: Stable small splenic cyst.PANCREAS: Fatty atrophy of the pancreas. Multiple pancreatic cystic lesions.The largest is in the mid body measuring 1.6 x 1.1 cm (series 11/23), unchanged. The numerous additional subcentimeter cystic foci are not significantly changed in size dating back to 7/8/2011. No enhancing nodularity. The main pancreatic duct is normal in size.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable left renal superior pole simple cyst.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: No significant interval change in the size or number of multiple pancreatic cystic lesions compatible with side branch IPMNs.


Instruction: Generate impression based on findings.

Input: Female, 15 years old. RUQ pain, cholelithiasis on US. LIVER, BILIARY TRACT: There is intrahepatic and extra hepatic biliary ductal dilatation, with the common bile duct measuring up to 11 mm in diameter. An 8 mm obstructing stone is seen within the common bile duct distal to the cystic duct and just superior to the level of the pancreatic head. Distal to this level, the common bile duct is normal in caliber. An additional stone is noted within the gallbladder, without gallbladder wall thickening or surrounding edema. No focal hepatic lesions.SPLEEN: No significant abnormality noted.PANCREAS: The pancreatic duct is normal in caliber.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: The kidneys enhance symmetrically, without focal lesion or hydronephrosis. No obstructing urinary stone.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No abnormal bowel wall thickening or evidence of obstruction. No free intra-abdominal air or abnormal free fluid.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Obstructing common bile duct stone. No evidence of acute cholecystitis.


Instruction: Generate impression based on findings.

Input: Male; 46 years old. Reason: patient with ulcerative colitis found to have rectal adenocarcinoma on colonoscopy evaluate wall invasion and lymph nodes History: same PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Scattered subcentimeter perirectal and bilateral pelvic sidewall lymph nodes are not enlarged by size criteria.BOWEL, MESENTERY: In the distal rectum along the right anterolateral wall approximately 10 cm from the anal verge, there is mild increased mucosal and wall enhancement with slight thickening in a curvilinear fashion measuring up to 2 x 0.5 cm (AP by transverse, series 1303/368). This finding is nonspecific and may be related to postsurgical change from recent colonoscopy, however, this also may be due to underlying tumor given that a sessile lesion was seen near this location on recent colonoscopy. No focal, intraluminal mass. No evidence of perirectal fat invasion.At the 7 o'clock position near the anal verge, there is a rim-enhancing lesion at the 7 o'clock position measuring up to 1 cm and extending to the skin surface of the right medial gluteal cleft, suspicious for small perianal abscess.Submucosal fatty infiltration of the visualized signal rectal colon, most likely due to chronic inflammatory bowel disease. There is also perirectal fibrofatty proliferation. The partially visualized proximal colon is collapsed, limiting evaluation.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Mucosal and wall enhancement with slight thickening of the rectum as detailed above, which is nonspecific and may be related to postsurgical change from recent colonoscopy versus known underlying lesion. No definite mesorectal fat invasion.2.Small perianal abscess, measuring up to 10 mm.3.Findings of chronic inflammatory bowel disease.4.Subcentimeter perirectal and bilateral pelvic sidewall lymph nodes are not enlarged by size criteria.


Instruction: Generate impression based on findings.

Input: 71-year-old female with brain metastases, status post stereotactic radiosurgery Redemonstrated are enhancing lesions involving the right inferior parietal lobule as well as left post central gyrus, unchanged in appearance. A left temporal occipital lesion is no longer discernible. There are no new enhancing foci.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: Redemonstrated are enhancing lesions involving the right inferior parietal lobule as well as left post central gyrus, unchanged in appearance. A left temporal occipital lesion is no longer discernible. There are no new enhancing foci.


Instruction: Generate impression based on findings.

Input: There is no acute infarct, suspicious intracranial enhancement, mass, or cerebral edema. There are scattered periventricular and subcortical T2 hyperintensities which are nonspecific and likely representing chronic microvascular ischemic changes similar to prior exam. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable.

Output: Mild chronic small vessel ischemic changes similar to prior. No acute infarct, intracranial mass, or mass effect.


Instruction: Generate impression based on findings.

Input: 33-year-old female with history of sickle cell disease and anti-phospholipid syndrome presenting with altered mental status, agitation, and tachycardia. Rule out acute intracranial abnormalities. There is no evidence of intracranial hemorrhage, mass or edema. The ventricles are midline and demonstrate normal morphology and volume. Increased density in the suprasellar cistern may be due to partial volume averaging, though correlation with MRI may be helpful to further evaluate as clinically indicated.The calvaria and skull base are radiographically normal. There has been interval partial opacification of the right mastoid air cells and right frontal sinuses, with the remainder the visualized paranasal sinuses are normally pneumatized.

Output: 1. Mild inflammatory changes around the visualized right mastoid air cells.2. Increased density in the suprasellar cistern may result from artifact, though correlation with MRI to assess for sellar pathology may be helpful if clinically indicated.


Instruction: Generate impression based on findings.

Input: Right shoulder pain and long thoracic nerve palsy, assess for rotator cuff or labral lesion ROTATOR CUFF: There is tendinopathy of the supraspinatus tendon. Otherwise, the rotator cuff appears normal without evidence of tear.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is an irregularly of the anterior inferior labrum that may represent fraying and/or scarring. There is no communication of contrast between the glenohumeral joint and the subacromial/subdeltoid bursas. We see no tears.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: 1. Tendinopathy of the supraspinatus tendon.2. Irregularity of the anterior inferior labrum that may represent fraying and/or scarring.


Instruction: Generate impression based on findings.

