Instruction: Generate impression based on findings.

Input: Left eye with visual loss due to CRVO in the left eye: please evaluate for mass versus bleed behind the left eye. Orbits: There is no evidence of intraorbital mass lesions or hemorrhage. At least portions of the bilateral superior ophthalmic veins appear to enhance appropriately. The globes, extraocular muscles, optic nerves, and lacrimal glands are unremarkable bilaterally.Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are a few mild nonspecific cerebral white matter T2 hyperintensity foci. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull and scalp soft tissues are grossly unremarkable. There are secretions and mucosal thickening in the ethmoid air cells.

Output: 1. No evidence of intraorbital mass lesions or hemorrhage.2. No evidence of intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: History of cholecystectomy with epigastric pain and elevated lipase. Normal CT. EGD demonstrated gastritis, possible pancreas divisum and pancreatic parenchymal abnormalities. ABDOMEN:LIVER, BILIARY TRACT: Prominent Riedel's lobe. Otherwise normal hepatic morphology without a discrete lesion. The patient is status post cholecystectomy. The common bile duct is dilated up to 11 mm with mild intrahepatic biliary ductal dilatation. The common bile duct tapers smoothly at the level of the pancreatic head without a discrete mass lesion, favoring a benign stricture, measuring approximately 2.4 cm. The liver demonstrates mild signal loss on out of phase imaging compatible with diffuse fatty infiltration.SPLEEN: 2.0 cm T2 hyperintense non-enhancing splenic lesion, compatible with a cyst. PANCREAS: The main pancreatic duct is prominent up to 4 mm. At the level of the pancreatic head it appears to taper smoothly for approximately 4 cm to the major ampulla without shouldering or discrete lesion, again favoring a benign stricture (series 3 images 25-27). The pancreatic parenchyma demonstrates normal intrinsic T1-weighted signal intensity aside from mild decrease in the pancreatic head. The pancreas enhances homogeneously. Following secretin administration there is prompt voluminous excretion into the small bowel suggesting intact exocrine function. The main pancreatic duct does not demonstrate significant increase in caliber suggesting decreased compliance and there appears to be subtle side branch ectasia, findings suggesting chronic pancreatitis.Punctate foci of T2 weighted hyperintensity likely represent sites of side branch ectasia as opposed to IPMNs.The minor duct is not well visualized. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter right renal cyst. No hydronephrosis or suspicious lesion.RETROPERITONEUM, LYMPH NODES: Infrarenal abdominal focal ectasia measuring up to 2.8 cm in AP dimension.BOWEL, MESENTERY: Diverticulosis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Basilar consolidation and/or atelectasis.

Output: 1.No specific findings of pancreas divisum.2.Benign nonflow-limiting strictures of the common bile duct and main pancreatic duct at the level of the pancreatic head without a filling defect or mass lesion evident. 3.Intact pancreatic parenchymal exocrine function. However, there is decreased main pancreatic duct compliance and side branch ectasia, consistent with sequela of chronic pancreatitis, no evidence of acute inflammation.4.Infrarenal abdominal aorta ectasia.5.Basilar consolidation.


Instruction: Generate impression based on findings.

Input: Word finding difficulty and hyperreflexia in the setting of breast cancer. Evaluate for structural cause. BRAIN: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is minimal cerebral parenchymal volume loss. There are scattered punctate foci of abnormal T2 hyperintensity within the periventricular and subcortical white matter, which are nonspecific. 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. CERVICAL SPINE: There is mild retrolisthesis of C3 on C4 and C5 on C6. There is mild anterior wedging of the C4-C6 vertebral bodies. There is loss of disc height and end plate degenerative changes throughout the cervical spine. The vertebral bone marrow signal is heterogeneous with nonspecific foci of enhancement at the C6-C7 vertebral bodies and C7 and T1 facets and spinous processes. There is mild enhancement of the left paravertebral soft tissues at the level C6-C7.C2-C3: No significant disc bulge, spinal canal or foraminal stenosis.C3-C4: Posterior disc-osteophyte complex, bilateral uncinate spurs, thickening of the ligamentum flavum and bilateral facet arthropathy, contributes to mild spinal canal and mild to moderate right and moderate left foraminal stenosis.C4-C5: Posterior disc-osteophyte complex, bilateral uncinate spurs, thickening of the ligamentum flavum and bilateral facet arthropathy, contributes to flattening of the left ventral cord, mild to moderate spinal canal and mild right and moderate to severe left foraminal stenosis.C5-C6: Posterior disc-osteophyte complex, bilateral uncinate spurs, thickening of the ligamentum flavum and bilateral facet arthropathy, contributes to moderate spinal canal and moderate bilateral foraminal stenosis.C6-C7: Posterior disc-osteophyte complex, bilateral uncinate spurs, thickening of the ligamentum flavum and bilateral facet arthropathy, contributes to severe spinal canal and severe bilateral foraminal stenosis. Abnormal T2 signal within the central cord at this level.C7-T1: No significant disc bulge, spinal canal or foraminal stenosis.

Output: 1. No evidence of acute intracranial hemorrhage, mass, or acute infarct.2. Advanced degenerative cervical spondylosis with spinal canal stenosis at C3-C4 through C6-7, most severe at C6-C7 with abnormal cord signal and impingement of the cervical cord at this level, which may represent myelomalacia. Variable degrees of neural foraminal stenosis are present at multiple levels of the cervical spine as well.3. Foci of enhancement in the C6-C7 vertebrae, C7 and left T1 posterior elements and left C6-C7 paravertebral soft tissues, which may be neoplastic in nature. A PET-CT may be useful for further evaluation.Findings were conveyed to Dr. Mastrianni by EPIC email on 3/7/2015 at the time of dictation.


Instruction: Generate impression based on findings.

Input: 81 year old female with left masticator space sarcoma, follow-up A large heterogenous enhancing soft tissue mass is identified centered at the left masticator space. The medial and lateral pterygoid muscles are involved. The masseter muscle has been displaced laterally. No clear margin is seen between the lesion and the masseter muscle. Posteriorly, the mass infiltrates the left parotid space and displaced the retromandibular vein posteriorly. Both lateral and medial cortex of the mandible are eroded, including the left mandibular foramen. Medially, the parapharyngeal space is partially effaced. Superiorly, the lesion extends along the CN V mandibular nerve, through the foramen ovale and filling the left Meckel's cave. The foramen ovale is enlarged and cortex is eroded. The lesion is measuring 4.4 x 4.7 x 5.1 cm on axial image 28 series 3 and image 33 series 80248. No pathologic lymphadenopathy is appreciated based on the size criteria for lymphadenopathy. The oral cavity, oro/nasopharynx, hypopharynx, larynx and subglottic airways are patent. The epiglottis, vallecula, piriform sinuses, and vocal cords are normal. Tiny hypodense lesions in the thyroid glands. Correlate with ultrasound exam. The parotid and submandibular glands are unremarkable. The carotid arteries and jugular veins are patent. Scarring and small nodules are noted in the lung apices. Please refer to the dedicated chest CT for more comments. There is redemonstration of extensive degenerative change in the cervical spine including grade I retrolisthesis of C5 on C6, C4/5 to C6/7 multilevel neural foramina narrowing and C4/5 and C5/6 central canal stenosis. Please refer to dedicated MRI of the cervical spine acquired at other institute for more details. A large intraosseous hemangioma is again noted in the C6 vertebral body.

Output: 1. Large heterogenous enhancing soft tissue mass centered at the left masticator space with perineural extension into the Meckel's cave. A MRI study is recommended to further evaluate intracranial spread.2. There is no pathologic lymphadenopathy.3. Extensive degenerative change in the cervical spine with multilevel neural foramina narrowing and central canal stenosis. Please refer to dedicated MRI of the cervical spine acquired at other institute for more details. 4. Scarring and small nodules are noted in the lung apices. Please refer to the dedicated chest CT for more comments.


Instruction: Generate impression based on findings.

Input: 84 year old with history of nonischemic cardiomyopathy, CLL, PMR and LBBB presenting for evaluation Left VentricleThe left ventricle is mildly dilated with mildly reduced systolic function. The overall LV ejection fraction is 45%, the LV end diastolic volume index is 106 ml/m2 (normal range: 74+/-15), the LVEDV is 211 ml (normal range 142+/-34), the LV end systolic volume index is 59 ml/m2 (normal range 25+/-9), the LVESV is 117 ml (normal range 47+/-19), the LV mass index is 32 g/m2 (normal range 85+/-15), and the LV mass is 63 g (normal range 164+/-36). There is septal bounce consistent with LBBB. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is is normal in size and systolic function. The overall RV ejection fraction is 59%, the RV end diastolic volume index is 75 ml/m2 (normal range 82+/-16), the RVEDV is 149 ml (normal range 142+/-31), the RV end systolic volume index is 31 ml/m2 (normal range 31+/-9), and the RVESV is 61 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is mildly dilated with mildly reduced systolic function. The overall LV ejection fraction is 45%. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.2. The right ventricle is is normal in size and systolic function. The overall RV ejection fraction is 59%.


Instruction: Generate impression based on findings.

