Instruction: Generate impression based on findings.

Input: 50-year-old female with history of jejunal diverticulitis, assess resolution ABDOMEN:LIVER, BILIARY TRACT: Hepatomegaly measuring 22.5 cm in craniocaudal dimension. Punctate right hepatic hypodensity is too small to characterize but likely represents a cyst. Loss of signal on out of phase images suggests steatosis.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.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Resolution of diverticulitis without evidence of a small bowel lesion.2.Hepatomegaly and hepatic steatosis.


Instruction: Generate impression based on findings.

Input: A patient submitted outside study for review. Submitted for review is MRI dated March 13, 2015 performed at DuPage Medical Group in Naperville, Illinois. For comparison, prior mammograms dated June 13, 2014 and March 21, 2014 are available. Bilateral screening breast MRI was performed per outside institution protocol without and with gadolinium based contrast agent. Interpretation of this examination is somewhat limited given the inability to upload and interpret the dynamic images utilizing Dynacad.There is heterogeneous amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.An area of non-mass enhancement is present within the upper inner right breast, mid depth, measuring 1.9 x 1.1 x 1.9 cm, and is not appreciated on prior examinations. Additionally, there is mild skin indentation overlying the area of enhancement within the medial right breast. Elsewhere, multiple patchy areas of enhancement are appreciated throughout both breasts, unchanged from prior examinations. No abnormal lymph nodes are identified in either axillary region.

Output: New area of non-mass enhancement within the upper inner right breast with overlying skin indentation. Correlation with history of biopsy or other surgical procedure recommended. MRI guided ultrasound is recommended. If no sonographic correlate is identified, MRI with possible biopsy is advised.BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Altered mental status and ataxiaClinical question: r/o stroke, NPHSigns and Symptoms: r/o stroke, AMS ataxia There is a 20x29mm axial dimension cyst in the pineal region compatible with arachnoid cyst. It follows CSF on all pulse sequences. There is associated flattening of the tectal plate.The lateral ventricles are relatively large in relation to the sulci.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.There is loss of volume along the left middle frontal gyrus associated with medial displacement of the adjacent vasculature.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. The eye lenses are thin.

Output: 1.Large lateral ventricles. The possibility of normal pressure hydrocephalus cannot be excluded. Another possibility is that this is related to the pineal region arachnoid cyst.2.Pineal region arachnoid cyst associated with flattening of the tectal plate.3.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 4.No evidence for acute ischemic cerebral infarction.5.Focal volume loss along the left middle frontal gyrus is non-specific.


Instruction: Generate impression based on findings.

Input: 44 year old female with DM, HTN, fibromyalgia, DKA, syncope and unexplained LVOT gradient with SAM of the mitral valve. Left VentricleThe left ventricle is normal in size with mild concentric hypertrophy and normal systolic function. The overall LV ejection fraction is 73%. The LVEDV is 127 ml (normal range 109+/-23), LV end diastolic volume index is 88 ml/m2 (normal range: 65+/-11), LVESV is 35 ml (normal range 31+/-10), and LV end systolic volume index is 24 ml/m2 (normal range 18+/-5). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. There is evidence for flow acceleration in the LVOT.The native T1 myocardial relaxation time is upper normal and similar in the septum and other myocardial segments. There is no LV thrombus. There is mild sigmoid hypertrophy of the interventricular septum.Left AtriumThe left atrium is normal in size.Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 45%, the RVEDV is 177 ml (normal range 110+/-24), the RV end diastolic volume index is 122 ml/m2 (normal range 69+/-14), the RVESV is 98 ml (normal range 35+/-13) and the RV end systolic volume index is 68 ml/m2 (normal range 22+/-8).Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve is trileaflet, opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is 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. CVenous AnatomyThe SVC and IV 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.Normal sized left ventricle with mild concentric hypertrophy and hyperdynamic systolic function.2.Normal sized right ventricle with normal systolic function.3.Mild sigmoid hypertrophy of interventricular septum.4.No evidence of infiltrative disorder.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Bilateral lower extremity weakness, evaluate for cord compression Again seen are postsurgical changes of cervical laminoplasty with laminectomies from C3 to C7, spinous processes resection, and placement of bone graft at the C4 and C6 levels on the left. There are foci of T2 hyperintensity involving the right lateral aspect of the cord at the C5-C6 and C6-C7 levels with volume loss consistent with myelomalacia, and similar to 6/8/2015. Vertebral body heights are maintained. Reversal of cervical lordosis again seen as well as trace retrolisthesis of C4 on C5 and C5 on C6.Multilevel degenerative changes are seen, individual levels as below:C2/3: No significant neural foraminal or central canal stenosis.C3/4: Diffuse disc bulge results in effacement of the ventral thecal sac and minimal indentation of the ventral cord. Dorsal thecal sac is patent. Uncovertebral hypertrophy results in moderate left and mild right neural foraminal stenoses. C4/5: Disk osteophyte complex and ligamentum flavum thickening result in partial effacement of the ventral and dorsal thecal sac and overall mild spinal canal stenosis. There is severe right and moderate to severe left neural foraminal narrowing.C5/6: Disc osteophyte complex is present without significant spinal canal stenosis. Uncovertebral hypertrophy results in mild to moderate left and moderate to severe right neural foraminal stenoses.C6/7: Disc osteophyte complex is associated with effacement of the ventral and dorsal thecal sac, particularly on the right. Severe right and moderate to severe left neural foraminal stenosis again seen related to uncovertebral hypertrophy. C7/T1: Mild disc bulge and ligamentum flavum thickening without significant spinal canal or neural foraminal stenosis.

Output: 1. Postoperative changes of C3-C7 cervical laminoplasty are again seen. Spinal canal caliber is improved when compared to preoperative MRI from 2/14/2015. There does remain however mild degree of spinal canal stenosis/thecal sac effacement at C3-C4, C4-C5, and to a slightly greater degree relatively at C6-C7 levels, similar to prior from 6/8/2015.2. T2 hyperintensity in the right lateral cord at the C6-C7 level and to a lesser degree C5-C6 level related to myelomalacia as seen before.


Instruction: Generate impression based on findings.

Input: 54 years Female (DOB:12/25/1961)Reason: stroke? History: L sided weaknessPROVIDER/ATTENDING NAME: NAOUM ISSA MRI of the brainNo diffusion weighted abnormalities are appreciated.There is a mild to moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. 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 left maxillary sinus is small. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.Some narrowing of the upper cervical spine is present.Exam is mildly degraded due to patient motion.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. The right A1 segment is hypoplastic. The posterior communicating arteries are not readily identified. The vertebral arteries are similar in size. There is extracranial origin of the posterior inferior cerebellar artery bilaterally.Exam is mildly degraded due to patient motion.

Output: 1.No evidence for cerebrovascular occlusive disease.2.No evidence for intracranial aneurysm.3.No evidence for acute ischemic cerebral infarction.4.Periventricular and subcortical white matter signal changes of a mild to moderate degree are present which are nonspecific. They could be vascular related, related to demyelination, trauma, vasculitis, sarcoid. They are nonspecific. 5.Examination is mildly degraded due to motion artifact which may obscure more subtle abnormalities.


Instruction: Generate impression based on findings.

Input: Recent surgery on left hip. Pain in the right hip. Rule out fracture. Components of a left total hip arthroplasty device are situated in near-anatomic alignment, although the distal extent of the prosthesis is not included on the field-of-view of this study.I see no fracture.The bones appear demineralized, suggesting osteopenia. The lateral margin of the right femoral head is slightly indistinct, which I suspect simply reflects the patient's underlying osteopenia/osteoporosis; however if the patient has a known primary malignancy, then I would recommend CT or MRI for further evaluation to exclude an unusual metastatic focus.Mild degenerative arthritis affects the pubic symphysis. Degenerative arthritic changes also affect the visualized lower lumbar spine.

Output: I see no fracture. The bones are demineralized, suggesting osteopenia. The lateral margin of the right femoral head is slightly indistinct which I suspect simply reflects the patient's underlying osteopenia; however, if the patient has a known primary malignancy, then I would recommend CT or MRI for further evaluation to exclude an unusual metastatic focus.


Instruction: Generate impression based on findings.

Input: Evaluate for rotator cuff tear. Left shoulder pain. ROTATOR CUFF: There is marked thickening and fraying of the supraspinatus tendon suggesting an intrasubstance tear, with intact fibers identified. There is mild atrophy of the supraspinatus muscle. The teres minor and subscapularis are normal. There is mild to moderate tendinopathy of the infraspinatus.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: There are mild degenerative changes of the glenohumeral joint. There is a focus of T2 hyperintensity within the posterior lateral aspect of the humeral head, probably secondary to degenerative changes given location and patient's age, less likely posttraumatic. The labrum is grossly intact.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: Intrasubstance tear of the supraspinatus and mild to moderate tendinopathy of the infraspinatus.


Instruction: Generate impression based on findings.