Input: Significantly limited exam due to susceptibility artifact from cochlear implant, motion artifact and fast imaging technique. Changes associated with sinonasal surgery are seen. Mucosal thickening in the bilateral maxillary sinuses and opacification of scattered ethmoid air cells appear similar or slightly improved from a prior MR brain study. Mild rightward deviation of the nasal septum. The imaged orbits appear unremarkable. The airway is patent. No definite abnormal enhancing mass.

Output: Severely limited exam as above. Within these limitations, no gross mass is identified.


Instruction: Generate impression based on findings.

Input: 56-year-old female with lung cancer status post chemotherapy and radiation, new suspicious left renal mass ABDOMEN:LIVER, BILIARY TRACT: Arterial enhancing focus in inferior right lobe of liver, segment six, is nonspecific. Multiple T2 hyperintense, nonenhancing foci are too small to characterize although likely reflect cysts.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Redemonstrated is a hypoenhancing, low T2 signal mass, with indistinct margins in the left interpolar kidney measuring 3.2 x 3.2 cm. There is no hydronephrosis or perinephric inflammation. A retroaortic left renal vein is patent.RETROPERITONEUM, LYMPH NODES: There is a peripherally enhancing left para-aortic lymph node measuring 1.8 x 1.6 cm (series 11, image 998). There is another left para-aortic lymph node measuring 1.1 x 1.5 cm (series 11, image 879). BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Hypoenhancing mass in the left kidney and regional lymphadenopathy as described above. Provided that there was no regional lymphadenopathy and FDG avid tumor evident on recent PET scan, findings are favored to represent metastatic disease.2.Arterial enhancing focus in inferior right lobe of liver, segment six, is nonspecific. Attention no subsequent imaging is suggested.


Instruction: Generate impression based on findings.

Input: History of hepatocellular carcinoma status post TACE/RFA. ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis within a partially contracted gallbladder with mild gallbladder wall thickening but no additional specific findings of gallbladder inflammation. Trace perihepatic ascites. Cirrhotic fibrotic liver morphology. No biliary ductal dilatation.The small segment 8 ablation cavity is unchanged without evidence of marginal recurrent or residual disease. No suspicious arterial enhancing and washing out lesion is noted in the liver. Dilated portal vein which is otherwise patent. Recanalized periumbilical vein.SPLEEN: Splenomegaly measuring 17 cm in craniocaudal length. Perisplenic varices.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral simple appearing cysts. No hydroureteronephrosis or suspicious lesion. Splenorenal shunt formation.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.Cirrhotic fibrotic liver morphology with an unchanged segment 8 ablation cavity. No evidence of recurrent or new disease.2.Findings of portal hypertension including splenomegaly and trace perihepatic ascites and collateral vessel formation.


Instruction: Generate impression based on findings.

Input: 48-year-old female with history of right breast cancer status post mastectomy in 2009 with autologous breast reconstruction. Patient received radiation, chemotherapy, and hormonal therapy. History of left breast reconstruction as well. Family history breast cancer diagnosed in sister at age 36. Personal history of Cowden syndrome. There is heterogeneous amount of fibroglandular tissue in left breast.Mild parenchymal enhancement is noted.There are stable postsurgical changes of a right mastectomy and breast reconstruction.There are stable enhancing foci in the left breast. No new or suspicious enhancement is seen in the left 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: 21-year-old male with pain. There is perhaps a small amount of fluid within the joint without evidence of a large effusion. No acute fracture or malalignment is evident. Deformity of the medial facet of the patella consistent with the patient's known history of osteochondral defect seen on prior MRI.

Output: No acute radiographic findings to account for the patient's pain. Other findings as described above.


Instruction: Generate impression based on findings.

Input: 48-year-old female with primary sclerosing cholangitis with elevated liver enzymes status post hepaticojejunostomy. ABDOMEN: LIVER, BILIARY TRACT: No suspicious hepatic lesions. Areas of dilation and stricturing of the intrahepatic biliary ducts, including tight strictures of the right and left hepatic ducts near the Klatskin's point, compatible with known primary sclerosing cholangitis. The caliber of the biliary tree is similar to prior study. Hepatolithiasis is present in both lobes, right greater than left. Hepaticojejunostomy is patent. Increased enhancement of the bile ducts diffusely with perfusional changes in the liver, suspicious for inflammatory cholangitis. Status post cholecystectomy. 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: Edema-like signal related to incision from recent hepaticojejunostomy within the anterior abdominal wall.OTHER: No significant abnormality noted.

Output: 1.Abnormal appearance of the biliary tree, compatible with PSC, with tight strictures of the right and left hepatic ducts. Patent hepaticojejunostomy.2.Hepatolithiasis.3. Findings suspicious for inflammatory cholangitis.


Instruction: Generate impression based on findings.

Input: 75 years Male (DOB:5/1/1940)Reason: assess for herniated disk, spinal stenosis History: groin pain and weakness. EMG with S1 pathologyPROVIDER/ATTENDING NAME: WILLIAM R. HARPER WILLIAM R. HARPER Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is loss of disc space height and disc desiccation and a mild disc bulge at this level.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is asymmetric loss of disc space height with more loss of disc space height on the right side compared to the left side of the disc space. There is partial effacement of the fat at the lateral recess bilaterally at this level which has mildly progressed compared to the previous exam. There are endplate reactive changes present at this level with some T2 signal hyperintensity suggestive of some acute or subacute endplate reactive change along the right half of the disc space.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is mild loss of disc space height, disc desiccation and diffuse disc bulge at this level which was also present on the prior exam.At L2-3 there is no significant compromise to spinal canal or neural foramina. There is disc desiccation present at this level.At L1-2 there is no significant compromise to spinal canal or neural foramina.Since the prior exam an abdominal aortic aneurysm has decreased significantly in size.There is redemonstration of a renal cyst along the right kidney which currently measures 33 x 24 mm axial dimensions and previously measured 24 x 19 mm axial dimensions.