Input: Female 49 years old Reason: increased AP in setting of OLT History: abd pain ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. There is mild intrahepatic biliary ductal dilatation within irregularity of the central bile ducts at the level of the biliary enteric anastomosis. No focal hepatic lesions. The hepatic artery, total vein and hepatic veins are patent.There is a right perihepatic fluid collection which is complex and contains hemorrhagic contents. It measures at least 5.3 x 5.3 cm (image 33/series 501). It extends along the superior aspect of the liver beneath the diaphragm.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: IVC filter is in place.BOWEL, MESENTERY: Bowel obstruction. There is a pocket of loculated ascites along the gastrosplenic ligament in the left upper abdomen which is not significantly changed.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Right perihepatic complex fluid collection likely representing a aging hematoma. Superinfection is not excluded.2.Mild intrahepatic ductal dilatation and irregularity at the level of the biliary enteric anastomosis. Overall configuration is not significantly changed from prior.


Instruction: Generate impression based on findings.

Input: Left side weakness There is no evidence of acute ischemic or hemorrhagic lesion on this scan.Multiple small nodular signal void lesion on bilateral hemispheres on gradient echo images. Diagnostic possibilities include amyloid angiopathy, multiple small hemorrhages, multiple cavernous malformations or calcifications.Multifocal patchy high signal intensities on bilateral periventricular white matter and centrum semiovale on FLAIR images indicate non specific small vessel disease.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal distal ICAs, MCAs and ACAs.Acom artery and right Pcom artery are patent but the left Pcom artery is not seen.There is no evidence of intracranial aneurysm.There is no evidence of intracranial arterial luminal stenosis or occlusion.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion on this scan.2. Non specific small vessel ischemic disease as described above.3. Multifocal bi-hemispheric signal voids on gradient echo images indicating possible amyloid angiopathy, multiple small hemorrhages, multiple cavernous malformations or calcifications.


Instruction: Generate impression based on findings.

Input: Relapsed AML, evolving HA. There are postoperative findings related to right parieto-occipital craniotomy. There are unchanged scattered punctate foci of supratentorial and infratentorial susceptibility effect. There is no evidence of mass or acute infarct. There is no abnormal intracranial enhancement. The ventricles and sulci are unchanged in appearance. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits and paranasal sinuses are grossly unremarkable. There is diffuse low T1 signal in the bone marrow.

Output: 1. The unchanged scattered punctate foci of supratentorial and infratentorial susceptibility effect are nonspecific. Otherwise, no evidence of intracranial metastases.2. The diffuse bone marrow signal abnormality may be related to leukemia.


Instruction: Generate impression based on findings.

Input: A patient submitted outside study for review. Submitted for review are standard mammogram (07/03/2015 and 7/16/2015), ultrasound (07/03/2015 and 7/16/2015), and breast MRI (7/29/2015) performed at Advocate Trinity Hospital. For comparison,mammogram (11/07/2012, 7/16/2013, and 7/18/2014) are available. MAMMOGRAM (7/3/2015): Two standard views of both breasts were submitted. An exaggerated CC lateral and spot compression views of the right breast were also submitted. The breast parenchyma is heterogeneously dense, which limits the sensitivity of the mammogram . A BB denotes the site of the palpable abnormality in the right breast. Deep to the BB is a high density mass with obscured margins measuring 32 x 35 mm. A few right axillary lymph nodes are also seen with the largest seen posteriorly on MLO view measuring 23 mm. Of note, these lymph nodes have not significantly increased in size when compared to the prior mammogram dating back to 11/7/2012.No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in the left breast. ULTRASOUND (07/03/2015): Static images from ultrasound of the right breast at the 10:00 position 7 cm from the nipple at the site of palpable abnormality demonstrates a 3.9 x 1.5 x 3.1 cm hypoechoic mass with lobulated margins and marked internal vascularity, highly suspicious for malignancy. Static images from ultrasound right axilla show a few indeterminate lymph nodes with mild cortical thickening, one of which is measured at 1.0 x 1.1 cm.ULTRASOUND-GUIDED BIOPSY AND POSTBIOPSY MAMMOGRAM (7/16/2015): Static images from ultrasound guided core biopsy of the right breast at the 10:00 position 7 cm show appropriate target of the hypoechoic mass and of one right axillary lymph node. Postbiopsy mammogram show a buckle clip within the central aspect of the right breast mass and a tophat clip within the right axilla node. Post biopsy changes are present.PATHOLOGY REPORT: Pathology report from outside hospital reads "right breast mass 10:00 7 cm from nipple (invasive poorly differentiated ductal carcinoma)" and "right axillary lymph node (lymph node without histologic evidence of metastasis. cytokeratin stain is performed)."MRI (7/9/2015): There is mild background parenchymal enhancement.Right Breast: There is a lobulated enhancing mass in the right breast upper outer quadrant 10:00 position measuring 3.3 x 2.9 x 2.6 cm (CC x AP x TV), with clip artifact seen in the medial/central mass, consistent with biopsy-proven palpable index cancer. Medial to this is a 1.1 cm enhancing mass, highly suspicious for malignancy. Additionally, there is a large area of non-mass enhancement extending from the mass to the nipple measuring 5.3 x 7.0 x 4.5 cm (CC x AP x TV) with multiple enhancing foci also highly suspicious for malignancy.Left Breast: There are no areas of abnormal enhancement in the left breast.Axilla: Nonspecific fairly symmetric bilateral axillary lymph nodes. Clip artifact is noted in one of the previously biopsied right axillary nodes(negative for malignancy per report).

Output: Concordant biopsy proven right breast cancer 10:00 position measuring 3.3 x 2.9 x 2.6 cm on MR. Additional enhancing mass (measuring 1.1 cm) medial to the index cancer and large area of non mass enhancement extending from the mass to the nipple measuring 5.3 x 7.0 x 4.5 cm seen on MR are highly suspicious for malignancy.No suspicious findings in the left breast or either axilla.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Headache [R51], Reason for Study: ^Reason: questioning headaches History: new onset of headaches waking patient up in the morning every day, with new onset of numbness and tingling No evidence of acute ischemic or hemorrhagic lesion.No evidence of abnormal enhancement.Several scattered T2/FLAIR high signal intensity lesions on periventricular white matter which are nonspecific.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. 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: 1. No evidence of acute ischemic or hemorrhagic lesion.2. No evidence of abnormal enhancement.3. Nonspecific T2/FLAIR high signal intensity white matter lesions likely represent small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: Female, 52 years old, vertigo, right hand tingling and retinal migraines. Brain:Several scattered small T2 hyperintense white matter lesions are seen involving the subcortical white matter of the frontal lobes, and the left middle cerebellar peduncle. These are stable to smaller when compared to the prior examination. One small T2 hyperintense lesion is also evident within the splenium of the corpus callosum, smaller than on the prior exam. No new lesions are evident. No additional corpus callosum or periventricular lesions are seen.No evidence of significant parenchymal edema or mass effect is seen. No abnormal extra-axial collections are detected. The ventricular system is normal in size and morphology.C-spine:Mild reversal of the cervical lordosis is seen. Vertebral body height is preserved. Degenerative endplate irregularity is noted at C6-7, but elsewhere vertebral body morphology and signal characteristics are within normal limits.The visualized spinal cord demonstrates normal signal intensity and morphology. No focal lesions are suspected. No epidural abnormality is seen.C2-3: No spinal canal stenosis or neuroforaminal narrowing. C3-4: Right greater than left uncovertebral hypertrophy. No significant spinal canal stenosis. Mild right foraminal narrowing. C4-5: Mild posterior disc-osteophyte complex formation. No spinal canal stenosis. Mild left foraminal narrowing. C5-6: Posterior disc-osteophyte complex formation. Effacement of the ventral thecal sac but no significant generalized canal stenosis. Mild right foraminal narrowing. C6-7: Mild posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Mild left foraminal narrowing. C7-T1: No spinal canal stenosis or neuroforaminal narrowing.

Output: 1.Scattered small white matter lesions are redemonstrated within the supratentorial and infratentorial brain. None of these lesions has progressed from prior, and some are smaller. No new lesions are detected. The lesions are nonspecific in morphology and distribution, and could reflect the sequelae of demyelinating disease, vasculitis, migraine headache, or some other inflammatory process.2.No convincing evidence of any cervical spinal cord lesions are seen. Relatively mild disc degeneration is seen in the cervical spine but with no areas of high-grade spinal canal or foraminal stenosis.


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. The paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain.

Output: Negative MRI of the brain including gadolinium enhancement. Specifically, there are no MRI findings to explain the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Female, 39 years old, with dizziness, nystagmus, nausea and vomiting. Evaluate for vestibular etiology of symptoms. A small curvilinear focus of subcortical FLAIR hyperintensity is demonstrated within the precuneus of the right parietal lobe. Several additional scattered punctate foci of white matter are also seen.No evidence of edema or mass effect is detected. No restricted diffusion is seen. A small ill-defined focus of enhancement is present within the cerebellum at the level of the fastigial point which is favored to represent a small vascular anomaly such as a DVA or telangiectasia. No definite pathologic parenchymal enhancement is observed.No evidence is seen to suggest acute or chronic intracranial hemorrhage. There are no abnormal extra axial fluid collections. Ventricular size and morphology are within normal limits.The fluid-filled structures of the inner ear demonstrate normal morphology and signal characteristics. The cranial nerve 7/8 complex is within normal limits. No pathologic enhancement is seen within the IACs or CP angles.