Input: Patient with history of juvenile idiopathic arthritis, presenting with thoracic back pain, evaluate. Minimal dextroscoliosis of the thoracic spine is identified, better seen on recent radiograph from 7/6/2016. Otherwise the alignment is anatomic. There is diffuse T1 hypointensity and T2 hyperintensity involving the T6 vertebral body as well as the anterior aspect of the T10 vertebral body. There are endplate irregularities of the vertebral bodies at these levels, with mild loss of height involving the left aspect of the T6 vertebral body. Otherwise the remainder of the vertebral body heights are maintained. There are areas of abnormal enhancement involving the T6 and T10 vertebral bodies. No associated paraspinous or epidural soft tissue mass.There is no evidence of spinal cord signal abnormality. No spinal canal or neural foraminal stenosis is identified.

Output: Edema and abnormal enhancement involving the T6 vertebral body and to a lesser degree T10 vertebral body with irregularity/erosion involving the inferior endplates at these levels. Differential is broad and includes: endplate erosion related to known inflammatory arthropathy with reactive edema and enhancement; chronic recurrent multifocal osteomyelitis; Langerhans cell histiocytosis or neoplastic process seem less likely but remain in the differential given the nonspecific appearance of these lesions. Appearance would also be unusual for Schmorl's nodes with reactive vertebral edema and enhancement or for bone infarcts.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 62 year-old female with nausea, vomiting, and dizziness. Evaluate for bleed.IMAGE ACQUISITION: Nonenhanced CT of the head and MRI of the brain dated 8/20/11 There is a rounded focus of hyperattenuation in the left pons, correlating with the site of abnormality seen on recent MRI. There is no midline shift or hydrocephalus.Mild hypoattenuation in the periventricular and subcortical white matter is most consistent with small vessel ischemic disease. No skull fracture is evident. Visualized paranasal sinuses are grossly clear.Postsurgical changes are again seen with left temporo-occipital encephalomalacia, unchanged.

Output: Rounded focus of hyperattenuation in the left pons correlating with site of abnormality seen on MRI. This most likely represents a hemorrhagic metastases. A subsequent MRI was ordered.


Instruction: Generate impression based on findings.

Input: Female, 77 years old. Reason: 77 yo with amyloidosis, fever having worsening somnolence History: somnolence There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.Calcifications are seen at the level of the upper cervical cord likely corresponding to known expansile mass at the cervicomedullary junction as seen on prior MRI scan from 8/21/09.

Output: No intracranial abnormality. Known spinal cord mass is partially visualized on this study.


Instruction: Generate impression based on findings.

Input: Frequent ankle sprains Metallic susceptibility artifact overlies the distal fibula representing suture anchors as seen on prior radiographs. TENDONS: The Achilles tendon is unremarkable. Note is made of a type I accessory navicular. A small amount of fluid surrounds the medial tendons which is of doubtful clinical significance. There is a longitudinal tear of the peroneus brevis tendon as it courses posterior and beneath the lateral malleolus. The anterior tendons are unremarkable.LIGAMENTS: The anterior talofibular ligament is indistinct with an adjacent ossicle in its location, representing a chronic tear. The calcaneofibular ligament is likewise indistinct, likely from prior tearing. The posterior talofibular ligament appears attenuated which may reflect prior partial tearing. The distal tibiofibular syndesmotic complex is intact. There is loss of the normal fatty striations of the deep tibiotalar fibers of the deltoid ligament likely reflecting prior sprain. The spring ligament is grossly intact.ARTICULAR SURFACES AND BONE: A small focus of signal abnormality is noted within the talar dome laterally with heterogeneity of the overlying articular cartilage, representing an osteochondral defect that may be degenerative in nature or related to prior trauma. Subchondral edema is noted within the tibial plafond laterally that may also be degenerative in nature or represent a bone contusion. There is signal abnormality within the body of the calcaneus below the angle of Gissane which may represent a large normal vascular remnant or less likely early intraosseous ganglion formation. Mild osteoarthritis affects the subtalar joint with osteophytes noted along the posterior facet and degenerative edema within the sustentaculum talus.

Output: 1. Tears of the anterior talofibular and likely calcaneofibular ligaments, with attenuation of the posterior talofibular ligament which may reflect partial tearing.2. Longitudinal tear of the peroneus brevis tendon.3. Osteoarthritis of the subtalar and tibiotalar joints with other findings detailed above.


Instruction: Generate impression based on findings.

Input: MRI brain: There is inferior descent of the cerebellar tonsils up to 11 mm below the foramen magnum compatible with Chiari I malformation. There is diminished CSF space at the level of foramen magnum, worse posteriorly.CSF flow sequence is technically limited and direction of the flow cannot be evaluated. Magnitude images demonstrate mildly diminished CSF flow ventrally and more severe diminished flow dorsally.There is no diffusion abnormality. There are no areas of abnormal signal. The ventricles and sulci are within normal limits. There is no hydrocephalus. The basal cisterns remain patent. There is no midline shift or mass effect. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. There is minimal opacification of the paranasal sinuses. MRI spine: There is a large cervical syrinx which begins at the upper C4 level and more inferiorly occupies nearly the entire diameter of the cervical cord, measuring approximately 11 x 9 mm in the axial plane at the C6 level. There is further extension of the syrinx down to the thoracic cord at the lower T12 level.Conus terminates normally at the upper L2 level. There is no evidence of filar lipoma or other lesions within the lumbar spinal canal. On prone sagittal imaging, there appears to be minimal ventral motion of the conus, approximately 1 mm; however, there is greater ventral motion of the cauda equina about 4 mm at the L3 level. The apparent reduced ventral motion of the conus is of questionable significance given the normal position of the conus, appropriate ventral motion of the cauda equina nerve roots, and absence of additional lesions in the lumbar spinal canal.The spine is in normal alignment. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. There is no significant spinal canal or foraminal stenosis within the spine at any levels. The paraspinal soft tissue structures are unremarkable.

Output: 1. Inferior descent of the cerebellar tonsils of up to 11 mm below the foramen magnum consistent with Chiari I malformation. 2. Extensive syringohydromyelia involving the cervical and thoracic spinal cord extending from upper C4 to the lower T12 vertebral levels.3. No convincing imaging evidence of tethered cord. Please see comment above.


Instruction: Generate impression based on findings.

Input: History of right intraocular retinoblastoma s/p intraocular chemotherapy x 2: disease status evaluation. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Orbits: There is a lesion that measures approximately 2 x 6 mm in cross section along the posterolateral aspect of the right globe, which is not significantly changed. The right optic nerve appears to be intact and the rest of the right intraorbital structures appear to be unremarkable. The left orbit appears to be unremarkable.

Output: 1. Unchanged treated subcentimeter right intraocular retinoblastoma. 2. No evidence of left orbital tumor.3. No evidence of intracranial tumor to suggest trilateral retinoblastoma.


Instruction: Generate impression based on findings.

Input: Female, 36 years old, with left hemi-body sensory loss. Evaluate for right thalamic infarct. No parenchymal edema or mass effect is detected. No restricted diffusion is evident. There is no intracranial hemorrhage or any abnormal extra axial fluid collection. The ventricles are normal in size and morphology.

Output: Unremarkable evaluation with no evidence of acute ischemia or any other specific findings to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Left ischium pressure ulcer to bone. Rule out osteomyelitis. Large soft tissue ulceration is seen laterally extending from the skin to the greater trochanter. Surrounding soft tissue edema suggests inflammation or infection. There is cortical loss of the underlying bone and marrow signal abnormality in the proximal femur centered in the greater trochanter, with increased T2 signal and decreased T1 signal as well as enhancement on postcontrast images, compatible with osteomyelitis.Small skin ulceration is also seen in the posterior subcutaneous soft tissues superficial to the coccyx with soft tissue enhancement suggesting inflammation or infection. No clear evidence of marrow signal abnormality, cortical disruption, or abnormal osseous enhancement is seen to suggest underlying osteomyelitis.There are no other areas of bone signal abnormality. Specifically, there is no involvement of the ischium. Small bilateral hip joint effusions are present, right greater than left.

Output: 1.Large ulceration of the lateral left hip and underlying osteomyelitis centered in the greater trochanter of the left femur.2.Additional sacral ulcer without evidence of osteomyelitis in this region.


Instruction: Generate impression based on findings.

Input: 50-year-old female with history of benign biopsy of the right breast and strong family history of breast cancer in her mother presents for MRI Surveillance. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.Multiple cysts are present in both breasts.Focal non-mass enhancement is unchanged at middle 12 o'clock position in the left breast.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Erb's palsy. The study is limited, especially axial fat saturated T2 weighted images for technical reasons. The avulsion of the right C8 nerve root from the spinal cord with retraction has not changed and there is persistence of the increased T2 signal in the right C7-T1 neural foramen, reflecting an associated small pseudomeningocele which abuts the thecal sac. The right T1 nerve root shows minimally increased T2 signal and is also slightly less distinct than the contralateral T1 nerve root, with slight asymmetric prominence of the right T1 nerve root sleeve. There is no other definite abnormality of the right brachial plexus. There is no mass. The cervical spinal cord shows no abnormality.The right humeral head is posteriorly subluxed relative to the glenoid. However, this study is not optimized for shoulder assessment and this may relate to positioning.