Output: 1.There are degenerative changes present in the lumbar spine which appear to be worse at L4-5 where there is some subacute endplate reactive changes and mild encroachment of the nerve roots at the lateral recess is. Overall the findings at L4-5 have slightly progressed.2.Since prior exam a cyst along the right kidney has mildly enlarged3.The prior exam the patient is undergone abdominal aortic aneurysm repair


Instruction: Generate impression based on findings.

Input: 31-year-old male with liver lesions, cirrhosis, status post orthotopic liver transplant. ABDOMEN:LIVER, BILIARY TRACT: Postsurgical appearance of an orthotopic liver transplant are noted. Cirrhotic liver morphology. No suspicious liver lesions. The intrahepatic portal vein and hepatic veins are patent. There is a changing caliber at the confluence of the splenic vein and SMV. The splenic vein is chronically thrombosed with large splenic varices. There are large collaterals the region of the SMV.SPLEEN: Evidence of portal hypertension and chronic splenic vein thrombosis with large varices and splenomegaly measuring up to 26 cm. Low T1 and T2 punctate foci scattered throughout the spleen may represent Gamna-Gandy bodies.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: Small volume ascites an diffuse mesenteric edema is present, decreased since the prior exam. Small bowel caliber is within normal limits without evidence of obstruction.BONES, SOFT TISSUES: Fluid containing umbilical hernia.OTHER: Small right and trace left pleural effusions.

Output: 1.Change in caliber at the confluence of the SMV and splenic vein (varices) which may represent a site of anastomosis or a potential partial thrombosis of the SMV. The intrahepatic and central portal portal vein is patent.2.No suspicious focal liver lesions.3.Other findings as above.


Instruction: Generate impression based on findings.

Input: Female, 79 years old, with lumbar stenosis. All lumbar vertebral bodies demonstrate some degree of height loss. L1 is most severely affected with near complete loss of height centrally. L4 is the next most severely affected with approximately 70% loss of height. These findings are similar to prior.A kyphotic angulation of the spine is seen centered at L1. Stepwise mild retrolistheses of L2 on L3, L3 on L4, and L4 on L5 are seen, similar to prior.Marrow signal characteristics are heterogeneous and there is evidence of mild edema within the L1 vertebral body and along the endplates of L3-L5, likely degenerative in nature. Findings are unchanged. No worrisome marrow replacement is detected.The visualized spinal cord and conus are unremarkable. Details of the cauda equina are discussed below.With the exception of L1-2 and L5-S1, the intervertebral discs show severe loss of height. Additional level specific findings are as follows:T12-L1: Facet hypertrophy and ligamentum flavum thickening. Disc bulging, osteophytic spurring and mild vertebral body retropulsion. Mild generalized spinal canal stenosis. Mild foraminal narrowing. No significant interval changes.L1-2: Bulging disc asymmetric to the right. No significant spinal canal stenosis. Mild right foraminal narrowing. No interval changes. L2-3: Facet hypertrophy and ligamentum flavum thickening. Disc bulging and osteophytic spurring, asymmetric to the right. No significant generalized spinal canal stenosis. Moderate right and mild left foraminal narrowing. No significant interval changes.L3-4: Facet hypertrophy and ligamentum flavum thickening. Bulging disc and osteophytic spurring. Moderate to severe spinal canal narrowing with some crowding of the cauda equina. Moderate right and mild left foraminal narrowing. No significant interval changes.L4-5: Severe facet hypertrophy and ligamentum flavum thickening. Bulging disc and osteophytic spurring. Severe spinal canal stenosis with crowding and probable impingement of the cauda equina. Severe right and moderate left foraminal narrowing. No interval changes. L5-S1: Severe facet hypertrophy and ligamentum flavum thickening. Bulging disc. Moderate generalized spinal canal stenosis. No significant neuroforaminal narrowing. No significant interval changes.

Output: 1.No significant change in multilevel vertebral body compression deformities, most severely affecting L1 and L4.2.No significant change in severe disc degeneration with relatively severe spinal canal stenoses and right-sided foraminal narrowing at L3-4 and L4-5.


Instruction: Generate impression based on findings.

Input: 67-year-old male with a history of transient alteration of awareness and subdural hematoma on outside hospital examination. Follow up examination. There is encephalomalacia of the right superior frontal gyrus. These findings are consistent with the patient's history of right superior frontal infarct. There is no evidence of intracranial hemorrhage, mass or edema. Additionally, there are age indeterminant multiple scattered hypodensities in the periventricular and deep white matter. These findings are nonspecific and likely represent small vessel ischemic disease, however, if acute infarct remains a clinical concern further evaluation with MRI could be considered.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. No evidence of acute territorial infarct, intracranial hemorrhage, mass or edema.2. Encephalomalacia in the right superior frontal gyrus secondary to prior ischemic infarct.3. Age indeterminant multiple scattered hypodensities in the periventricular and deep white matter bilaterally. These findings are nonspecific and likely represent small vessel ischemic disease, however, if acute infarct remains a clinical concern further evaluation with MRI could be considered.


Instruction: Generate impression based on findings.

Input: VHL. Tumors or aneurysm? LIVER: The liver measures 15.2 cm in length. No focal liver lesions are evident.GALLBLADDER, BILIARY TRACT: No gallstones. The common duct measures 2 mm which is within normal limits.PANCREAS: Pancreas is replaced by numerous hypo and anechoic nodules of varying sizes. Many of these are nonspecific but are compatible with pancreatic cysts which occur in Hippel-Lindau disease. These are nonspecific on ultrasound and could be better characterized with CT or MRI if clinically indicatedRIGHT KIDNEY: No hydronephrosis of either kidney. The right kidney measures 10 cm in length and the left kidney measures 10.5 cm in length.OTHER: No significant abnormalities noted.