Output: 1.Scattered small foci of FLAIR hyperintensity are demonstrated within the cerebral white matter, one of which is relatively curvilinear and subcortical location. These lesions are nonspecific, though the distribution and morphology raise the possibility of a demyelinating process. An inflammatory or vasculitic process could also be considered.2.Unremarkable evaluation of the IACs.


Instruction: Generate impression based on findings.

Input: 81 years, Male, Reason: staging exam History: high grade prostate cancer newly diagnosed. PELVIS:PROSTATE:Prostate Size: 4.9 x 2.8 x 3.1 cmPeripheral Zone: There is a large lesion extending from the right base to apex (501/14) with low signal on ADC/T2 which extends beyond the posterior capsule and invades the right neurovascular bundle. Increased T1 signal in the left peripheral zone likely represents hemorrhage from prior biopsy.Central Gland: Heterogeneous lesions in the central gland likely represent benign prostatic hypertrophy.Seminal Vesicles: No involvement.Extracapsular Extension: Right posterior extracapsular extension into the right neurovascular bundle.BLADDER: No significant abnormality noted.LYMPH NODES: No lymphadenopathy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Large right peripheral zone lesion extending from the right base to apex with extracapsular extension into the right neurovascular bundle.2.No lymphadenopathy.


Instruction: Generate impression based on findings.

Input: Diagnosis: Malignant neoplasm of unspecified part of right bronchus or lungClinical question: concern for metastatic disease versus infectionSigns and Symptoms: hx of SCLC s/p chemotherapy, radiation, PCI; episodes of aphasia, fever, hypotension The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Additional T2 and FLAIR hyperintense lesions are present in the brainstem.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are partially opacified. The visualized portions of the orbits are intact. The eye lenses are thin.

Output: 1.Periventricular and subcortical white matter lesions of a mild degree as well as lesions in the brainstem are nonspecific. At this age they are most likely vascular related. This is stable compared to the prior exam.2.No postcontrast imaging was performed. Please note that post contrast MRI is more sensitive for the detection of brain metastases. There is no evidence for bran metastases on the available imaging.


Instruction: Generate impression based on findings.

Input: Thoracic or lumbosacral neuritis or radiculitis, unspecified. Lumbar radicular symptoms but no improvement s/p 12 sessions of PT. Evaluate for radiculopathy vs disc disease 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 disk dessication associated with a posterior peripherally located high T2 signal focus along the disk where the is a minor broad based disk protrusion. There is a right sided perineural cyst present along the right S1 neural foramenAt L4-5 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.No compromise to lumbar spinal canal or neural foramina. There is degenerative disk disease present at L5-S1.2.Small perineural cyst along the right s1 neural foramen


Instruction: Generate impression based on findings.

Input: Reason: assess cord astrocytoma for growth CERVICAL SPINE:T2 hyperintense expansile mass within the right aspect of the cord extending from the C3-C4 level to C7-T1 is not appreciably changed in size measuring approximately 1.5 x 1.2 cm in the transverse dimension at the mid C6 level extending craniocaudally from the C3-C4 to the C7-T1 levels. Subtle areas of enhancement are again questioned. T2 hyperintensity involving the left lateral aspect of the cord at these levels is also again seen and not significantly changed.There is mild reversal of the normal cervical lordosis. Vertebral body heights are intact. Mild multilevel disc desiccation with mild degenerative disc disease at C5-C6 and C6-C7 is unchanged. Diffuse T1 hyperintensity throughout the vertebral bodies likely related to radiation. Postsurgical changes along the posterior cervical spine with laminectomies at C5 and C6 are unchanged.THORACIC SPINE:T2 hyperintense expansile mass centered on the left aspect of the cord extending from the T2-T3 level to the T8 level is unchanged in size and overall distribution, measuring 11 x 10 mm in the axial plane at the mid T4 level similar to prior. Cord signal abnormality involving the right lateral aspect of the cord is also not significant changed. There is abnormal enhancement which is increased since prior, which may represent posttreatment change but suggest continued close follow.No significant spinal or neural foraminal narrowing throughout the thoracic spine. Central disc protrusion at T7-T8 as well as additional mild multilevel degenerative changes are not significantly changed. Vertebral body heights and alignment are normal. T1 hyperintensity in the marrow likely reflects post radiation change.

Output: Compared to 3/23/2016, cervical and thoracic astrocytomas demonstrate no appreciable change in size. Increased enhancement is noted associated with the thoracic lesion which may reflect posttreatment change and may also be in part related to slight differences in technique. Would suggest continued close follow-up.


Instruction: Generate impression based on findings.

Input: Male; 61 years old. Reason: eval for choledocholithiasis History: fever, abdominal pain, elevated biliary enzymes Moderate motion artifact limits contrast-enhanced images.ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesions. No intrahepatic biliary ductal dilation. Distended gallbladder with biliary sludge and/or small stones. There is mild circumferential gallbladder wall thickening with increased enhancement. These findings are most compatible with acute cholecystitis. The distal cystic duct and entire common bile duct are patent and normal in caliber without evidence of choledocholithiasis. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Findings most compatible with acute cholecystitis. 2. No evidence of choledocholithiasis.3. Moderate motion artifact limits contrast-enhanced images.


Instruction: Generate impression based on findings.

Input: Weakness [R53.1], Reason for Study: ^Reason: seizure History: transient neurological deficit Motion artifact degraded exam quality.There is no evidence of acute ischemic or hemorrhagic lesion on scan.A couple of FLAIR/T2 high signal intensities on bifrontal white matter are again seen, unchanged since prior scan.Redemonstration of cavum septum pellucidum, unchanged.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear. Thornwaldt cyst in nasopharynx is again seen, unchanged.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. A few punctate nonspecific foci of FLAIR/T2 high signal intensity lesions especially within bifrontal white matter, unchanged since prior scan.


Instruction: Generate impression based on findings.

Input: Diagnosis: Tremor, unspecified Headache Arnold-Chiari syndrome without spina bifida or hydrocephalusClinical question: History of ChiariSigns and Symptoms: headache, numbness of left arm and hand MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. The cerebellar tonsils extend well below the level of the foramen magnum. The patient is status post Chiari I decompression. The CSF flow study demonstrates no obstruction to CSF flow.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.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal enhancing lesions are identified in the cervical spine.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina. There is a small central disk protrusion at this level.At C4-5 there is no significant compromise to the spinal canal or neural foramina. There is a small central disk protrusion at this level.At C5-6 there is no significant compromise to the spinal canal or neural foramina. There is a small central disk protrusion at this level.At C6-7 there is no significant compromise to the spinal canal or neural foramina. At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.Status post Chiari decompression without evidence for CSF flow obstruction, ventriculomegaly or syrinx.2.Minor degenerative changes are present in the cervical spine without significant compromise to the spinal canal or neural foramina.


Instruction: Generate impression based on findings.

Input: 72 year old male patient with prostate cancer, PSA of 22. Local staging before planned prostatectomy. PELVIS:PROSTATE:Prostate Size: 5.4 x 4.3 x 3.7 cm. Peripheral Zone: The right peripheral zone is near completely replaced by heterogeneous T2 hypointensity with corresponding ADC hypointensity compatible with tumor. One region of confluent signal abnormality within the right mid-gland measures 2.5 x 0.8 cm (image 45, series 301). The right mid-gland and right base are enlarged by tumor. For example, heterogeneous T2 and ADC hypointensity within the right base measures 3.2 x 3.3 cm (image 59, series 301). There is also regions of T2 hypointensity with mild ADC hypointensity within the left peripheral zone. For example, a lesion in the left mid-gland measures 1.4 x 0.5 mm (image 47, series 301). Central Gland: There is invasion of tumor from the right peripheral zone into the right central gland with mass effect.Seminal Vesicles: There is T2 and ADC hypointensity within the bilateral seminal vesicles compatible with tumor invasion. Extracapsular Extension: There is capsule overlying the right peripheral zone is indistinct compatible with extraprostatic extension with invasion of the right neurovascular bundle.BLADDER: There are multiple bladder diverticula. LYMPH NODES: There are enlarged left internal iliac and left mesorectal lymph nodes.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Tumor enlarging the right peripheral zone and tumor in the left mid-gland with extraprostatic extension and seminal vesicle involvement as described above.2.Enlarged pelvic lymph nodes compatible with metastatic disease.3.Bladder diverticula suggesting chronic bladder outlet obstruction.


Instruction: Generate impression based on findings.