Output: 1. Avulsion and retraction of the right C8 nerve root with associated small pseudomeningocele, as on the previous examination from January 2015. Please correlate with Klumpke palsy.2. Subtle abnormality of the right T1 nerve root and sleeve may represent partial injury as well. 3. There is suggestion of posterior right glenohumeral subluxation. However, this study is not optimized for shoulder assessment. If there is clinical concern for glenohumeral derangement, dedicated shoulder MRI would be helpful.


Instruction: Generate impression based on findings.

Input: Female, 68 years old. Reason: evaluate thyroid nodule History: incidental thyroid nodule RIGHT LOBE MEASUREMENTS: 2.6 x 2.2 x 5.6 cm.LEFT LOBE MEASUREMENTS: 3.1 x 2.5 x 6 .0 cmISTHMUS MEASUREMENTS: 0.6 cmRIGHT LOBE: Mildly heterogeneous echotexture, with a few benign-appearing subcentimeter cysts.LEFT LOBE: Mildly heterogeneous echotexture. A well marginated, heterogeneous noncalcified solid nodule in the left thyroid lobe, with surrounding hypoechoic rim and mildly increased peripheral blood flow measures 2.7 x 1.4 x 2.4 cm.ISTHMUS: Mildly heterogeneous echotexture without focal lesion.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: A 2-3 cm solid, noncalcified left thyroid nodule is identified as detailed above, and is amenable to biopsy for further evaluation.


Instruction: Generate impression based on findings.

Input: 64 year-old male with sharp disabling pain across the upper abdomen before meals. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: There is a subcentimeter focus of fluid signal intensity in the body of the pancreas which is too small to characterize but may represent a branch type IPMN or cyst.ADRENAL GLANDS: There is a 1.7 x 1.3 cm left adrenal nodule with loss of signal on out of phase imaging and fat saturated sequences consistent with a lipid rich adrenal adenoma. KIDNEYS, URETERS: Multiple subcentimeter foci of fluid signal intensity are identified in the kidneys, which are too small to characterize, likely represent simple cysts. Simple cysts in the left kidney.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is a large amount of debris, as well as an air-fluid level within a distended stomach.BONES, SOFT TISSUES: Leftward curvature of the lower thoracic spine.OTHER: No significant abnormality noted.

Output: 1.Large amount of debris with associated air fluid level within a distended stomach is nonspecific but can be seen in gastroparesis. Correlation with a nuclear medicine gastric emptying study could be considered if clinically indicated. 2.Left adrenal nodule appears most consistent with an adrenal adenoma. 3.Subcentimeter cystic lesion in the body of the pancreas may represent a branch type IPMN or cyst.


Instruction: Generate impression based on findings.

Input: 34 years, Male, with multiple sclerosis, evaluate for progression. Again seen is a tiny nonspecific focus of T2/FLAIR hyperintensity in the right frontal corona radiata, axial FLAIR series 701 image 56. No new lesions are identified. There is unchanged linear enhancement in the left posterior frontal lobe which likely represents an incidental developmental venous anomaly. No suspicious foci of enhancement in the brain. Brain parenchyma is otherwise unremarkable without convincing evidence of demyelinating lesions within the brain. Brain parenchymal volume is preserved. No intracranial mass or mass effect. Ventricles and sulci appear within normal limits. Calvarium and extracranial soft tissues are grossly unremarkable.

Output: No evidence of progressive demyelinating disease in the brain. Tiny punctate focus of FLAIR hyperintensity in the right frontal white matter is unchanged and nonspecific.


Instruction: Generate impression based on findings.

Input: HCV cirrhosis. Evaluate for HCC. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology without a focal lesion biliary ductal dilatation or vascular abnormality.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: Scattered retroperitoneal and porta hepatis lymph nodes are not pathologically enlarged.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Cirrhosis without a suspicious lesion.


Instruction: Generate impression based on findings.

Input: Diagnosis: Secondary malignant neoplasm of brain and spinal cordClinical question: pre-op for tomorrowSigns and Symptoms: pre-op for tomorrow There is redemonstration of a 20 mm x 20 mm well-circumscribed enhancing mass located along the superior aspect of the left cerebellar hemisphere. There is redemonstration of a 16 x 19 mm axial dimension ring-enhancing lesion in the vermis. There is redemonstration of a 25 x 27 mm axial dimension ring-enhancing mass in the right cerebellar hemisphere centered in the inferior semilunar nodule. There is associated with vasogenic type edema with these cerebellar lesions. Overall compared to the prior exam there does not appear to be a significant interval change.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Multiple cerebellar metastases appear stable compared to prior exam. Examination is performed for the purpose of stereotactic guidance during surgery.


Instruction: Generate impression based on findings.

Input: Female 17 years old Reason: left heel pain evaluate for stress fracture History: left heel pain TENDONS: Tendons are intact without evidence of abnormal thickening or tear.LIGAMENTS: Ankle ligaments are intact.ARTICULAR SURFACES AND BONE: There is hazy and mildly serpiginous low T1 signal within the posterior calcaneal apophysis. There is also associated edema within this apophysis. The physis is not completely fused, however this abnormal low T1 and high T2 signal situated posteriorly and inferiorly to the physis. These findings are concerning for stress reaction or early stress fracture. The remaining articular surfaces and bone marrow is normal in signal.ADDITIONAL

Output: Stress reaction or early stress fracture within the calcaneal apophysis.


Instruction: Generate impression based on findings.

Input: 46-year-old female with right kidney lesion ABDOMEN:LIVER, BILIARY TRACT: T2 hyperdense cyst in the posterior right liver lobe. Status post cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Status post right partial nephrectomy. T2 hyperintense simple cyst in the right kidney. Enhancing subcentimeter nodule at the right kidney resection bed measuring 6 x 5 mm (series 12, image 296). This lesion corresponds to the enhancing nodule seen on prior CT, unchanged in size since 9/10/2015. 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.Partial right nephrectomy with unchanged (from 9/2015 CT imaging) subcentimeter enhancing nodule in the surgical bed, differential considerations include postsurgical sequelae but continued followup suggested.


Instruction: Generate impression based on findings.

Input: 37-year-old male with history of stage I seminoma (92) status post left orchiectomy and XRT. Evaluate for recurrence. As per oacis, subcutaneous lesion in the back muscles was biopsy proven granular cell tumor. CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: Precarinal lymph node measuring 1.3 x 0.6 cm, (image 36, series 4) a second reference lymph node measures 0.9 x 1.4 cm, (image 48, series 4).CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Three well-defined hypervascular lesions are seen within the liver which are not identified on prior examinations. Segment two liver lesion measures 0.9 x 0.8 cm, (image 75, series 4). Segment eight liver lesion measures 1.4 by 1.2 cm, (image 82, series 4). Segment four A liver lesion measures 1.3 x 1.1 cm, (image 86, series 4). Dedicated liver protocol was not obtained.These lesions demonstrate an appearance of hemangioma however since these lesions are not seen on previous examinations other considerations must include hypervascular metastatic lesions which would be atypical for seminomatous dissemination. Further evaluation with MRI or PET CT may be considered as clinically indicated.SPLEEN: Single ill-defined hypodense lesion remains stable compared to previous examinations.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: 1. Nonspecific mediastinal lymphadenopathy. 2. Multiple hypervascular hepatic lesions likely demonstrate an appearance of hemangioma however since these lesions are not seen on previous examinations other considerations must include hypervascular metastasis which would be atypical for seminomatous dissemination. Further evaluation with MRI or PET CT may be considered as clinically indicated.


Instruction: Generate impression based on findings.

Input: Low back pain bilateral leg pain altered gait. There is multilevel degenerative spondylosis. At L5-S1, there is an eccentric left disc protrusion that impinges upon the nerve roots in the left lateral recess and results in mild left neural foraminal narrowing medially. There is also slight anterolisthesis and facet hypertrophy that contribute to neural foraminal narrowing bilaterally. At L4-5, disc bulging and facet hypertrophy result in effacement of the bilateral lateral recesses and narrowing of the central spinal canal, as well as mild neural foraminal narrowing bilaterally. At L3-4, there is a disc bulge and superimposed small eccentric left protrusion and mild bilateral facet hypertrophy that results in mild spinal canal and neural foraminal narrowing bilaterally. At L2-3, there is a disc bulge and superimposed and bilateral facet hypertrophy that results in mild spinal canal and neural foraminal narrowing bilaterally. At L1-2, there is mild disc bulging, with slight left neural foraminal narrowing, but no significant right neural foraminal or spinal canal narrowing. There is no significant degenerative disease at T12-L1. There is mild lumbar levoscoliosis. The vertebral body heights are preserved. The vertebral bone marrow signal is unremarkable. The imaged portions of the spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable. There is a partially imaged right renal lesion.