Output: Numerous cystic nodules in the pancreas which are nonspecific on ultrasound. Further characterization could be performed using CT or MRI if clinically indicated.


Instruction: Generate impression based on findings.

Input: 52 year old woman with history of right breast triple negative IDC on neoadjuvant chemotherapy. There is scattered fibroglandular tissue in both breasts.Minimal parenchymal enhancement is noted bilaterally.There is no enhancing focus seen at the site of previously seen right breast mass. No additional foci of abnormal enhancement are identified in either breast. A right axillary lymph node now measures 1.7 cm, previously 2.3 cm. No new lymphadenopathy is identified.

Output: 1. Complete imaging resolution of the right breast lesion.2. Persistently enlarged, although decreased in size, right axillary lymph node.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Diagnosis: Acquired spondylolisthesis LumbagoClinical question: L5-S1 spondylolisthesis, look for cord involvementSigns and Symptoms: Back pain, RLE radiculopathy Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. There is multilevel disc desiccation present.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is marked bilateral facet hypertrophy present at this level. There is partial effacement of the fat at the lateral recesses sees at this level and some mild narrowing of the neural foramina.At L4-5 there is a cystic type lesion adjacent to the right facet joint which mildly displaces the thecal sac and effaces the fat surrounding the nerve roots at the right lateral recess. There is a moderate degree of bilateral facet hypertrophy at this level. The fat surrounding the nerve roots within the neural foramina is not effaced.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.There is a synovial cyst present at the right lateral recess at L4-5 which encroaches on the nerve roots at the right lateral recess.2.There are marked facet degenerative changes present at L5-S1. Please note that this examination was obtained with the patient in the supine position. The subluxation noted on the plain films is not readily appreciated on the current exam.


Instruction: Generate impression based on findings.

Input: 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. Mucosal thickening is present within left ethmoid air cells and the left maxillary sinus. The remaining paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain.

Output: Mucosal thickening is present within left ethmoid air cells and the left maxillary sinus. Otherwise negative MRI of the brain including gadolinium enhancement.


Instruction: Generate impression based on findings.

Input: Reason: Evaluate left hip for labral tear History: LEFT HIP PAIN ACETABULAR LABRUM: There is indistinctness of the acetabular labrum at the anterior/superior aspect without distinct linear tear, compatible with labral degeneration.ARTICULAR CARTILAGE AND BONE: There is no focal chondral thinning of the left hip.SOFT TISSUES: No significant abnormality noted. ADDITIONAL

Output: Labral degeneration of the anterior superior labrum without detachment or discrete linear tear.


Instruction: Generate impression based on findings.

Input: Male, 67 years old, with unstable balance, affected proprioception, assess for cord compression. Diffuse marrow heterogeneity is seen compatible with widespread osseous metastatic disease. Vertebral body heights are preserved. At the T8-9 level, there appears to be epidural soft tissue thickening which causes effacement of the thecal sac and likely some mass effect upon the spinal cord. There may be a smaller area of dorsal epidural soft tissue thickening at the T10-11 level.

Output: 1.Widespread osseous metastatic disease without significant loss of vertebral body height.2.Findings are seen concerning for epidural tumor at the T8-9 level and at the T10-11 level. These findings are better assessed on dedicated thoracic spine MRI.


Instruction: Generate impression based on findings.

Input: Female, 37 years old, history of right parietal grade 3 oligodendroglioma status post resection, radiation and chemotherapy. Again seen are postsurgical changes of right parietal craniotomy for tumor resection. The resection cavity involving the inferior parietal lobule with surrounding T2/FLAIR hyperintensity remains unchanged with signal abnormality extending into the posterior temporal lobe also similar to prior. No new T2/FLAIR hyperintensity, mass effect, or suspicious enhancement is appreciated. Intrinsic T1 hyperintensity and susceptibility effect are again seen consistent with posttreatment change.There is a small developmental venous anomaly within the right thalamus. Mild ex vacuo dilatation of the right lateral ventricle is again seen. Remainder of the brain parenchyma is unremarkable without evidence of new infarct, hemorrhage, mass, or mass effect. No hydrocephalus. Aside from postsurgical changes, calvarium and extracranial soft tissues are unremarkable.

Output: Posttreatment changes in the right temporoparietal lobes remain unchanged. No evidence of tumor progression.


Instruction: Generate impression based on findings.

Input: 52 years, Female, headache. Patient states imaging at Cook County states she had tumor. Brain parenchyma appears within normal limits. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved.Partially empty sella is noted. Orbits are grossly unremarkable. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: 1. Brain parenchyma appears within normal limits for age.2. Partially empty sella, which can be normal variant or associated with intracranial hypertension in the appropriate clinical setting.


Instruction: Generate impression based on findings.

Input: 63 year old female with a personal history of BRCA positive female. Strong family history of breast cancer in mother, sister, two maternal aunts and two maternal cousins. Personal history of benign right breast MRI guided biopsy in 2008. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.Previously biopsied benign non-mass enhancement in the 3 o'clock position of the right breast is unchanged. No new abnormal enhancement is seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.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: NS - Routine Screening Mammogram.


Instruction: Generate impression based on findings.