Input: 80-year-old woman with history of HCV cirrhosis, evaluate for HCC. Please note that this examination was limited by motion as the patient was unable to hold her breath.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted within the liver. The patient is status post cholecystectomy. There is mild extrahepatic biliary duct dilatation measuring up to 0.8 cm. Additionally there is a 0.7 cm area of curvilinear T2 hypointensity seen along the distal common bile duct (series 4, image 25).SPLEEN: Accessory splenule is noted.PANCREAS: The distal pancreatic duct is dilated to 7 mm (series 7, image 22) to level of aforementioned distal CBD T2 hypointensity. Smaller T2 hypointense focus seen in distal pancreatic duct, next to or in contiguity with distal CBD T2 hypointense signal.ADRENAL GLANDS: The adrenal glands are normal.KIDNEYS, URETERS: Innumerable bilateral renal cysts are noted, some of which demonstrate high T1 signal suggestive of hemorrhage or proteinaceous contents.RETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Examination limited by patient motion/inability to hold breath and lack of intravenous contrast.2.No focal hepatic lesion identified.3.CBD and pancreatic duct dilatation with T2 dark signal focus in the distal common bile duct and extending to region of PD suspicious for benign or malignant ampullary stricture, however underlying choledocholithiasis not entirely excluded. ERCP should be considered for further evaluation as clinically warranted.4.Bilateral renal cysts, some mildly complex with proteinaceous/hemorrhagic contents.


Instruction: Generate impression based on findings.

Input: Disease of intestine, unspecified [K63.9] / Enteropathic arthropathies, unspecified site [M07.60], Reason for Study: ^Reason: back pain History: stiffness, IBD arthropathy. For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. There is a central broad-based disc protrusion which abuts thecal sac at the level of L5-S1. Disc desiccation is also demonstrated.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 T12-L1 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: no neuroforaminal narrowing or spinal stenosis. L5-S1: Broad based central disc protrusion which abuts thecal sac. No definitive evidence of spinal canal stenosis or neuroforaminal stenosis. Disc dessication is seen.

Output: 1. Broad based central disc protrusion with disc dessication at the level of L5S1 without spinal canal stenosis.2. Otherwise unremarkable.


Instruction: Generate impression based on findings.

Input: 60-year-old female with jaundice and transaminitis. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver with nodular surface contour and hypertrophy of the left hepatic lobe. Loss of signal diffusely on opposed phase images, suggestive of hepatic steatosis. Subcentimeter segment 3 cyst. No suspicious hepatic lesions. Portal and hepatic veins are patent.No biliary ductal dilation. Biliary sludge and/or small stones seen layering dependently within the gallbladder.SPLEEN: Splenomegaly. 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: Wall thickening of the partially visualized colon, most likely related to portal colopathy. Small gastroepiploic and gastric varices noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Moderate to large amount of upper abdominal ascites. Trace pleural effusions, partially visualized.

Output: Cirrhotic liver with findings suggestive of portal hypertension. No suspicious hepatic lesions.


Instruction: Generate impression based on findings.

Input: Male, 40 years old, with history of pineal tumor status post resection with hydrocephalus, VP shunt revised on 5/2015. Assess ventricular megaly. A right parietal approach ventricular shunt catheter is in place coursing through the right lateral ventricle and terminating to the left of midline within the left lateral ventricle. Since the prior examination, the size of the lateral ventricles has significantly increased. They were previously slitlike and now are significantly dilated with a transfrontal diameter of 5 cm. A rim of T2 hyperintensity around the ventricles is new and compatible with transependymal CSF flow.Postoperative changes in the posterior fossa and pineal region are redemonstrated including T2 hyperintensity and encephalomalacia of the vermis and paramedian cerebellar hemispheres. A previously demonstrated small enhancing focus in the pineal region is not distinctly appreciated on this examination which may reflect differences in technique. Otherwise, no significant interval change is seen in these postoperative findings.An area of thickening and enhancement along the undersurface of the left tentorium is unchanged. No definite new pathologic intracranial enhancement is seen. No evidence of acute intracranial hemorrhage is detected. Sequelae of prior right frontal approach instrumentation are redemonstrated.

Output: 1.Interval development of supratentorial ventriculomegaly with evidence of transependymal CSF flow.2.Stable postoperative findings in the posterior fossa and pineal region. A focus of enhancement seen in the pineal region on prior examinations is not distinctly visualized which may be technical.3.Nonspecific thickening and enhancement along the undersurface of the left tentorium is unchanged and favored to be postsurgical in nature.


Instruction: Generate impression based on findings.

Input: Acute onset left diplopia and left-sided hyperreflexia. History of mesothelioma. The bilateral subdural convexity subdural effusions are not significantly changed and measure up to 1 cm in thickness. They are associated with susceptibility effect indicating the presence of blood products along the inner dural membrane and in other dependent foci. The mild mass-effect on the underlying brain parenchyma is unchanged and there is no midline shift. There is no parenchymal hemorrhage or acute infarct. Minimal diffuse pachymeningeal dural contrast enhancement and thickening might be reactive or may reflect decreased intracranial pressure but there are no other signs of intracranial hypotension. Otherwise, there is is no abnormal intracranial contrast enhancement or mass. The major intracranial arterial flow voids are preserved. The dural venous sinuses are patent.There are small left maxillary retention cysts and mild ethmoid mucosal thickening, which are nonspecific. The orbits are unremarkable.

Output: 1.The bilateral convexity subdural hemorrhagic effusions remain unchanged compared to the CT scan from the same day and cause only mild mass-effect on the underlying brain and no midline shift. These bilateral, chronic complex subdural hematomas are of uncertain etiology but intracranial hypotension should also be considered.2.There is no acute infarct, parenchymal hemorrhage, abnormal contrast enhancement or mass.


Instruction: Generate impression based on findings.

Input: History of Gleason 3+3 prostate cancer. PELVIS:PROSTATE:Prostate Size: 4.1 x 2.8 x 3.1 cm.Peripheral Zone: There is an area of decreased ADC and T2 signal within the right mid gland which measures 0.6 x 0.5 cm (series 701, image 80) and which is suspicious for neoplasm.Central Gland: There is an area of decreased ADC signal within the left transitional zone without corresponding T2 signal abnormality which is favored to reflect a hyperplastic nodule.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: No extracapsular extension detected.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Subcentimeter focus of signal abnormality within the right peripheral zone mid gland suspicious for neoplasm without evidence of extraprostatic extension.


Instruction: Generate impression based on findings.

Input: 49 years Male (DOB:7/31/1967)Reason: evaluate for left lumbar root impingement or left lumbosacral plexus injury/inflammation History: hx of L3-L4 disc placement, chronic back pain, left thigh pain and numbness after surgery 4/15/2016 which was done via anterior approachReferring Attending: SERVICES ANCILLARY 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. No abnormal enhancing lesions are appreciated in the lumbar spine.Since the prior exam patient is undergone lumbar spine surgery anteriorly at the L3-4. There is metallic artifact which obscures the L3-4 level.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is a disc bulge present at this level. There is some facet hypertrophy. Since the prior exam the disc bulge at L5-S1 appears to have extended a little further and now mildly abuts the nerve roots at the lateral recesses.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is a mild disc bulge present this level.At L3-4 there is no significant compromise to spinal canal or neural foramina identified, however, this level is partially obscured by metal artifact..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: The patient status post lumbar spine surgery at the disc space of L3-4. The L3-4 level is obscured by metal artifact. To the extent of visualization there is not appear to be significant compromise to spinal canal at this level.There are degenerative changes present in the lumbar spine worse at L4-5 and L5-S1 where there are disc bulges present without significant compromise to the spinal canal or exiting nerve roots. Since the prior exam a disc bulge at L5-S1 appears to have extended further into now abuts the nerve roots at the lateral recess bilaterally..


Instruction: Generate impression based on findings.

Input: Compared to outside MRI dated 12/23/2014, interval postsurgical changes of partial corpectomy involving the right aspect of the T11 vertebral body, T10-T11 laminectomies, and posterior spinal fusion hardware placement from T9 to L1 are seen. Paraspinous rods, pedicle screws, and T11 cage produce susceptibility artifact which limit evaluation. Ventral and dorsal thecal sac however appear preserved without significant stenosis demonstrated. Left T10 screw is noted to be medially positioned and appears to encroach into the lateral aspect of the spinal canal. Distortion from hardware limits precise hardware evaluation.The thoracic spine is in normal alignment. The vertebral body heights in the thoracic spine are maintained. There is abnormal T1 and T2/STIR hyperintense signal involving the T11 vertebral body on the left extending into the posterior elements. Benign-appearing T1 hyperintense marrow signal is seen along the anterior endplates from T1 to T4 as well as T1 hyperintensity in the lower thoracic spine related to radiation. No new suspicious lesions appreciated. Mild degenerative changes are seen including small disc bulges at T6-T7, T7-T8, and T8-T9 with partial effacement of the ventral thecal sac but no significant stenosis. No obvious cord signal abnormality is appreciated although susceptibility artifact from hardware limits evaluation of cord signal abnormality at the operated levels. Paraspinous soft tissues demonstrate postoperative changes but are otherwise unremarkable.