Output: 1. Multilevel degenerative spondylosis, which is most pronounced in the lower lumbar spine, left worse than right. 2. Partially imaged right renal lesion. Renal ultrasound may be useful for further evaluation.


Instruction: Generate impression based on findings.

Input: Left lower extremity weakness and back pain Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is diffusely heterogeneous similar to prior, which is nonspecific, and without discrete suspicious osseous lesions. The conus medullaris is normal in position.Mild degenerative changes are seen including multilevel disc desiccation with relatively preserved disc heights. Additional details as below: L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: Mild disc bulge, ligamentum flavum thickening, and facet arthropathy. No significant spinal canal stenosis. Mild bilateral neural foraminal narrowing. L4-L5: Mild disc bulge eccentric to the left with dorsal annular fissure, ligamentum flavum thickening, and bilateral facet arthropathy. No significant spinal canal stenosis. There is mild to moderate right neural foraminal stenosis. There is moderate left neural foraminal stenosis, which is slightly worse than prior. Bilateral facet joints are distended with fluid.L5-S1: Mild disc bulge which is eccentric to the left. No significant spinal canal or right neural foraminal stenosis. There is mild to moderate left neural foraminal stenosis similar to prior. Bilateral facet arthropathy with facet joint distention.

Output: 1. There is moderate left L4-L5 and mild to moderate left L5-S1 neural foraminal stenosis which may be contributing to patient's left lower extremity weakness. Overall degenerative changes are stable to minimally worse since 1/21/2010. 2. Facet arthropathy at L4-5 and L5-S1 with facet distension similar to prior. Additional details as above.


Instruction: Generate impression based on findings.

Input: Female, 60 years old, with history of parotid cancer with lymph node metastases. Brain:Scattered foci of FLAIR hyperintensity are demonstrated in the cerebral white matter and pons, without significant interval change. No diffusion restricting lesions are seen. No edema or mass effect is detected. There is no pathologic parenchymal or left meningeal enhancement. No abnormal extra-axial fluid collections or evidence of intracranial hemorrhage is seen. Ventricular size and morphology remain within normal limits.Neck:Postoperative findings are redemonstrated compatible with right parotidectomy, right neck dissection and radiotherapy. No masslike lesion or pathologic enhancement is seen in the operative bed. Persistent enhancement of the geniculate, tympanic and mastoid portions of the right facial nerve are again seen similar to prior. The right submandibular gland remains smaller than the left. No pathologic adenopathy is detected in the visualized portion of the neck. T2 hyperintense material within the subcutaneous tissues of the face may reflect prior cosmetic instrumentation. The right mastoid air cells remain opacified similar to prior.

Output: 1.No evidence of intracranial metastases.2.Redemonstration of postoperative and posttreatment findings in the neck with no evidence of recurrent tumor or pathologic adenopathy.3.Persistent enhancement of the right facial nerve is redemonstrated without significant interval change.


Instruction: Generate impression based on findings.

Input: Headaches and hypertension. MRI: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.MRA: There is no evidence of significant intracranial steno-occlusive lesions or cerebral aneurysms.

Output: 1. No evidence of intracranial hemorrhage, mass, or acute infarct. 2. No evidence of significant intracranial steno-occlusive lesions.


Instruction: Generate impression based on findings.

Input: BRAIN: There is an approximately 1 cm focus of restricted diffusion in the region of the left posterior limb of the internal capsule and lateral left thalamus with associated increased T2 signal compatible with an acute ischemic infarction. No additional foci of restricted diffusion are identified. There are several punctate and confluent foci of increased T2/FLAIR signal within the periventricular and subcortical white matter which are nonspecific but favored to represent chronic small vessel ischemic changes. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. Incidental note is made of a partially empty sella. There is redemonstration of a chronic right lamina papyracea fracture.MRA HEAD: The intracranial internal carotid arteries are normal in course and caliber. The middle and anterior cerebral arteries are unremarkable. The vertebral arteries, basilar artery, and posterior cerebral arteries are normal in course and caliber. There is no evidence of flow-limiting stenosis or aneurysm.

Output: 1.Small, acute lacunar infarct within the region of the left lateral thalamus/posterior horn of the left internal capsule.2.Mild chronic small vessel ischemic changes.3.MRA without intracranial aneurysm or significant stenosis.Discussed with FINTEL, BARA at 12:48 on 8/29/2015.


Instruction: Generate impression based on findings.

Input: 53 year old female patient with sickle cell anemia with acute chest, obtunded. Question of CVA or encephalitis. There are scattered foci of restricted diffusion throughout both cerebral hemispheres consistent with perfusional acute ischemic infarcts. This is on a background of extensive chronic small vessel and lacunar ischemic disease which is in a watershed distribution. Patchy cortical and subcortical edema is seen involving the cerebral hemispheres and particularly the right temporal lobe. There has been interval progression in diffuse cerebellar edema, right greater than left, causing crowding of the brainstem and effacement of the 4th ventricle.There are innumerable punctate and ill-defined foci of susceptibility artifact throughout the cerebral hemispheres and particularly in the cerebellum. There is no abnormal intracranial enhancement. The supratentorial ventricles and basal cisterns are stable in size and configuration. There is no midline shift or herniation. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. A few small acute perfusional ischemic infarcts are seen on a background of extensive watershed distribution chronic small vessel ischemic disease.2. Extensive susceptibility artifact is evident throughout the brain, and particularly the cerebellum, which could represent a component of chronic ischemic microhemorrhage or perhaps hemosiderosis from iron overload. Microhemorrhage secondary to a chronic coagulopathy would also be a reasonable consideration.3. The cerebellum appears diffusely edematous, the etiology of which is unclear. This could be ischemic in etiology, although there is no definite acute ischemia by diffusion-weighted imaging, or possibly related to toxicity from excessive hemosiderin deposition. Inflammatory and infectious disease can also produce a similar appearing cerebellitis type pattern of inflammation.4. Relatively asymmetric edema involving the right temporal lobe is of uncertain significance but coud be secondary to an infectious or inflammatory process, including viral infection.


Instruction: Generate impression based on findings.

Input: Chiari malformation: autism. Brain: There cerebellar tonsils extend up to approximately 6 mm inferior to the foramen magnum, but display rounded to minimally pointed morphologies. There is flow of cerebrospinal fluid across the foramen magnum, albeit slightly blunted posteriorly. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Cervical Spine: The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: 1. Low-lying cerebellar tonsils may represent a mild form of Chiari type 1 malformation.2. No evidence of syringohydromyelia in the cervical spine.


Instruction: Generate impression based on findings.

Input: Secondary malignant neoplasm of bone [C79.51], Reason for Study: ^Reason: with metastatic breast cancer and concerning cervical spine lesion, back pain; please evaluate for risk of cord compression/nerve compression History: with metastatic breast cancer Cervical spine MRIThere are interval development of soft tissue signal intensity at the level of C3 and C4 vertebral bodies, and left side lateral mass. On Gad enhancement scan, the enhancing portion of the soft tissue mass extend toward left side C23 and C34 neuroforamen as well as transverse foramen and encasing vertebral artery.Diffuse bulging of disc at the level of C45 and broad based disc protrusion central to right laterally at the level of C56 do not show any interval change since prior scan.At the level of C56 in conjunction with protruded disc with bilateral ligamentum flavum results mild to moderate spinal canal stenosis, grossly unchanged since prior scan.Spinal cord signal intensity is normal. There is normal cervical lordosis. The cranial-cervical junction is normal. Thoracic spine MRIThere are multilevel various sized soft tissue lesions on thoracic vertebral bodies including T3, T5, T8, T9, T10, T11, T12, L1 and L2. Left side T8, T9, T10, T11 and T12 ribs also show soft tissue lesion involvement. Especially at the level of T10, there is evidence of soft tissue extension from the left side rib toward pleura.The T10 vertebral body shows about 10% of compression fracture.There is normal thoracic kyphosis and the alignment is anatomic. The cord signal is normal. The conus medullaris terminates at the level of T12-L1.

Output: 1. Multilevel metastatic lesions involving both cervical and thoracic level as well as left lower ribs. In particular, at the level of C3 and C4, the lesion involves and encasing left side neural foramen and transverse foramen. There is also pleural extension of metastatic rib lesion at the level of T10.2. There is about 10% of compression fracture of T10 vertebral body. 3. Spinal cord signal intensity remains normal.


Instruction: Generate impression based on findings.

Input: Reason: r/o infection, look for signs of increased icp History: fevers, confusion in liver transplant patient There is no evidence of intracranial hemorrhage, mass or edema. Patchy periventricular and subcortical white matter hypoattenuation is consistent with small vessel ischemic disease of indeterminate age.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Small vessel ischemic disease of indeterminant age. Otherwise, no acute intracranial abnormality.