Input: Male, 43 years old, with history of bilateral lower extremity paraplegia s/p gun shot wound, with more recent history of enterococcal MV endocarditis, now with sepsis, back pain and new fecal incontinence, assess for epidural abscess. The T11 vertebral body is compressed and deformed with mild osseous retropulsion. In addition, the T11-12 disc space is degenerated with fatty endplate signal change on both sides of the disc. There is mild endplate enhancement which is likely degenerative. No evidence of marrow edema is seen. No evidence of any paraspinal or epidural fluid collection is seen at the T11-12 level. These osseous findings are stable when compared to a prior MRI from 2014.The lower spinal cord is diffusely atrophic beginning at approximately the T7 level and continuing down to the level of the conus. Based on limited comparison with the prior lumbar MRI, this is unchanged. The distal cord is very thinned and deformed at the T11-12, but again, no epidural collections are seen.A large right anterior osteophyte is evident at L3-4 which has substantially increased in size from the prior exam. The osteophyte and adjacent vertebral body marrow are mildly edematous and there is enhancement within the osteophyte and the adjacent paraspinal soft tissues. However, no fluid collections are seen.Otherwise, spinal alignment is grossly anatomic and the remaining vertebral bodies demonstrate preservation of height. No other areas of concerning marrow replacement, edema or pathologic enhancement are seen. The right neural foramen at T11-12 is narrowed due to osseous deformities, but elsewhere, no significant spinal canal or foraminal stenosis is seen.

Output: 1.Chronic compression and osseous deformity of the T11 vertebral body, along with chronic degeneration of the T11-12 disc space, show no significant interval change when compared to a prior MRI from 2014.2.No evidence to suggest osteomyelitis-discitis or epidural abscess is seen at T11-12 or at any other level in the thoracic or lumbar spine.3.A large right anterior osteophyte is evident at L3-4 with edema and enhancement of the adjacent bone and paraspinal soft tissues. No discrete fluid collections are seen. These findings are favored to be inflammatory and likely reactive to the large osteophyte, with infection a less likely consideration.Findings were discussed with Dr. Cardin at 0930 on 6/3/16.


Instruction: Generate impression based on findings.

Input: History of intractable hiccups, assess for changes, especially brainstem. History of seizures and developmental delay. MRI brain: There is no diffusion abnormality. There is mild prominence of the ventricular system and the sulci, unchanged from the prior exam. The brainstem may be slightly smaller than normal, unchanged. There are no findings of cortical dysplasia or gray matter heterotopia. Otherwise, the brain parenchyma and pituitary gland appear unremarkable. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.MRI cervical spine: There is evidence of orthopedic instrumentation involving C1-C2 level with some deformity of the odontoid process. A scoliotic curvature is evident affecting the lower cervical and thoracic spine. The cervical vertebral bodies are appropriate in overall height and morphology . The cervical spinal cord shows normal signal characteristics and morphology.The left-sided neural foramina appear narrower than the right with questionable left facet hypertrophy. Findings may be related to the spinal curvature. There is no significant disc disease. There is no evidence of spinal canal stenosis.The paraspinal soft tissue structures are unremarkable.

Output: 1. Mild global parenchymal volume loss, including the brainstem. No changes from the prior exam.2. Evidence of prior surgery at C1-C2. No significant canal stenosis or spinal cord abnormalities.


Instruction: Generate impression based on findings.

Input: Left true vocal cord paralysis. Head CT:There is no evidence of intracranial mass, hemorrhage or infarction. No enhancing abnormality is seen.Neck CT:There is mild dilatation of the left laryngeal ventricle, compatible with history of vocal cord paralysis. No mass, or lymphadenopathy based on radiological criteria is identified. The thyroid gland appears unremarkable.Extensive degenerative disease of cervical spine results in spinal canal and neuroforaminal stenosis at multiple levels. Patchy opacities are seen in the lung apices.There are lytic lesions in C7 and T1 vertebrae. They demonstrate marginated borders, suggesting vertebral hemangiomas. They can be further correlated with MRI if clinically indicated.

Output: 1. Findings compatible with left vocal paralysis, however, no discrete mass or adenopathy is seen in the neck.2. Severe degenerative disease of cervical spine, resulting in spinal canal and neuroforaminal stenosis.3. Lytic lesions within C7 and T1 vertebrae, suggesting hemangiomas. They can be further correlated with MRI if clinically indicated.


Instruction: Generate impression based on findings.

Input: Reason: h/o seizures since teen years History: seizure disorder The CSF spaces are appropriate for the patient's stated age with no midline shift. There are several periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.There is mild cerebellar atrophy present.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus. The left vertebral artery appears to be hypoplastic distally.The visualized portions of the paranasal sinuses demonstrate some mild mucosal thickening in the maxillary sinuses. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Periventricular and subcortical white matter changes of a mild degree are nonspecific but most likely vascular related. 2.There is mild cerebellar atrophy present. One explanation may be long-term antiseizure medication use.


Instruction: Generate impression based on findings.