Output: 1. Compared to outside MRI from 12/23/2014, interval postsurgical changes of partial right T11 corpectomy with cage placement, T10-T11 laminectomies, and thoracolumbar fusion from T9 to L1 are noted. Susceptibility artifact slightly limits evaluation however no high-grade spinal canal stenosis is appreciated.2. Left T10 screw appears medially positioned and encroaches into the spinal canal. No high-grade stenosis at this level. Given distortion related to hardware, CT may be considered to better assess hardware positioning if clinically indicated.3. Abnormal T1 and T2/STIR hyperintensity involving the T11 vertebral body extending into the posterior elements on the left. Signal features are consistent with tumor which has been treated with radiation.


Instruction: Generate impression based on findings.

Input: Reason: right thigh mass? Lipoma? History: right mobile thigh mass, mostly painless Patient motion artifact limits multiple sequences. A skin marker overlies the lateral aspect of the right thigh presumably corresponding to the patient's palpable area of concern. There is a lobulated mass situated within the proximal thigh within the vastus lateralis muscle which demonstrates predominantly fat signal intensity with some internal septations, measuring 5.0 x 2.0 x 6.5 cm. No dominant nodular nonadipose elements are identified. No bone marrow signal abnormality is seen. Metallic susceptibility artifact from the patient's right total hip arthroplasty limits evaluation of the right hip. There is a small right-sided hydrocele. The remaining soft tissues of the right thigh are unremarkable.

Output: Adipocytic tumor of the vastus lateralis likely representing a lipoma or less likely an atypical lipomatous tumor.


Instruction: Generate impression based on findings.

Input: NF1, scoliosis, paraspinal plexiform tumor. Evaluate for change. Since the prior MRI, interval postsurgical changes of posterior spinal fusion are evident throughout the thoracic spine. Hardware integrity can be better assessed with radiographs or CT. Susceptibility artifact limits evaluation.As demonstrated previously, the neural foramina and paraspinal soft tissue structures are again notable for a left sided plexiform neurofibroma spanning T2 through T10, measuring approximately 10 cm in the craniocaudal dimension. There appears to be some interval resection involving the posterior subcutaneous/paraspinous aspect of the tumor. Extension into the paraspinal muscles to the right of the spinous process and along the left chest wall and extrapleural space, appearing to involve some of the intercostal nerves in the left chest again seen. No area of enlargement is seen to suggest malignant degeneration. Severe levoscoliosis in the upper thoracic spine as well as exaggerated thoracic curvature appear improved in the interval and can be better assessed with standing radiographs as clinically indicated. Cord contour deformity related to the curvature is again seen without clear evidence of significant spinal canal stenosis at any level within the limits of susceptibility artifact from the hardware.Vertebral body heights and alignment in the lumbar spine are normal. Bone marrow signal is normal. No evidence of tumor in the lumbar spine. No significant spinal canal or neural foraminal stenosis seen at any level in the lumbar spine.

Output: Compared to prior MRI from 1/8/2013, interval postsurgical changes of posterior spinal fusion involving the thoracic spine are seen. Severe levoscoliosis in the upper thoracic spine as well as exaggerated kyphosis appear improved. There appears to have been partial resection of the posterior paraspinous aspect of the plexiform tumor which extends from T2 to T10 as described above; extent of resection can be better assessed with outside operative note or immediate postoperative imaging. No new area of tumor is seen to definitively suggest enlargement. Note due to susceptibility artifact from the hardware small areas of epidural and neural foraminal tumor are difficult to assess.


Instruction: Generate impression based on findings.

Input: Evidence of migraines with "worst HA of life" and associated dizziness, nausea, and blurry vision yesterday. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable.

Output: No evidence of intracranial hemorrhage, mass, or acute infarction.


Instruction: Generate impression based on findings.

Input: Reason: adnexal mass History: pelvic discomfort. History of breast cancer.Ultrasound report 4/29/2016: An ovary is seen midline and is normal in size and appearence. This is presumed to be the right ovary. A cyst with low level echoes, measuring 55 x 53 x 42 mm, is seen in the left adnexa. This may represent the left ovary. No free fluid visualized in pelvis. PELVIS:UTERUS, ADNEXA: Status post hysterectomy. 3 mm left Bartholin's gland cyst.The right ovary is normal-appearing containing small follicles measuring 4.6 x 3.4 cm. The left ovary measures 1.9 x 2.4 cm and contains small follicles.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: There is a small to moderate amount of free fluid in the pelvis, decreased since the prior CT.

Output: 1.Normal-appearing ovaries with small follicles.2.Small to moderate amount of fluid within the cul-de-sac is decreased from the prior exam likely represents loculated free fluid.


Instruction: Generate impression based on findings.

Input: 38-year-old female with history of renal cell carcinoma status post right nephrectomy. Evaluate for recurrence.Patient pathology with chromophobe renal cell carcinoma. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Status post right nephrectomy without evidence of disease recurrence.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Bilateral physiologic adnexal cysts are noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No evidence of local recurrence or metastatic disease.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate cord compression. Signs and symptoms: Unable to move lower extremities. Nonenhanced total spine MRI:Examination is performed utilizing cord compression protocol and without dedicated axial images.Examination demonstrates diffuse marrow signal changes of vertebral column consistent with patient's previously known diffuse metastatic disease. There is no fracture or malalignment and no significant interval change since prior exam. There is a an epidural defect at C3-C4 level similar to prior exam and with resultant significant central spinal stenosis. There is a focus of T2 increased signal intensity which is suspected of being within the cord similar to prior exam and is believed to represent a focus of edema or myelomalacia. This finding however demonstrate no change since prior MRI exam in this limited evaluation.The signal intensity of the cord is otherwise appears normal on this suboptimal motion degraded images. There is diffuse lumbar stenosis extending from L2 inferiorly to S2 levels similar to prior exam. Lack of intravenous contrast also reduces the sensitivity of the exam for better assessment. This appearance however is believed to be secondary to congenitally small pedicle as well as hypertrophic changes.

Output: 1.Diffuse osseous metastatic lesions throughout the spine without fracture - malalignment or interval change since prior exam.2.Significant central spinal stenosis at C3-C4 and a focus of myelomalacia of the cord similar to prior exam.3.Uniform spinal stenosis in the lower lumbar spine which is believed to be secondary to hypertrophic changes as well as congenitally short pedicles without change since prior MRI study.


Instruction: Generate impression based on findings.

Input: As seen on the recent MRI neck, there is enhancing mass in the left posterior cerebellum, measuring 1.4 x 1.6 cm in greatest axial dimensions, with prominent surrounding T2/FLAIR hyperintensity and effacement of the cerebellar sulci, due to localized mass effect from the vasogenic edema. No other enhancing lesion is identified. There is a nonspecific focus of T2/FLAIR hyperintensity in the left parietal centrum semiovale without enhancement.The ventricles and sulci are within normal limits. The cisterns remain patent. There is no midline shift. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. Marrow signal within the clivus and inferior occipital bone appears fatty, relative to other areas which may be related to post radiation changes in the field of prior treatment.

Output: 1. Redemonstration of left cerebellar metastasis with prominent surrounding vasogenic edema and minimal localized mass effect. No other definite intracranial metastatic disease identified.2. Single punctate focus of nonenhancing T2/FLAIR hyperintensity in the left parietal centrum semiovale which is nonspecific.


Instruction: Generate impression based on findings.

Input: 5 day old 37 week gestation infant delivered by emergency C-section after placental abruption. Low APGARs status post cooling protocol now with seizures. Evaluate for hypoxic ischemic injury. There is diffuse patchy mildly restricted diffusion throughout the supratentorial brain with more conspicuous restricted diffusion to diffuse in the corpus callosum. There is relative sparing of the cerebellum. The cerebral cortex demonstrates diffuse subtle increased T2 and decreased T1 signal, along with blurring of the gray-white junction, compatible with cerebral edema. Abnormal signal is also identified along the brainstem. The deep gray nuclei demonstrate prominent patchy areas of increased T1 signal. Normal T1 hyperintense and T2 hypointense signal in the posterior limb of internal capsules is not visualized. The constellation of findings is compatible with hypoxic ischemic encephalopathy.There is associated local mass effect with diffuse effacement of the cortical sulci and perhaps minimal decrease in size of the lateral ventricles. The basal cisterns remain patent. No evidence of herniation.No evidence of intracranial hemorrhage. The expected intracranial vascular flow voids are present.The middle ears and mastoid air cells are opacified with fluid. The orbits are unremarkable. There is a moderate occipitoparietal caput succedaneum.

Output: 1. Diffusely abnormal signal in the supratentorial brain and brainstem as described, compatible with hypoxic ischemic encephalopathy.2. More conspicuous diffusion restriction diffusely to the corpus callosum which may relate to acute neuronal degeneration.3. Nonspecific fluid opacification of bilateral middle ears and mastoids.


Instruction: Generate impression based on findings.

Input: Ms. Schuenemann is a 56-year-old female with BRCA1 gene. Family history of ovarian cancer in sister and breast cancer in maternal great aunt and maternal second cousin. She has no current breast related complaints. There is scattered fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.A few benign cysts are seen in the right breast. No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary or internal mammary region.

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


Instruction: Generate impression based on findings.