Instruction: Generate impression based on findings.

Input: Epilepsy, surveillance. Again seen are postsurgical changes related to right amygdo-hippocampal laser ablations. There is continued evolution of laser ablation affects involving the right hippocampus and posterior amygdala with increase in encephalomalacia. Previously seen nodular enhancement in this region has decreased, also consistent with evolution.Evidence of prior burr holes as well as focus of encephalomalacia in the right frontal lobe along a prior surgical tract is again seen. Foci of chronic hemorrhage are also evident along the surgical tracts including in the right medial temporal lobe.There is no evidence of acute infarct, new hemorrhage, intracranial mass, or mass effect. No midline shift or herniation. Ventricles are normal in size. Major flow-voids are preserved.

Output: Continued evolution of the laser ablation effects involving the right hippocampus and posterior amygdala with mild increase in encephalomalacia and decrease in enhancement at the ablation site.


Instruction: Generate impression based on findings.

Input: 30 years Male (DOB:5/20/1986)Reason: epilepsy History: seizuresPROVIDER/ATTENDING NAME: PETER C. WARNKE PETER C. WARNKE There is a heterogeneous appearance of the medial aspect of the left temporal lobe which appears similar to the prior exam.The patient status post left temporal burr hole placement. Patient's also status post left occipital burr hole placement. Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate a mucous retention cyst in the left side. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: Examination was performed for stereotactic guidance. There are postoperative changes present related to left medial temporal lobe stereotactic surgery.


Instruction: Generate impression based on findings.

Input: 36-year-old male with inflammatory bowel disease, ulcerative colitis. Evaluate for small bowel Crohn's disease. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No bowel obstruction or ascites. No abnormal wall thickening or enhancement. No definite stricture formation. No obvious fistulization.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No evidence for active inflammatory bowel disease.


Instruction: Generate impression based on findings.

Input: Female 14 years old Reason: evaluate for ligament/tendon pathology; History: patient with persistent ulnar sided wrist pain LIGAMENTS: Scapholunate ligament is intact.TRIANGULAR FIBROCARTILAGE COMPLEX: Contrast is seen in the body of the triangular fibrocartilage complex most consistent with tear, although this does not communicate with the distal radial ulnar joint.TENDONS: No significant abnormality noted. BONES: No significant abnormality noted.ADDITIONAL

Output: Findings most consistent with tear of the triangular fibrocartilage complex.


Instruction: Generate impression based on findings.

Input: Redemonstrated are changes from previous craniotomy involving the skull bilaterally. Encephalomalacia is present involving the anterior right temporal lobe with adjacent gliosis as well as susceptibility abnormality from presumed hemosiderin staining, stable in appearance.There are multiple foci of T2 hypointensity with matching susceptibility abnormality throughout the supratentorial and infratentorial brain, including a lesion within the left lateral upper cervical cord, not demonstrated on the prior study. More foci of hypointensity are noted with susceptibility technique. The largest of these lesions resides in the left periatrial white matter measuring approximately 11 x 14 mm in transaxial dimension on T2 imaging, unchanged. A small lesion involving the right perisylvian region has slightly decreased in size, and a previous heme/fluid level within it is no longer evident. A previous lesion identified only on susceptibility weighted imaging involving left frontal subcortical white matter now demonstrates a small heme/fluid level, suggesting interval hemorrhage, however without current perilesional edema to suggest recent hemorrhage. No other lesions demonstrate perilesional edema. There are no associated developmental venous anomalies.The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There is no mass effect or midline shift. The pituitary gland is normal in size. No diffusion-weighted abnormalities are identified to suggest the presence of acute ischemia. 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.

Output: 1.MRI evidence for multiple cerebral cavernous malformations. 2.There appears to be a new lesion within the left lateral upper cervical cord, not demonstrated on the prior study, although axial images on the prior study did not extend inferiorly to this level.3.A small lesion involving the right perisylvian region has slightly decreased in size, and a previous heme/fluid level within it is no longer evident. 4.A previous lesion identified only on susceptibility weighted imaging involving left frontal subcortical white matter now demonstrates a small heme/fluid level, suggesting interval hemorrhage, however without current perilesional edema to suggest recent hemorrhage. 5.No other lesions demonstrate perilesional edema.


Instruction: Generate impression based on findings.

Input: Male 12 years old Reason: Patient with history of RLE osteomyelitis, neutropenic at time of last imaging that was negative for osteomyelitis. Now with recovered counts and persistent fevers. Please assess for osteomyelitis. History: Persistent fevers, other workup thus far negative. There is no evidence of cellulitis, osteomyelitis or abscess. Normal bone marrow and soft tissues as well as cortical bone signal.

Output: Normal examination.


Instruction: Generate impression based on findings.

Input: 2-year-old male with sacral dimple. There is a fat signal intensity lesion that measures up to 25 mm in length along the posterior aspect of the conus medullaris, which is slightly indented by the lesion and terminates at the L2 level. The rest of the spinal cord displays normal signal and morphology. However, there is an additional fat signal lesion that measures up to 3 mm in length along the filum terminale at the L3-4 level. There appears to be deficiency of the posterior elements of L5 and portions of the sacral spine. However, the reported overlying dimple is not apparent. The prone images are degraded by patient motion, thereby limiting the assessment of cord mobility. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The paravertebral soft tissues are unremarkable.

Output: 1. An intradural lipoma along the posterior aspect of the conus medullaris measures up to 25 mm and a fibrolipoma along the filum terminale at the L3-4 level measures up to 3 mm.2. The prone images are degraded by patient motion, thereby limiting the assessment of cord mobility.3. Apparent deficiency of the posterior elements of L5 and in portions of the sacral spine may indicate dysraphism.


Instruction: Generate impression based on findings.

Input: Examination is motion degraded which limits assessment for subtle findings. Laminectomies are again seen from T6 to T9. Again seen is extensive long segment T2 signal abnormality involving the thoracic cord extending from approximately the T2 to the T12 levels not significantly changed in longitudinal extent since prior. Compared to examination from 2/18/2015, the expansile component of the signal abnormality appears to be improved. Many of the areas of T2 hyperintensity appear to be related to areas of cavitation with thinning of the cord parenchyma. Due to the motion degradation, the margins of the cord are difficult to define. There is evidence of adhesions in this thecal sac with areas of contour deformity of the cord and loculations of CSF. Shunt catheter is seen in the spinal canal at approximately the T9 level. There is a right pleural effusion which is again seen.T1 hyperintense lesions involving the T9 and T12 vertebral body are again seen. No suspicious osseous lesions. Vertebral body heights and alignment are grossly maintained. There is no significant spinal canal or neural foraminal stenosis at any level.

Output: Again seen is extensive T2 signal abnormality involving the thoracic cord from approximately the T2 to the T12 levels. Although the longitudinal extent of the signal abnormality is not significantly changed, the expansile nature appears less evident when compared to prior study from 2/18/2015. Most of the extensive T2 signal abnormality in the cord on the current study has the appearance of cavitation/cystic myelomalacia. There is also evidence of adhesions in the thecal sac/arachnoiditis as seen before. Findings are compatible with sequela of infection.


Instruction: Generate impression based on findings.

Input: Male 44 years old Reason: 0.8 cm liver lesion on US for further characterization History: Liver lesion ABDOMEN:LIVER, BILIARY TRACT: Liver has a cirrhotic morphology with widened fissures and a nodular contour. T2 hyperintense focus in segment 6/7 of the liver without central enhancement represents a cyst.No suspicious lesion in the left hepatic lobe to correspond to the abnormality seen on ultrasound. There are several sub-capsular nodules which do not have arterial enhancement which may be the abnormality seen on ultrasound.Hepatic and portal veins are patent.The gallbladder wall edema likely due to hypoalbuminemia and ascites. No gallstones are evident.SPLEEN: Status enlarged. Splenic vein is patent.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: Extensive upper abdominal varices including a recanalized paraumbilical vein. There are perihepatic paraesophageal and gastric vertices.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Moderate upper abdominal ascites.

Output: 1.Cirrhotic liver with a nodular contour but no lesion that meets criteria for HCC.


Instruction: Generate impression based on findings.

Input: Clinical question: Brain metastases, extent? Signs and symptoms: None. Pre and post enhanced brain MRI:Examination demonstrates a well-demarcated inhomogeneously enhancing intra-axial left posterior paramedian parietal high convexity metastatic lesion. It measures at 32 x 23 x 30 mm in size. There is surrounding vasogenic edema with resultant regional mass effect which includes a mass effect on the left lateral ventricle.Additional focus of enhancement in the left basal ganglia measuring at 5 mm in transaxial dimensions without appreciable surrounding edema or mass effect. There is no convincing evidence of any additional parenchymal or leptomeningeal metastatic lesions.Calvarium also demonstrate normal signal intensity without evidence of abnormal enhancement/ metastases.Unremarkable images through the orbits.Examination in addition demonstrate multiple small foci of FLAIR hyperintensity in the subcortical and periventricular white matter of cerebral hemispheres suggestive of mild chronic small vessel ischemic strokes.The signal void of major intracranial arterial branches are identified.