Input: 13-day-old male with low Apgars at birth, evidence of ischemic damage to the liver. Concern for hypoxic ischemic encephalopathy. Plan to wean off iNO overnight. Per chart review, patient is an ex-37 2/7 infant male patient born via emergent c-section to a 31-yo G2P2 mother secondary to placental abruption. He remains in stable condition as his LFTs and ammonia levels have been decreasing, but continues to require aggressive NICU management given likely multiorgan involvement from mixed acute on chronic hypoxic-ischemic injury. Today there is plan to wean NO and hydrocortisone and going up on feeds. There are foci of restricted diffusion in the periventricular white matter along the trigone of the lateral ventricles, left greater than right, which demonstrates increased T1 and T2/FLAIR hyperintensity. Otherwise the remaining brain parenchyma is unremarkable; specifically there is no cortical or deep gray matter signal abnormality.. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Findings compatible with focal ischemic infarcts within the periventricular white matter adjacent to the trigone of the lateral ventricles, left greater than right. Otherwise the cortical and deep gray matter signal is within normal limits. No acute hemorrhage.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for structural lesion, ischemia. Signs and symptoms: Comatose, diskitis and flexor positioning. Nonenhanced brain MRI:Diffusion-weighted images are severely degraded due to extensive artifact from patient's significant intracranial hemorrhage.A large irregularly shaped dissecting hematoma in the left basal ganglia and thalamus is again identified. Hematoma measures approximately 40 x 40 2-mm in its largest transaxial dimensions. There is extensive surrounding vasogenic edema and constellation of findings results in significant rightward deviation of midline of approximately 12.5 mm. There is inferior extension of vasogenic edema into the left cerebral peduncle, left pons as well as left quadrigeminal plate.There is extensive extension of hemorrhage into the ventricular system with large CSF/blood layering in dependent bilateral occipital horns (left greater than right) without significant change since prior exam. There is evidence of resultant ventriculomegaly with a uniform thick bands of flair hyperintensity surrounding the ventricles suggestive of trans-ependymal exiting off CSF. Possibility of overlapping chronic small vessel ischemic strokes however cannot be entirely excluded. The cortical sulci remain small likely secondary to increased intracranial pressure. The basal cistern remains patent and without evidence of herniation. A right frontal approach ventricular catheter traverses the right frontal lobe, traverses the right lateral ventricle and the tip of the catheter within the hematoma and likely within the third ventricle. The signal void of all major intracranial arterial branches are identified.Nonenhanced brain MRA: Right internal carotid artery is patent across the skull base and in its supraclinoid segment. Right middle cerebral artery and its branches are patent. Mild vascular irregularity of right M1 could represent atherosclerotic disease however without vascular lumen compromise. There is absence of the right A1 representing an anatomical variation of hypoplasia. Bilateral anterior cerebral arteries however are filled via a larger left A1.Patent and unremarkable left internal carotid artery across the skull base and in the supraclinoid segment. Unremarkable left anterior and middle cerebral arteries and their branches.Unremarkable dominant right vertebral artery, right pica, basilar artery, superior cerebellar and bilateral posterior cerebral arteries. Short segmental moderate vascular lumen compromise of the perimesencephalic segment of the left posterior cerebral artery as result of atherosclerotic disease is noted. Distal branches however remain patent. A hypoplastic left vertebral artery is visualized only in its distal segment on reformatted images. The left vertebral artery, left pica however is well identified and patent on source images.Examination demonstrates no detectable increased vascularity within the hematoma to suggest a vascular malformation or aneurysm as a cause of hemorrhage.

Output: 1.Large dissecting hematoma in the left basal ganglia/thalamus measuring maximum although 40 times 40 mm in transaxial dimensions.2.Extensive surrounding vasogenic edema and associated mass-effect resulting 12.5-mm deviation of midline to the right.3.Extensive intraventricular hemorrhage, supratentorial ventriculomegaly and CSF/blood layering in dependent occipital horns.4.A band of flair hyperintensity surrounding the ventricular system suggestive of transependymal exudate of CSF.5.Effaced cortical sulci over patent basal cistern.6.MRA of intracranial circulation demonstrate patency of all the intracranial vasculature. There is a short segmental moderate vascular lumen compromise of the perimesencephalic segment of left posterior cerebral artery representing atherosclerotic disease. The distal branches of this vessel however remain patent. There is no detectable increased vascularity or aneurysm within the left hemispheric hematoma.


Instruction: Generate impression based on findings.

Input: Female 24 years old Reason: knee patellar instability, evaluate TT-TG distance, evaluate MPFL. Pt also with h/o R knee surgery for patellar dislocations. Multiple left patellar dislocations as well MENISCI: Menisci are intact.ARTICULAR CARTILAGE AND BONE: No bone marrow signal abnormality. There is articular cartilage fraying at the median eminence of the patella. No focal articular cartilage defect. The remainder of the articular cartilage is within normal limits.LIGAMENTS: The ACL, PCL, MCL, and lateral collateral complex is intact. EXTENSOR MECHANISM: The quadriceps and patellar tendons are thickened suggesting chronic tendinosis. There is linear increased signal intensity within the extensor mechanism anterior to the patella which may reflect interstitial tearing, similar to the prior exam. Ossicle is present in the proximal patellar tendon.ADDITIONAL

Output: 1.Within the left knee there is patella alta, borderline tibial tubercle-trochlear groove distance, and other findings as detailed above which are compatible with suspected history of patellofemoral instability.2.Within the right knee there is mild patella alta, edema in the superior lateral corner of Hoffa's fat pad, as well as fraying of the patellar cartilage, consistent with history of patellofemoral instability. Tibial tubercle trochlear groove distance is within normal limits.


Instruction: Generate impression based on findings.

Input: Pulmonary fibrosis. History of syncope. Headache x 1 month. Question bleed or midline shift. There is no evidence of intracranial hemorrhage, mass or midline shift. Patchy areas of subcortical and periventricular white matter hypodensity likely represent mild small vessel ischemic disease, age indeterminate by CT. There is a left high convexity cortical stroke of indeterminate age. If the patient is symptomatic, an MRI may be considered for further evaluation. Vascular calcifications are noted within the cavernous carotid and vertebral arteries. Calcification within the parotid glands bilaterally may be from prior infection and appears unchanged.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Small vessel ischemic disease. Left high convexity cortical stroke of indeterminate age. If the patient is symptomatic, an MRI may be considered for further evaluation. No evidence of intracranial hemorrhage.


Instruction: Generate impression based on findings.

Input: 55-year-old female with right knee pain. Right knee: Tricompartmental osteophytes and mild lateral tibiofemoral compartment narrowing indicative of moderate osteoarthritis. There is a small joint effusion.Left knee: Tricompartmental osteophytes and mild lateral tibiofemoral compartment narrowing indicative of moderate osteoarthritis.