Input: 53 years Male (DOB:8/17/1962)Reason: new right ptosis and swelling, evaluate cranial nerves 3-6 History: as abovePROVIDER/ATTENDING NAME: JONAS ARAUJO DE SOUZA JONAS ARAUJO DE SOUZA There is a heterogeneous lesion present in the right cingulate gyrus and adjacent to right paracentral lobule associated with the foci of susceptibility effect and local volume loss. It is associated with some foci of T1 signal hyperintensity Axial dimensions of the FLAIR signal abnormality are approximately 54 x 28 mm axial dimensions. On coronal T2 imaging measures approximately 34 x 27 mm coronal dimensions. On the prior exam from 3/15/2016 measured approximately 33 x 63 mm axial dimensions Another heterogeneous lesion is present in the right basal ganglia which measures 20 x 26 mm axial dimensions. This was larger on the prior exam. It is associated with some foci of T1 signal hyperintensityThere is a 3 mm T2 hyperintense lesion associated with susceptibility effect located in the left caudate nucleus which remains stable compared to the prior exam. It is associated with T1 signal hyperintensity.A small focus of susceptibility effect is present along the left occipital lobe lingual gyrus adjacent to the calcarine sulcus anteriorly. It is stable compared to the prior exam.A punctate focus of T2 and FLAIR hyperintensity is present in the right thalamus stable. It is associated with susceptibility effect.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.Some of the images are degraded due to patient motion as well as by motion. Many of the imaging sequences were repeated.

Output: 1.Since the previous examination lesions located in the right basal ganglia and right cingulate gyrus have regressed in overall size predominantly due to regression of edema.2.Small lesions in the left caudate nucleus, right thalamus and the left occipital lobe are stable.3.Although no cranial nerve lesion is identified contrast-enhanced MRI exams or more sensitive in identifying cranial nerve lesions when compared to noncontrast exams.4.Please note that contrast-enhanced exams or more sensitive in detecting recurrent tumor.5.The patient had difficulty cooperating with the exam and as a result the examination was not completed as intended ( with contrast and with more imaging specific to the cranial nerves)


Instruction: Generate impression based on findings.

Input: There is no restricted diffusion to suggest acute ischemic infarction. No intracranial masses are identified. A few scattered punctate foci of increased T2/FLAIR signal are present within the subcortical and periventricular white matter as well as the basal ganglia in a nonspecific pattern. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable. The midline structures and craniocervical junction are within normal limits.

Output: Few scattered punctate foci of abnormal signal within the supratentorial white matter which are nonspecific but in the proper clinical setting could be related to multiple sclerosis.


Instruction: Generate impression based on findings.

Input: History of elevated LFTs and metastases from uveal melanoma. ABDOMEN:LIVER, BILIARY TRACT: There are numerous liver metastases compatible with melanoma metastases. The largest is a large mass in the right hepatic lobe measuring up to 9.8 x 10.4 cm (series 5/23). Additionally there is extensive porta hepatis soft tissue infiltration encasing the common bile duct.. The thin section MRCP images demonstrate a focal high-grade narrowing of the midportion of the common bile duct (series 9 image 3), which may be in part due to a crossing vessel. Proximally the common bile duct measures 3 to 4 mm. Additionally there is a focal complete narrowing of the right biliary tree with significant right hepatic lobe biliary ductal dilatation.The portal vein is patent.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Aortocaval and portacaval lymphadenopathy extending into the porta hepatis.BOWEL, MESENTERY: Soft tissue implants in the mesentery compatible with metastatic disease. A right mesenteric mass measures 3.1 x 2.5 cm (series 5 image 2).BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Left pleural effusion with extensive soft tissue pleural nodular thickening, left greater than right compatible with metastatic disease. Left hilar lymphadenopathy better characterized on recent CT.

Output: 1.Focal high-grade narrowing of the midportion of the common bile duct, which may be in part due to a crossing vessel, and focal complete narrowing of the right biliary tree with significant right hepatic lobe biliary ductal dilatation.2.Extensive hepatic metastases and tumor infiltration in the porta hepatis encasing the biliary system. Upper abdominal metastases including lymphadenopathy and mesenteric implants.3.Extensive metastatic disease to the chest.


Instruction: Generate impression based on findings.

Input: 66 year old female with left visual field deficit per Optho. Evaluate for parietal CVA. The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma. Scattered T2/FLAIR hyperintense foci in the subcortical and periventricular white matter which demonstrate no restricted diffusion and are nonspecific but are likely vascular in nature related to chronic small vessel ischemic disease. 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.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related. 2.There is no evidence for acute cerebral infarction.


Instruction: Generate impression based on findings.

Input: increasing speaking difficulty and dizziness No evidence of acute ischemic or hemorrhagic lesion.There are multifocal tissue losses involving bilateral cerebellar hemispheres, especially involving left inferior cerebellar hemisphere, and inferior vermis as well as left occipital lobe especially around the calcarine sulcus and lingual gyrus.There are evidence of prior craniotomy on the left side occipital bone as well as right frontal burr hole. Right frontal subcutaneous located about 10mm sized fluid filled material is likely representing VP shunt reservoir. The VP shunt tip is located in the right lateral ventricle.  There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.

Output: No evidence of acute ischemic or hemorrhagic lesion.Postoperative status of posterior fossa with multifocal tissue losses involving bilateral cerebellar hemispheres, inferior vermis and left occipital lobe as described above.VP shunt has placed through the right frontal burr hole with normal ventricle size.


Instruction: Generate impression based on findings.

Input: Susceptibility artifact from recent surgery limits examination. Postoperative findings consistent with laminectomies T6-T9 and posterior fixation T6-T10. Further, there has been interval decrease in the amount of visualized dorsal epidural fat consistent with resection from the level of T6-T10. As a result, there is improved/decompressed morphology of the thecal sac at the levels of the surgical decompression. However, there has also been a change in contour of thecal sac above and below the levels of surgery with overall decreased CSF circumferentially, especially dorsally. This extends up to the T3-T4 level, and also down to the L1 level. Lipomatous tissue remains more conspicuous laterally at the levels of decompression. Overall, findings result in up to mild to moderate spinal canal stenosis at multiple levels.The thoracic spine demonstrates exaggerated kyphosis. The vertebral body heights are maintained. There remains ventral flowing osteophytes at multiple levels, most evident with ventral osteophyte complex at T8-T9. There is T1 hyperintensity in the disc at T4-T5 and T10-T11, which could be related to mineralization. The small T8-T9 disc bulge is again visualized, however is partially obscured by the hardware artifact.

Output: 1. Postoperative appearance of the thoracic spine including T6-T9 laminectomies with posterior spinal fixation of T6-T10. Further there has been central spinal canal decompression with interval removal of dorsal epidural lipomatous tissue at T6-T10.2. Decreased CSF space surrounding the spinal cord thoracic levels other than those affected by the surgery, extending up to T3-T4 and down to L1. This is favored to be secondary to redistribution of CSF due to increased CSF space at levels of surgery, although there is residual mass effect now from lateral epidural fat at these levels. Overall, there is multilevel mild to moderate spinal canal stenosis.


Instruction: Generate impression based on findings.

Input: Multiple sclerosis, history of sensory and worsening leg weakness. Brain: There are multiple supratentorial and infratentorial T2 hyperintense lesions. Some of the lesions demonstrate corresponding T1 hypointensity. However, there is no abnormal enhancement or associated restricted diffusion in any of these lesions. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There is an unchanged subcentimeter cystic pineal gland. The major cerebral flow voids are intact. There is hypoplasia of the right maxillary sinus with mild mucosal thickening and mucosal thickening involving the right ethmoid sinus. There is also fluid within the right sphenoid sinus. The orbits, skull, and scalp soft tissues are grossly unremarkable.Thoracic Spine: The thoracic spinal cord signal appears unremarkable. There is no evidence of mass lesions or abnormal enhancement. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. There are prominent posterior disc osteophyte complex at T6-T7 and T7-T8, which indent the spinal cord. There is also a right neural foraminal disc-osteophyte complex at T9-10. The paravertebral soft tissue structures are otherwise unremarkable.

Output: 1. No significant interval change of the demyelinating lesions in the brain.2. No evidence of demyelinating lesions in the thoracic cord.3. Prominent posterior disc osteophyte complex at T6-T7, T7-T8, and T9-T10 indent the spinal cord.4. Findings suggestive of acute sinusitis.


Instruction: Generate impression based on findings.

Input: Planning brain biopsy using stealth with fiducial markers. Skin fiducial markers are in position. Redemonstrated is an abnormal appearance of a portion of the posterior fossa and diencephalic structures, which are otherwise incompletely characterized on this exam. The ventricles are unchanged in size and configuration, with a right transfrontal catheter in position and nearly collapsed appearance of the lateral and third ventricles, and effacement of the fourth ventricle. There is no midline shift or herniation. The major cerebral flow voids are intact. There is fluid within the left middle ear and mastoid antrum. There is also mucosal thickening or secretions within the paranasal sinuses.

Output: Preoperative planing MRI with skin fiducial markers in position.