Output: 1.Left paramedian posterior parietal paramedian mildly hemorrhagic metastatic lesion measuring 32 x 23 x 30 mm with surrounding vasogenic edema and regional mass effect.2.5 mm enhancing metastatic lesion in the left basal ganglia as detailed.3.Negative diffusion weighted images and findings suggestive of mild chronic small vessel ischemic strokes.4.Unremarkable calvarium, orbits, paranasal sinuses and mastoid air cells.


Instruction: Generate impression based on findings.

Input: 67 year old woman with history of atrial fibrillation and hypertension referred for pre-ablation cardiac MRI to delineate pulmonary vein anatomy. Left VentricleThe left ventricle is normal in size with hyperdynamic function. The overall LV ejection fraction is 68%, the LV end diastolic volume index is 67 ml/m2 (normal range: 65+/-11), the LVEDV is 149 ml (normal range 109+/-23), the LV end systolic volume index is 22 ml/m2 (normal range 18+/-5), the LVESV is 48 ml (normal range 31+/-10), the LV mass index is 72 g/m2 (normal range 67+/-11), and the LV mass is 161 g (normal range 114+/-24). There is eccentric hypertrophy of the left ventricle; at the base there is asymmetric hypertrophy of the septum/anterior wall, and mid chamber hypertrophy of the inferior wall. Wall motion is hyperdynamic with mid cavity obliteration and some evidence of flow acceleration in the LVOT. There are no regional wall motion abnormalities present. There is patchy late gadolinium enhancement in the septum which is associated with hypertrophy, and suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process.The native T1 myocardial relaxation time is 1060-1070ms, which is borderline elevated. Left AtriumThe left atrium is moderate-severely dilated. No evidence of left atrial appendage thrombus. The interatrial septum bows to the right suggestive of elevated left atrial pressure.Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 65%, the RV end diastolic volume index is 71 ml/m2 (normal range 69+/-14), the RVEDV is 158 ml (normal range 110+/-24), the RV end systolic volume index is 25 ml/m2 (normal range 22+/-8), and the RVESV is 56 ml (normal range 35+/-13). Right AtriumThe right atrium is mild-moderately dilated. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is at least mild mitral regurgitation. The leaflet tips are thickened. There is no systolic anterior motion of the mitral valve.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 pseudobovine 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 evidence of pericardial effusion.Extracardiac Findings This 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 normal in size with hyperdynamic function (EF 68%). There is evidence of asymmetric/eccentric moderate hypertrophy of the basal anterior wall/septum and mid inferior wall, with mid cavity obliteration in systole and the appearance of flow acceleration in the LVOT. There is also mild patchy late gadolinium enhancement in the septal associated with areas of hypertrophy. However, there is no systolic anterior motion of the mitral valve. This is likely a hypertrophic variant and, less likely, eccentric hypertrophy due to hypertension.2. Normal size right ventricle with normal systolic function (EF 65%).3. Biatrial dilation with evidence of elevated left atrial filling pressures. 4. At least mild mitral regurgitation.


Instruction: Generate impression based on findings.

Input: Laser fiber placement: pre surgical planning. There has been recent insertion of multiple right transtemporal and bilateral transoccipital temporal region deep brain electrodes. There is no gross evidence of intracranial hemorrhage, within the limits of the metal artifact. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. There is mucosal thickening in the right anterior ethmoid and frontal sinuses.

Output: Preoperative planning MRI with bilateral temporal region deep brain electrodes.


Instruction: Generate impression based on findings.

Input: Evaluate for septic embolic infarction, subacute: subtle right face, arm motor deficit, and MSSA mitral valve endocarditis. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is encephalomalacia in the left anterior frontal lobe. There are also subcentimeter foci of T2 hyperintensity in the left basal ganglia and right corona radiata. In addition, there are a few nonspecific scattered foci of t2 hyperintensity in the cerebral white matter. 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, and scalp soft tissues are grossly unremarkable. There is a right sphenoid sinus retention cyst. There is nonspecific scattered fluid signal in the left mastoid air cells.

Output: Chronic left anterior frontal lobe infarct. Subcentimeter lesions in the left basal ganglia and right corona radiata also likely represent chronic lacunar infarct. No evidence of acute intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: A 24 year old male patient with known non-ischemic cardiomyopathy, severe left ventricular dysfunction, with a lifevest, referred to cardiac MRI for evaluation of etiology. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 19%, the LV end diastolic volume index is 187 ml/m2 (normal range: 74+/-15), the LVEDV is 477 ml (normal range 142+/-34), the LV end systolic volume index is 151 ml/m2 (normal range 25+/-9), the LVESV is 385 ml (normal range 47+/-19), the LV mass index is 88 g/m2 (normal range 85+/-15), and the LV mass is 225 g (normal range 164+/-36). The myocardium is thin and there is global hypokinesis with regional variation. There is no obvious late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process; however, due to patient related issues, the image quality is somewhat noisy.No iron overload.Findings not compatible with amyloid. The left ventricle is hyper-trabeculated up to the level of the papillary muscles. This finding could support the diagnosis of left ventricular non-compaction.No LV thrombus is noted.Left AtriumThe left atrium is severely dilated (184 ml). The inter-atrial septum bows to the left suggesting increased left atrial pressure.Right VentricleThe right ventricle is normal in size with moderately reduced systolic function. The overall RV ejection fraction is 32%, the RV end diastolic volume index is 104 ml/m2 (normal range 82+/-16), the RVEDV is 268 ml (normal range 142+/-31), the RV end systolic volume index is 71 ml/m2 (normal range 31+/-9), and the RVESV is 182 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly dilated.Aortic ValveThe aortic valve opens widely, it is bicuspid with fusion of the right and non-coronary cusp and there is mild to moderate aortic regurgitation (regurgitant volume 12ml, regurgitant fraction 16%). There is systolic doming of the aortic leaflets, consistent with bicuspid aortic valve.Mitral ValveThe mitral valve opens widely and there mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size. The ascending aorta was approximately 30mm in dimension.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 severely dilated with severely reduced systolic function, LVEF 19%. The left ventricle is hyper-trabeculated up to the level of the papillary muscles. In the appropriate clinical scenario, this finding could support the diagnosis of left ventricular non-compaction.2. There is no obvious late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. No iron overload. Findings also not compatible with amyloid. 3. The right ventricle is normal in size with moderately reduced systolic function, RVEF 32%. 4. The left atrium is severely dilated (184 ml) and the right atrium is mildy dilated.5. The aortic valve is bicuspid with fusion of the right and non-coronary cusp and there is mild to moderate aortic regurgitation.


Instruction: Generate impression based on findings.

Input: Assess liver lesions. Enlarging liver lesion. Cirrhosis. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology with micronodular contour and widened fissures. No perihepatic ascites noted. Several prominent periportal lymph nodes are noted, likely reactive.Multiple lesions are identified in the liver. Two lesions demonstrate increased T2 signal and diffusion restriction. The larger of these lesions, in hepatic segment 5, measures 2.0 x 1.9 cm (series 10, image 44), previously 1.7 x 1.1 cm, and demonstrates arterial enhancement without washout. Second lesion, in hepatic segment 3, measures 1.8 x 1.8 cm (series 4, image 12), unchanged, with delayed enhancement and without washout. Additional smaller arterially enhancing lesions are also seen, without washout.Normal appearance of the gallbladder, without biliary ductal dilation.SPLEEN: Splenomegaly with siderosis.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: Increased T2 signal in the vertebral bodies near the endplates is incompletely evaluated though likely represents degenerative changes.

Output: Multiple enhancing liver lesions, which do not meet criteria for hepatocellular carcinoma, indeterminate and suspicious for dysplastic nodules. The largest of these in hepatic segment 5 is increased in size when compared to prior imaging.


Instruction: Generate impression based on findings.