Output: Moderate osteoarthritis of the bilateral knees.


Instruction: Generate impression based on findings.

Input: 73-year-old male with prostate cancer, status post radiation therapy. Now with biochemical recurrence. Please evaluate for metastatic disease. CHEST:LUNGS AND PLEURA: Punctate calcified granulomata are present at the lung bases.MEDIASTINUM AND HILA: There are coronary artery calcifications.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: There are centimeter sized hepatic parenchymal hypodensities at axial images 68 and 73/212 which may represent simple cysts.SPLEEN: The native spleen appears absent and partially regenerated including a 5-cm left infra-diaphragmatic remnant and axial image 67/212. This contains a solitary 6-mm diameter calcification. Anterior to the tail of the spleen and axial image 77/212 is a 4.2 x 4.7 cm mass which may represents regenerated spleen.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: There are bilateral renal lesions including a hypodense left upper pole lesion which measures approximately 4 cm in diameter with attenuation of less than 3 Hounsfield units compatible with a benign simple cyst. An exophytic right mid pole lesion measures 5 cm in diameter at axial image 92/212 and has attenuation of approximately 15 Hounsfield units. This may be an atypical cyst, but a solid renal mass cannot be excluded. Ultrasound or MRI examination may be helpful for further evaluation, if comparison studies are not available.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Atrophic prostate and seminal vesicles compatible with history of radiation therapy.BLADDER: Diffuse bladder wall thickening compatible with history of pelvic radiotherapy.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: Degenerative changes in the pelvis and spine.OTHER: No significant abnormality noted

Output: Probable regenerated spleen in the left upper quadrant. Left renal cyst. Right renal mass versus atypical cyst, recommend ultrasound or MRI, if CT comparison studies are not available. Hepatic hypodensities are probably cysts.


Instruction: Generate impression based on findings.

Input: Diagnosis: Unspecified cerebral artery occlusion with cerebral infarctionClinical question: r/o acute ischemic strokeSigns and Symptoms: vertigo, nausea, right sided weakness MRI of the brainNo diffusion weighted abnormalities are appreciated.There is are several periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. The left A1 segment is slightly larger than the right A1 segment. The posterior communicating arteries are very small. The vertebral arteries are similar in size.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries.

Output: 1.There is no evidence for intracranial cerebrovascular occlusive disease.2.There is no evidence for extracranial cerebrovascular occlusive disease.3.There is no evidence for acute ischemic cerebral infarction.4.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: Right axillary/shoulder pain ROTATOR CUFF: No significant abnormality noted.SUPRASPINATUS OUTLET: There is moderate osteoarthritis within the acromioclavicular joint. There is fluid within the joint which is most likely reactive in nature.GLENOHUMERAL JOINT AND GLENOID LABRUM: Moderate osteoarthritis affects the glenohumeral joint with degenerative cystic changes noted within the glenoid. There is abnormal morphology and signal intensity of the anterior and posterior labrum likely related to degenerative tearing.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: Moderate osteoarthritis of the acromioclavicular and glenohumeral joints.


Instruction: Generate impression based on findings.

Input: Images are limited by patient motion. The spine is in normal alignment. The vertebral body and disk heights are stable, with prominent Schmorl's nodes along the midthoracic spine. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal. The conus terminates at the mid L2 level. There has been further decreased enhancement of the spinal nerve roots diffusely throughout the spine.Previously described mild scattered spondylosis appears similar, without high-grade stenosis at any level.

Output: Further decreased enhancement of the spinal nerve roots diffusely, again significantly improved since September 2016.


Instruction: Generate impression based on findings.

Input: Flexor digitorum profundus laceration and reconstruction There are surgical changes relating to reconstruction of the flexor digitorum profundus of the fifth digit with increased signal intensity surrounding the reconstructed tendon as it courses through the flexor compartment. The tendon itself appears relatively normal in signal and caliber in this area and appears to be intact at least through the level of the mid diaphysis of the middle phalanx. Distal to this region, the tendon is difficult to visualize although there appear to be some fibers that reach the DIP joint. The extensor tendon is seen at the level of the MCP joint but becomes poorly visualized at the level of the PIP joint and further distally although it is again seen clearly distal to the DIP (series 5 image 17).The marrow signal intensity of the fifth finger is relatively normal and the DIP joint is preserved. Along the dorsal aspect of the DIP joint is a bilobed structure which demonstrates slight T1 hyperintensity and T2 hyperintensity which also contains small foci of low signal intensity centrally. This lesion in total measures approximately on 11 x 6 x 6 mm in the greatest transverse, AP, and craniocaudal dimensions and appears intimately associated with the base of the distal phalanx. Additionally, a second irregular and heterogeneous focus is identified within the soft tissues along the volar and ulnar aspect of the PIP joint which measures approximately 15 x 5 x 5 mm in the greatest craniocaudal and transaxial dimensions.The scapholunate and lunotriquetral ligaments are intact. The triangular fibrocartilage complex is intact. There is slight enlargement and increased signal intensity of the median nerve at the level of the hook of the hamate.

Output: 1. Surgical changes of the flexor digitorum profundus reconstruction of the fifth digit. Although the tendon itself appears relatively normal in signal intensity and caliber, there is increased signal intensity along the tendon sheath as courses through the flexor compartment and the tendon is poorly visualized distal to the middle phalanx and the presence of mild tenosynovitis and partial tearing cannot be excluded. There is also poor visualization of the extensor tendon between the levels of the PIP and DIP joint which concerning for at least partial tearing as well.2. Bilobed lesion within the dorsal soft tissues at the level of the DIP joint which is incompletely characterized on the exam given the lack of intravenous contrast. This lesion is nonspecific but may represent an epidermoid inclusion cyst or an area of surgical anchoring. There is an additional irregular focus within the volar soft tissues of the PIP joint of the fifth digit which is also nonspecific but may reflect scarring. These findings can be further evaluated with dedicated MRI of the fifth digit with and without contrast. Alternatively, ultrasound can be considered.