Instruction: Generate impression based on findings.

Input: 56 years Female (DOB:9/23/1959)Reason: dizziness, R>L, lasting for 3 weeks, nausea, History: as abovePROVIDER/ATTENDING NAME: KATARINA VESKOVIC KATARINA VESKOVIC The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus. There is fetal origin of the PCA bilaterally.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: No MRI abnormalities are identified in the brain to explain the patient's symptoms. MRI of the brain is within normal limits.


Instruction: Generate impression based on findings.

Input: The ventricles and sulci are prominent, consistent with mild age-related volume loss. The basal cisterns remain patent. There is no midline shift or mass effect. There are multiple nonspecific scattered punctate foci of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter. There is no pathological enhancement. There is redemonstration of foci of ill-defined enhancement within the central pons with a smaller focus in the right paramedian pons just cranially. These correspond to areas of abnormality seen at the edge of the field of view on MRI of the cervical spine. These demonstrate associated ill-defined susceptibility. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. There is a small mucosal retention cyst in the right maxillary sinus. Minimal mucosal thickening is noted in the left anterior ethmoid air cells. There is under pneumatization of the mastoids bilaterally.

Output: 1.Ill-defined small areas of enhancement in the central pons with associated mild susceptibility consistent with incidental capillary telangiectasias. No MR evidence of intracranial metastatic disease.2.Other scattered nonspecific punctate foci of T2/FLAIR hyperintensity within the subcortical and periventricular white matter without enhancement, which are nonspecific. Differential diagnosis would include infectious/inflammatory etiologies, chronic small vessel ischemic changes, demyelinating disease, and migraine headaches. Please correlate clinically.


Instruction: Generate impression based on findings.

Input: Male, 21 months old, unresponsive, with loss of most brainstem reflexes, breathing over the vent. Assess degree of neurologic injury after prolonged cardiac arrest. Diffuse abnormal cortical and subcortical T2/FLAIR hyperintensity is seen within the cerebral hemispheres, the basal ganglia, cerebellum and to a lesser degree the brainstem. Note is also made of diffuse extensive cortical T1 hyperintensity particularly involving the basal ganglia and the cortex of the posterior frontal lobes, parietal lobes, occipital and temporal lobes. No clear restricted diffusion is seen.There may be trace scattered parenchymal susceptibility suggesting a small amount of hemosiderin deposition. Note is made of small bilateral parietal and occipital extra-axial collections which demonstrate T1 hyperintensity. The sulci and ventricles have widened compared to prior CT examinations.

Output: Sequelae of extensive hypoxic ischemic injury are demonstrated including diffuse abnormal T2/FLAIR signal and cortical T1 hyperintensity suggesting laminar necrosis. The cerebral hemispheres, deep gray nuclei, cerebellum and to a lesser degree the brainstem are all involved.Since prior CTs, the sulci and ventricles have widened which may represent a combination of resolving edema and loss of parenchymal volume.Note is made of small subacute likely subdural hematomas along the bilateral parietal and occipital lobes.


Instruction: Generate impression based on findings.

Input: Clinical question of corner assess post op. Signs and symptoms: Status post right craniotomy. Nonenhanced head CT:Examination demonstrate expected postoperative changes of a large right-sided suboccipital craniectomy/repair. There is interval removal of previously noted large tumor in the right cerebellopontine angle. Subtle increased density within the right internal auditory canal is present on axial image 8 which may represent minimal residual tumor. Follow-up with an MRI is recommended. Widening of right cerebellopontine angle cistern is as result of prior tumor and postop change. Subtle deformity of the right cerebellum and right aspect of the pons is believed to be result of prior long-standing mass effect from tumor.There is also subtle deviation of the fourth ventricle across the midline to the left as was noted on preoperative study.There is no evidence of parenchymal hemorrhage or edema.Images through supratentorial space demonstrate no definitive evidence of abnormality.

Output: Expected postoperative changes of a large right suboccipital craniectomy and repair repair for removal of tumor.


Instruction: Generate impression based on findings.

Input: 4-year-old male with developmental delay Brain parenchyma appears within normal limits. No structural lesions are appreciated. Sulcation and myelination appear within normal limits. Midline structures and posterior fossa structures are within normal limits. Pituitary gland is somewhat small which is nonspecific. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Brain parenchyma appears within normal limits.


Instruction: Generate impression based on findings.

Input: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is redemonstration of several scattered punctate foci of abnormally increased T2/FLAIR signal within the supratentorial white matter without definite change from 2/20/2015 when accounting for differences in technique. 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 midline structures and craniocervical junction are within normal limits. The skull and scalp soft tissues are unremarkable. There is minimal paranasal sinus mucosal thickening. The optic nerves are incompletely evaluated on this examination.

Output: Several scattered foci of signal abnormality within the supratentorial white matter not significantly changed accounting for differences in technique. Lesions are nonspecific and may represent demyelinating disease or chronic small vessel ischemic disease among other etiologies.


Instruction: Generate impression based on findings.

Input: No intracranial mass or abnormal parenchymal or meningeal enhancement in the brain is appreciated to suggest metastatic disease. There is a subcentimeter focus of enhancement with susceptibility effect in the anterior aspect of the pons which likely represents a capillary telangiectasia. Remainder of the brain parenchyma appears unremarkable. No evidence of acute ischemia or hemorrhage. No hydrocephalus. No extra-axial collections. Bone marrow signal is within normal limits.There is an approximately 4 mm focus of abnormal enhancement and nodularity involving the right posterior aspect of the globe compatible with reported metastasis. There is minimal enhancement involving the adjacent retrobulbar fat which may be reactive. Bilateral orbits appear otherwise unremarkable including the extraocular muscles and bony orbital walls. No abnormal signal involving the optic nerves or chiasm.

Output: 1. Small focus of nodular enhancement involving the right posterior aspect of the globe is compatible with a choroidal metastasis.2. No evidence of intracranial metastatic disease. Subcentimeter focus of enhancement with susceptibility effect involving the anterior pons most likely represents capillary telangiectasia.


Instruction: Generate impression based on findings.

Input: Reason: Eval for fluid collection, worsening cellulitis History: Unstable BP. h/o fevers while in hospital. +Pasturella cellulitis in setting of chronic venous stasis ulcer Note is made of skin thickening and diffuse subcutaneous reticulation and edema consistent with the stated history of cellulitis. This is diffuse but appears most pronounced along the lateral aspect of the leg. Additionally, there is a loculated collection of fluid signal intensity within the subcutaneous tissues along the lateral aspect of the proximal fibular metadiaphysis which demonstrates peripheral enhancement on postcontrast sequences measuring 9.2 x 3.7 x 14.9 cm (AP x TR x CC) suspicious for early evolving abscess formation. This extends to the level of the fascia of the lateral compartment musculature. There is diffuse increased signal abnormality within the musculature of the leg which is nonspecific but may suspicious for a myositis. The bone marrow signal is within normal limits without findings to suggest osteomyelitis. Although this examination was not protocoled for detailed evaluation of the knee, there appears to be at least a small left knee joint effusion with thickened enhancing synovium suggesting a synovitis, incompletely imaged on this examination.

Output: 1. Diffuse inflammatory change most pronounced along the lateral aspect of the left leg consistent with the stated history of a cellulitis which extends to the level of the underlying fascia. There is a 14.9 cm loculated enhancing fluid collection within the subcutaneous tissue along the lateral aspect of the proximal fibular metadiaphysis suspicious for early evolving abscess formation. No evidence of osteomyelitis. Follow up examination to establish resolution/evaluate for interval change is recommended. 2. Diffuse increased signal within the musculature of the leg is nonspecific but suspicious for a myositis.3. Although this examination was not protocoled for detailed evaluation of the knee, there are findings suggestive of a synovitis of the left knee as described.


Instruction: Generate impression based on findings.

Input: Male, 33 years old, with Chiari malformation. The cerebellar tonsils descend to 5 mm below the level of the foramen magnum which just meets criteria for a Chiari I malformation. However, the tonsils maintain a relatively round morphology, and there is little if any crowding of the brainstem at the foramen magnum. Robust biphasic CSF flow signal is seen through the anterior foramen magnum. Robust biphasic CSF flow signal is seen posterior to the cervical cord. However, minimal if any flow signal is detected around the cerebellar tonsils.Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. No pathologic marrow replacement or marrow edema is detected. The visualized spinal cord demonstrates normal signal intensity and morphology. No evidence of any spinal cord syrinx or other focal cord lesion is seen.At C3-4, facet hypertrophy, uncovertebral hypertrophy, and a small central disc protrusion are noted. The spinal canal is not compromised, but the left neural foramen is narrowed. No other significant disc degeneration is seen.

Output: Findings are seen compatible with a Chiari I malformation. The cerebellar tonsils descend 5 mm below the level of the foramen magnum. Reduced CSF flow signal is evident around the cerebellar tonsils. However, the tonsils themselves maintain a relatively normal round morphology and there is little if any apparent crowding of the brainstem.


Instruction: Generate impression based on findings.