Input: Reason: assess for rotator cuff injury History: shoulder pain Examination is slightly limited by patient motion artifact.ROTATOR CUFF: There is a full thickness tear of the supraspinatus tendon, with retraction to the level of the top of the humeral head. The tear appears to involve the majority of the supraspinatus tendon at its insertion on the greater tuberosity, although we suspect that the posteriormost portion of the tendon remains intact. The supraspinatus muscle appears normal. Increased signal intensity within the infraspinatus tendon reflects a combination of tendinosis and interstitial tearing, with mild atrophy of the infraspinatus muscle. The teres minor muscle and tendon appear intact. There is also a complete tear of the subscapularis tendon with retraction to the level of the glenohumeral joint. There is mild atrophy of the subscapularis muscle. SUPRASPINATUS OUTLET: Mild osteoarthritis affects the acromioclavicular joint. There is a small amount of fluid within the subacromial/subdeltoid bursa, reflecting known rotator cuff tear, but there is no large bursal effusion. GLENOHUMERAL JOINT AND GLENOID LABRUM: Thin linear increased signal intensity incompletely traversing the posterior inferior labrum suggests a tear (best seen on series 4, image 16). Mild increased signal within the superior labrum suggests degeneration and degenerative fraying. There is a small glenohumeral joint effusion. BICEPS TENDON: The tendon of the long head of the biceps is not visualized within the rotator interval, suggesting rupture. Low signal intensity within the bicipital groove may reflect remnants of the torn biceps tendon. A band of low signal intensity within the anterior portion of the glenohumeral joint is favored to represent a large middle glenohumeral ligament, although could conceivably represent a displaced fragment of torn biceps tendon.

Output: Full thickness tears of the supraspinatus and subscapularis tendons and other findings as above. Findings were discussed by telephone with Dr. Havlin (at pager 5876) on 11/7/2016 11:10 AM.


Instruction: Generate impression based on findings.

Input: 16-year-old female patient with history of pancreatic lymphangioma status post distal pancreatectomy and splenectomy in March 2015. Now with recurrent left-sided pain, similar to how she presented before surgery. Assess pancreatic duct, evaluate for recurrence of lymphangioma. ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesion is identified. There is no intra or extrahepatic biliary ductal dilatation. The common bile duct is normal in diameter without dominant stricture.SPLEEN: Splenectomy has been performed.PANCREAS: Distal pancreatectomy has been performed. No dilatation of the main pancreatic duct. No focal pancreatic lesion is identified.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: A fluid-filled mass within the left retroperitoneum has been resected. A few small cystic foci are noted just superior and posterior to the left renal vein, along the inferior margin of prior tumor, which are nonspecific. Otherwise, there is no specific evidence of residual or recurrent disease.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Numerous bilateral ovarian follicles are present. The uterus is normal in appearance.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: 1.Changes of the distal pancreatectomy and splenectomy without specific evidence of residual or recurrent disease; a few cystic foci along the inferior margin of the tumor are nonspecific and should be followed on subsequent imaging.2.No specific findings to account for the patient's symptoms in the abdomen or pelvis.


Instruction: Generate impression based on findings.

Input: Other malaise [R53.81] / Other fatigue [R53.83], Reason for Study: ^Reason: rule out neoplastic, paraneoplastic process, or CO poisoning History: AMS, fatigue, LOC No evidence of acute ischemic or hemorrhagic lesion on the scan. There is no evidence of abnormal enhancement.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: Normal brain MRI


Instruction: Generate impression based on findings.

Input: Metastatic lung cancer, C7 and T1 symptoms. Cervical Spine:Again seen is metastatic lesion involving the C7 vertebral body with diffuse marrow infiltration. There is associated lytic changes which are better appreciated on CT. Noted is expansion and extension into the left pedicle, transverse process, facets as well as the spinous process. There is mild diffuse loss of height of the C7 vertebral body similar to prior. There is moderate to severe narrowing of the left C7-T1 neural foramen which was present previously but appears slightly worse. Abnormal signal involving the inferior articular facet of C6 on the left is again seen.Craniovertebral junction appears within normal limits. There is mild diffuse loss of C7 height, vertebral body heights are otherwise maintained. Alignment remains unchanged since 4/6/2015 with loss of normal cervical lordosis. No abnormal signal seen within the cervical cord.Individual levels as below:C2-3: Small central disk osteophyte complex with no spinal canal or neural foraminal stenosis.C3-4: Disk osteophyte complex and uncovertebral hypertrophy with mild facet arthropathy with no significant spinal canal or neural foraminal stenosisC4-5: Disk osteophyte complex and bilateral uncovertebral hypertrophy causing mild to moderate spinal canal stenosis. There is minimal left neural foraminal narrowing. No significant right foraminal stenosis.C5-6: Disk osteophyte complex eccentric to the left causing focal indentation of the ventral cord surface on the left. There is mild to moderate spinal canal stenosis particularly on the left. Mild left neural foraminal stenosis.C6-7: Disk osteophyte complex causing mild spinal canal stenosis. There is moderate to severe left neural foraminal stenosis which appears worse since 4/6/2015.C7-T1: Vertebral body metastasis extending into the posterior elements left greater than right causing moderate to severe left neural foraminal stenosis. There is mild right foraminal narrowing on a degenerative basis.There is minimal epidural soft tissue thickening and enhancement at the left ventral C7-T1 level suspected to represent minimal epidural tumor. There is no significant spinal canal stenosis associated with the epidural tumor. Thoracic Spine:Multiple metastatic lesions are seen in the thoracic spine. Small lesion is noted in the right posterior aspect of the T2 vertebral body. There is a lesion noted within the dorsal T3 vertebral body extending into the posterior elements. Small lesion is seen at T6. There is a lesion at T8 on the right which extends into the posterior elements. Small lesions are seen at T9 and T10. There is a larger lesion involving the T11 vertebral body extending into the posterior elements with expansion of the right pedicle and transverse process and infiltration of the adjacent rib. Small lesion is seen involving the inferior right T12 vertebral body.Vertebral body heights are maintained. No evidence of compression fractures. No significant spinal canal stenosis is demonstrated. Moderate right T10-T11 and mild right T11-T12 neural foraminal stenosis is seen related to tumor involving the posterior elements at T11. There is also mild right T8-T9 neural foraminal stenosis. Minimal epidural enhancement along the dorsal aspect of the lower thoracic spine is favored to be vascular. No convincing evidence of epidural tumor is appreciated. No cord signal abnormality. Abnormal marrow signal involving the ribs at multiple levels is also noted.

Output: 1. Vertebral body metastasis at C7 extending into the posterior elements on the left and to a lesser degree on the right is not significantly changed in size since 4/6/2015. There is minimal ventral epidural enhancement dorsal to the C7 level which is suspected to represent minimal epidural tumor. There is moderate to severe left C6-7 and C7-T1 neural foraminal stenosis which appears slightly worse in the interval.2. Multiple metastatic lesions throughout the thoracic spine without evidence of compression fracture. Several lesions extend into the posterior elements and narrow the neural foramina as detailed above particularly on the lesions at T8 and T11. No significant spinal canal stenosis in the thoracic spine. No definite evidence of epidural tumor in the thoracic spine.3. Degenerative changes in the cervical spine with mild to moderate spinal canal stenosis at C4-C5, C5-C6, and C6-C7.


Instruction: Generate impression based on findings.

Input: Female 54 years old. Reason: Right hip pain and low back pain. History: Right hip pain Four views of the lumbar spine are provided. The disk spaces are preserved with minimal anterior osteophytes at L5. There is no significant change from prior exam in 2007.The single view of the right hip and the single AP view of the pelvis demonstrate osteophyte formation and superior joint space narrowing with sclerosis of the right hip indicating moderate to severe osteoarthritis. There is sclerosis and osteophyte formation of the left hip indicating moderate osteoarthritis.

Output: Moderate to severe osteoarthritis of the right hip.


Instruction: Generate impression based on findings.

Input: Male; 72 years old. Reason: HCC s/p RFA, followup History: HCC, cirrhosis ABDOMEN:LUNG BASES: Large left pleural effusion with left lower lobe compressive atelectasis and trace right pleural effusion, partially visualized and similar to prior study.LIVER, BILIARY TRACT: Cirrhosis with recanalized umbilical vein. Paradoxical loss of signal on in-and-out of phase images, suggestive of iron deposition. Large amount of ascites, similar to prior study. Left hepatic lobe ablation cavity measures 3.9 x 3.9 cm, unchanged (series 14/34). No abnormal enhancement to suggest residual or recurrent disease. No new focal hepatic lesions. The portal vein is patent. Cholelithiasis.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.

Output: Left hepatic lobe ablation cavity without evidence of residual or recurrent disease.


Instruction: Generate impression based on findings.

Input: Recurrent pain and swelling Exam is slightly limited by patient motion artifact.MENISCI: No meniscal tear identified.ARTICULAR CARTILAGE AND BONE: Generalized thinning of the posterior lateral femoral condyle cartilage. There is also generalized thinning of the patellar cartilage without focal defect.LIGAMENTS: Cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: Quadriceps and patellar tendons are intact.ADDITIONAL

Output: Generalized thinning of the posterior lateral femoral condyle cartilage and patellar cartilage without focal defect.


Instruction: Generate impression based on findings.