Instruction: Generate impression based on findings.

Input: 10-year-old with worsening seizures. Evaluate for etiology. Redemonstrated findings of severe communicating hydrocephalus with marked dilatation of the supratentorial and infratentorial ventricular system which are not significantly changed from prior. A left parietal ventriculostomy catheter extends to the midline at the level of the third ventricle. There is associated marked thinning of the cortical mantle with areas of confluent increased T2 signal most notably in the left frontoparietal region likely reflecting gliosis.Evaluation the hippocampi and amygdala is limited by distortion from the dilated temporal horns of the lateral ventricles, but the mesial temporal structures are grossly symmetric.Additional postoperative findings from prior right frontoparietal craniotomy. The basal cisterns remain patent. The visualized orbits, paranasal sinuses, and mastoid air cells are clear. The expected intracranial vascular flow-voids are present.

Output: 1. Stable findings of severe communicating hydrocephalus with a left parietal ventriculostomy catheter in place.2. Chronic parenchymal abnormalities are noted, but there are no new structural findings to suggest an etiology for the patient's worsening epilepsy.


Instruction: Generate impression based on findings.

Input: A mass is present involving the left parietal lobe, centered in the left postcentral gyrus. It demonstrates gyral thickening, edema, and contains two separate peripherally enhancing foci. Foci of T2 hyperintensity are present within the white matter, basal ganglia, and pons, without associated mass effect. The ventricles are normal in size and shape. Expected vascular flow voids are demonstrated. The pituitary is unremarkable. Cerebellar tonsils are in appropriate position. The paranasal sinuses and mastoid air cells are clear.

Output: 1.A mass is present involving the left parietal lobe, centered in the left postcentral gyrus. It demonstrates gyral thickening, edema, and contains two separate peripherally enhancing foci.2.Advanced small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: Female, 37 years old. Pain. Evaluate for labral tear. ACETABULAR LABRUM: There is abnormal high signal within the anterior superior labrum, compatible with a tear.ARTICULAR CARTILAGE AND BONE: Bone marrow signal intensity is normal.SOFT TISSUES: No significant abnormality noted. ADDITIONAL

Output: Anterior superior labral tear.


Instruction: Generate impression based on findings.

Input: 39 year-old female with BRCA 2 positive, family history of breast cancer There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Cirrhosis, evaluate for HCC Examination is limited secondary to respiratory motion.ABDOMEN:LIVER, BILIARY TRACT: The liver has a cirrhotic morphology without evidence of suspicious lesion. Hepatic and portal veins are patent.SPLEEN: Splenomegaly.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right renal cyst.RETROPERITONEUM, LYMPH NODES: Prominent upper abdominal lymph nodes, unchanged.BOWEL, MESENTERY: Moderate ascites.BONES, SOFT TISSUES: No significant abnormality noted.

Output: Cirrhosis without suspicious hepatic lesion.


Instruction: Generate impression based on findings.

Input: Right breast DCIS status post right lumpectomy of unclear extent on 1/22/2016 at outside hospital) assess posterior central calcifications, unclear from outside hospital imaging and up noticed posterior calcifications were excised. There is heterogeneous amount of fibroglandular tissue in both breasts, slightly asymmetric, more in the right breast than left.Moderate parenchymal enhancement is noted bilaterally, limiting the sensitivity of MRI.No definite seroma cavity or postsurgical changes identified in the right inferior breast. Minimal amount of fluid noted in the ductal system in the right breast 6:00 position.Focal area of nonmass enhancement measuring 14 x 7 x 14 mm (APx CC X ML) identified in the right central breast, anterior depth located approximately 12 mm from the nipple. Reviewing the location of the focal asymmetry that was biopsy proven DCIS on the mammogram, the area of non mass enhancement could be seen along the superior aspect of the lumpectomy site.No abnormal enhancement in the central posterior right breast at the site of prior small cluster of calcifications. Asymmetric parenchymal enhancement identified in the inferior right breast however this appears to be due to asymmetric distribution of glandular tissue (which is apparent on the T2 sequence and the mammograms) for which 6 month follow up MRI is recommended. No abnormal enhancement is seen in left breast. No abnormal lymph nodes are identified in either axillary region.

Output: Focal nonmass enhancement in the right breast retroareolar region measuring 14mm. Given the lack of seroma, definite location of this focal non mass enhancement with respect to the lumpectomy site is difficult. However, this most likely is along the superior aspect of the biopsy proven cancer. Generous excision along the superior aspect of the lumpectomy bed can be performed. No abnormal enhancement in the central posterior right breast at the site of prior small cluster of calcifications. Limited examination due to moderate heterogenous parenchymal enhancement bilaterally, right inferior breast more than left for which 6 month follow up MRI is recommended. BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: 14-year-old female with history of pelvic rhabdomyosarcoma, 16 months off therapy. Evaluate for evidence of recurrent disease.EXAMINATION: MRI pelvis without and with intravenous contrast administration 12/07/16 The uterus is normal. No adnexal lesions are present. Foci of T1/T2 hypointensity within the vagina likely represent air.No pelvic/inguinal lymphadenopathy.The loops of bowel in the lower abdomen and pelvis are normal.Small amount of free pelvic fluid is present.Bone marrow signal intensity is normal. The surrounding soft tissues are normal.

Output: No evidence of recurrent or metastatic disease.