Input: History of multifocal 4+3 prostatic adenocarcinoma. Presents for staging. PELVIS:PROSTATE:Prostate Size: 2.9 x 5.4 x 5.2 cmPeripheral Zone: Multifocal prostatic adenocarcinoma with extensive T2-weighted hypointensity restricted diffusion and arterial enhancement involving the apex, mid gland and base of the prostate peripheral zone.Central Gland: No significant abnormality.Seminal Vesicles: Findings suspicious of seminal vesicle invasion near the midline (series 604/444).Extracapsular Extension: The tumor abuts the prostatic pseudocapsule extensively with regions where it is ill-defined compatible with extraprostatic extension.BLADDER: No significant abnormality noted.LYMPH NODES: No pathologically enlarged pelvic lymphadenopathy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Multifocal prostatic adenocarcinoma with suspected seminal vesicle invasion and extra prostatic extension. No pelvic lymphadenopathy by size criteria.


Instruction: Generate impression based on findings.

Input: MCP injury to second and third digits (index and middle finger) Note that the examination is limited by motion artifact.LIGAMENTS: There is increased signal and enlargement of the radial collateral ligaments of the second and third digit. A discrete tear is not seen.TENDONS: No significant abnormality noted. BONES: A benign or degenerative cyst is seen within the head of the third metacarpal. Otherwise the marrow signal is normal.ADDITIONAL

Output: Increased signal and enlargement of the radial collateral ligaments of the second and third metacarpals. Although limited by motion artifact, a discrete tear is not appreciated. These findings may represent a chronic injury and/or scarring.


Instruction: Generate impression based on findings.

Input: 58-year-old female with recurrent colorectal cancer, restaging after chemoradiotherapy. CHEST:LUNGS AND PLEURA: Biapical scarring. Few bilateral micronodules.MEDIASTINUM AND HILA: Subcarinal lymph node, not enlarged by CT criteria.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Duplicated collecting system on the left side with upper collecting system showing mild hydroureter in the midportion.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Fat containing umbilical hernia. PELVIS:UTERUS, ADNEXA: Surgically removed.BLADDER: No significant abnormality noted.LYMPH NODES: Stable cystic lymph node in the left pelvis measures 9 x 12 mm at image 183 of series 3. BOWEL, MESENTERY: Status post proctectomy with surgical staples near the anus. Small gas and fluid filled left presacral extension of the neorectum is stable, probably post-op change. Lesion in the left rectum seen on the prior MRI and PET exams is not definitely found. BONES, SOFT TISSUES: ScoliosisOTHER: Multiple radiodensities in superficial buttock soft tissues bilaterally may be calcifications - injection granulomata.

Output: Small left peri-rectal lesion seen on prior MRI and PET exam is not seen.Otherwise stable exam.


Instruction: Generate impression based on findings.

Input: BRAIN: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is a subcentimeter nonspecific focus of cortical T2/FLAIR hyperintensity within the medial left parietal lobe with a tiny curvilinear internal flow void and a prominent adjacent vessel on SWI which may be accentuated by the T2 hyperintensity, but without associated significant susceptibility effect, diffusion restriction, or enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. Thre is a 4 mm cystic structure in the pineal gland. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable.MRA HEAD: This portion of the exam is mildly degraded by motion artifact. The intracranial internal carotid arteries are normal in course and caliber. The middle and anterior cerebral arteries are unremarkable. The vertebral arteries, basilar artery, and posterior cerebral arteries are normal in course and caliber. There is no evidence of flow-limiting stenosis, aneurysm, or vascular malformation.

Output: Small nonspecific focus of cortical T2 hyperintensity within the medial left parietal lobe containing a very small internal curvilinear flow void with an adjacent prominent vein, and no significant susceptibility or enhancement at this time. This is non-specific and may represent a small cortical dysplasia or a very small vascular malformation such as a telangiectasia, and follow-up imaging is suggested to ensure stability. Otherwise, no evidence of intracranial vascular malformation.


Instruction: Generate impression based on findings.

Input: 36-year-old male with history of chronic pancreatitis in preparation for pancreatectomy and auto islet transplantation. ABDOMEN:LIVER, BILIARY TRACT: Postoperative changes of cholecystectomy. Common bile duct measures up to 5 mm. No intrahepatic biliary ductal dilatation. No suspicious hepatic lesions.SPLEEN: No significant abnormality noted.PANCREAS: The pancreas is atrophic with mild pancreatic ductal dilatation. No suspicious pancreatic mass.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Findings compatible with chronic pancreatitis. No suspicious pancreatic mass.


Instruction: Generate impression based on findings.

Input: 62 year-old female history of right upper quadrant pain status post cholecystectomy. ABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy. There is minimal intrahepatic biliary ductal dilatation. The common bile duct appears normal measuring 5 mm. No evidence of retained stone. No suspicious hepatic lesions. No perihepatic ascites.SPLEEN: No significant abnormality noted.PANCREAS: Small cystic lesion without enhancement at the pancreatic head measuring 7 x 5 mm without clear communication to the main pancreatic duct likely representing side branch IPMN (image 19 of series 501).ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral nonenhancing simple cysts.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. Status post cholecystectomy with no findings to account for the patient's right upper quadrant pain.2. Small pancreatic head cystic lesion, likely an IPMN.


Instruction: Generate impression based on findings.

Input: Reason: biliary duct dilation/obstruction History: Abdominal painAdditional history per electronic medical record:History of pancreatitis with elevated lipase. Examination mildly limited by patient motion.ABDOMEN:LIVER, BILIARY TRACT: The liver demonstrates normal background parenchymal signal intensity and enhancement. There is no significant loss of signal on out of phase images to suggest fatty infiltration. No suspicious focal hepatic lesions are identified.The hepatic vasculature appears patent.The gallbladder is contracted and contains gallstones. No significant pericholecystic inflammatory changes are identified. No intra or extrahepatic biliary ductal dilatation is identified. The common bile duct measures up to 5 mm. No evidence of choledocholithiasis.SPLEEN: No significant abnormality noted.PANCREAS: The pancreas demonstrates normal background T1 parenchymal signal intensity and enhancement. There is mildly increased T2 and DWI signal within the pancreatic head, uncinate process, and body suggestive of acute pancreatitis. There is also diffuse loss of the normal pancreatic lobulations with suggestion of a hypointense pancreatic rim. No focal pancreatic lesions are identified. The pancreatic duct is not well-visualized but is nondilated. No significant peripancreatic inflammatory changes are identified.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Trace pelvic free fluid which may be physiologic.

Output: 1.Cholelithiasis without evidence of acute cholecystitis, choledocholithiasis, or biliary ductal dilatation.2.Findings suggestive with acute pancreatitis without evidence of complication. Autoimmune pancreatitis is a differential consideration, consider correlation with serum IgG levels.3.Pancreatic duct is poorly visualized but nondilated.


Instruction: Generate impression based on findings.

Input: Secondary malignant neoplasm of unspecified site [C79.9] / Other symptoms and signs involving cognitive functions and awareness [R41.89] / Conduct disorder, unspecified [F91.9], Reason for Study: ^Reason: pt with behavioral/mood/memory changes No evidence of acute ischemic or hemorrhagic lesion.No evidence of abnormal enhancement. Slight there are subtle scattered high signal intensity lesions on periventricular white matter indicating nonspecific small vessel ischemic disease, no change since prior scan.Mild opacifications on bilateral mastoid air cells, slightly improved since prior scan.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses are clear. There is a small Thornwaldt cyst, no change since prior scan.

Output: No evidence of acute ischemic or hemorrhagic lesion.No evidence of abnormal enhancement.No change of nonspecific small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: Clinical question: AMS since shunt placement. Signs and symptoms: AMS since shunt placement. Pre and post enhanced brain MRI:Diffusion weighted images are partially obscured by extensive metallic artifact obscuring the right aspect of posterior fossa, right mid and posterior temporal lobe and portion of right parietal. Beyond the region of artifact no evidence of restricted diffusion detected.Stable extensive bilateral periventricular FLAIR hyperintensity since prior exam.Interval decreased size of chronic hemorrhagic changes in the right frontal along the course of previously removed right ventricular catheter. Mild residual blood still detected. Compared to prior study there is suggestion of mild interval decreased size of supratentorial ventricles. A right posterior temporal approach ventricular catheter is a new finding since prior exam. The catheter traverses the brain parenchyma, enters the right lateral ventricle and the tip in the anterior aspect of body of right lateral ventricle and intermediate and right paramedian location. There is edema of right posterior temporal-parietal parenchymal at the site of new catheter. Images through posterior fossa are unremarkable and stable since prior study.The signal void of major intracranial arterial branches are identified.Unremarkable images through the orbits.

Output: 1.No detectable acute intracranial process and negative diffusion-weighted images.2.New right posterior temporal-parietal ventricular catheter with the tip in the anterior right lateral ventricle. 3.Mild interval decrease size of ventricular system and focus of edema at the site of catheter entry in the right posterior temporal-parietal region.4.Stable examination otherwise and with revisualization of extensive periventricular FLAIR hyperintensity since prior study.5.Interval decreased size of focus of hemorrhage in the right frontal along the course of the previously removed catheter.