Input: History of metastatic colon cancer. Lack of intravenous contrast limits evaluation for solid organ, bowel and vascular pathology. LUNG BASES: Multiple T2 hyperintense lung masses are noted and are suspicious for metastatic disease. A left lung base mass measures 1.9 x 1.9 cm (series 701/37).ABDOMEN:LIVER, BILIARY TRACT: Several right hepatic lobe T2-weighted moderately and very hyperintense lobular lesions are suspicious for metastatic mucinous colonic adenocarcinoma given the patient's history. A representative lesion in segment 8 measures 2.0 x 1.9 cm (series 701/34). No biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple T2 hyperintense foci are incompletely characterized, likely cysts. Mildly hypointense T2 weighted foci are incompletely characterized and may represent proteinaceous/hemorrhagic cysts. No hydroureteronephrosis.RETROPERITONEUM, LYMPH NODES: No enlarged retroperitoneal lymphadenopathy.BOWEL, MESENTERY: Postsurgical changes from right hemicolectomy. No evidence of obstruction or fluid collection.BONES, SOFT TISSUES: Mottled marrow signal intensity is nonspecific.

Output: Limited nonenhanced examination demonstrates the following.1.Suspected multiple right hepatic lobe metastases and multiple lung metastases which are partially imaged. New from 2012.2.Stable left external iliac T2 hyperintense lymphadenopathy.


Instruction: Generate impression based on findings.

Input: Patient with idiopathic orbital inflammation; follow up- check for response to prednisone History: Eye pain, bilateral. There is no abnormal enhancement in the orbits. The lacrimal glands appear unchanged. The globes and ocular adnexa are unremarkable. There is no evidence of orbital mass lesions. The imaged portions of the brain and facial soft tissues are unremarkable. There is new scattered paranasal sinus mucosal thickening.

Output: 1. No evidence of orbital inflammation.2. New scattered paranasal sinus mucosal thickening may represent sinusitis.


Instruction: Generate impression based on findings.

Input: Clinical question: 51-year-old male with AML, Ommaya reservoir, history of peri ommaya hemorrhage. Now here with altered mental status. Please evaluate for intracranial hemorrhage or other intracranial process. Signs and symptoms: Altered mental status Right-sided ventricular catheter enters from high convexity right frontal bone and through the right frontal lobe with the tip at the right foramina of Monro. Slight prominence of the supratentorial ventricular system. Generalized uniform lower than normal density of white matter is noted. Please correlate with history. There are no old films available for comparison. This finding may be technique related. If clinical symptoms persist an MRI is recommended. Cortical sulci are within normal range for patient's stated age.No evidence of hemorrhage, mass-effect or midline shift. Calvarium, paranasal sinuses and mastoid air cells are unremarkable. A punctate air density within the temporal horn on the right.

Output: No evidence of hemorrhage. Three see above comments.


Instruction: Generate impression based on findings.

Input: Reason: Include ankle and mid foot. Assess lateral posterior superior calcaneal cyst. Ganglion vs reactive bursitis History: pain and swelling and increasing in size There is an ovoid mass within the soft tissues lateral to the Achilles tendon at its insertion on the calcaneus, corresponding to soft tissue opacity seen on prior radiographs. It measures approximately 13 x 8 mm in transverse dimension and approximately 15 mm in craniocaudal dimension. It is of similar signal intensity to muscle on non-fat-suppressed T1-weighted images, and is slightly hyperintense to skeletal muscle on fat-suppressed T1-weighted images. It is hyperintense on the fat-suppressed proton density weighted sequence, but is isointense to skeletal muscle on the STIR sequence. The mass enhances homogeneously following contrast administration. The mass abuts the lateral margin of the distal Achilles tendon and posterior calcaneus, but does not deform or invade either of these structures. The mass lies posterior to the sural nerve and lesser saphenous vein. We see no additional soft tissue masses. Bone marrow signal intensity is normal. We see no tenosynovitis or other significant tendon abnormalities.

Output: Enhancing soft tissue mass along the lateral margin of the Achilles at its insertion on the calcaneus. This does not have the typical appearance of a cyst, ganglion or bursa, and its uniform enhancement suggests a solid tumor. Although the signal intensity of the mass is relatively low on the STIR sequence, overall the characteristics of this lesion are nonspecific, and tissue sampling is recommended.


Instruction: Generate impression based on findings.

Input: Weakness [R53.1], Reason for Study: ^Reason: r/o ischemic stroke History: right arm weakness and slurred speech Brain MRI:There is a focal high signal intensity on the left parietal operculum which shows high signal intensity on diffusion-weighted imaging with equivocal restricted diffusion on ADC map, the lesion shows mild increased signal intensity on T2 weighted image, best seen on coronal T2-weighted image series #7 image #24. This lesion indicate either late subacute or early chronic ischemic infarct.There are linear and nodular susceptibility artifacts on the right frontal lobe indicating hemosiderin differentiation possibility due to prior localized subarachnoid hemorrhage.Underlying brain shows multiple patchy high signal intensity FLAIR lesions on bilateral periventricular white matter and centrum semiovale indicating nonspecific small vessel ischemic disease.Otherwise there is no evidence of new acute ischemic or hemorrhagic lesion on the 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. 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.Brain MRA:3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate less than 50% focal luminal narrowing on the left MCA distal M1 segment.There are multifocal intracranial arterial luminal narrowings on bilateral distal MCAs and PCAs indicating intracranial atherosclerosis without evidence of significant (more than 50%) luminal stenosis.The right ACA A1 segment and distal left vertebral artery are hypoplastic.There is no intracranial arterial aneurysm.

Output: 1. Equivocal restricted diffusion with slightly increased T2 signal intensity on the left parietal operculum indicate late subacute or early chronic ischemic infarction without hemorrhagic transformation. 2. Nonspecific small vessel ischemic disease.3. Focal but less than 50% of luminal narrowing on the left MCA distal M1 segment.4. Intracranial atherosclerosis as described above without evidence of significant luminal stenosis.


Instruction: Generate impression based on findings.

Input: Female, 69 years old, with lumbosacral pain, with history of T11-12 fracture at outside hospital, evaluate for fracture and for neuroforaminal involvement. Thoracic:A compression deformity of the T12 vertebral body is seen with complete loss of height centrally. A compression deformity of the L1 vertebral body is also noted with 50-60% loss of vertebral body height centrally. Both vertebral bodies and the intervening disc spaces demonstrate mild STIR hyperintensity suggesting mild edema. No significant retropulsion is evident at either level. The intervening neural foramina are not significantly narrowed and the spinal canal is not compromised.The remaining vertebral bodies demonstrate normal morphology and are free of concerning marrow signal abnormality or edema. Sagittal spinal alignment is unremarkable with the exception of a mild accentuation of the kyphosis at T12 and L1. The visualized spinal cord is unremarkable. No epidural abnormalities are seen. No significant disc bulge or disc herniation is present, and the spinal canal and neural foramina remain patent.Lumbar:Based on counting from C2 down, and on the presence of the lowest set of visible ribs at T12, there are six lumbar type vertebral bodies with a mild transitional morphology of the L6 vertebral body.Compression deformity of the L1 vertebral body is discussed above. The remaining lumbar vertebral bodies demonstrate normal morphology. There is no concerning marrow replacement or marrow edema. Spinal alignment is anatomic.The conus tip terminates at the inferior L2 level which is within normal limits. The nerve roots of the cauda equina are unremarkable. No epidural abnormality is seen.L1-2: Unremarkable. L2-3: Mild facet arthropathy. Loss of disc T2 signal with preserved disc height. No significant spinal canal or foraminal stenosis. L3-4: Mild facet arthropathy. Loss of disc T2 signal with preserved disc height and minimal lateral disc bulging. No significant spinal canal or foraminal stenosis. L4-5: Mild facet arthropathy and ligamentum flavum thickening. No significant spinal canal or foraminal stenosis. L5-L6: Mild facet arthropathy and ligamentum flavum thickening. No significant spinal canal or foraminal stenosis. L6-S1: Moderate facet arthropathy. No significant spinal canal or foraminal stenosis.

Output: 1.Compression deformities of the T12 and L1 vertebral bodies are seen. Please note that the presence of six lumbar type vertebral bodies accounts for the difference in level numbering relative to the history. Both compressed vertebrae show mild marrow edema which would suggest a late acute or subacute time course. Neither vertebra is significantly retropulsed, and the spinal canal and neural foramina are not compromised.2.No additional compression deformities or significant osseous lesions are seen. Relatively mild degenerative findings are noted in the lumbar spine, but without significant spinal canal or foraminal stenosis.


Instruction: Generate impression based on findings.

Input: History of malignant peripheral nerve sheath tumor, known left femoral diaphyseal tumor now here with increasing pain over the left femur tumor site. Assess for bony abnormality over proximal femur. Multiple soft tissue masses are compatible with the stated diagnosis of neurofibromatosis. There is a chronic fracture deformity of the distal femoral diaphysis resulting in posteromedial bowing. There is a defect of the proximal femur at the level of the lesser trochanter representing extrinsic erosion by an adjacent soft tissue mass seen on the prior MRI study. The femoral neck is thinned which may also reflect chronic extrinsic pressure erosion. A small round lucency in the distal femoral diaphysis may either be posttraumatic in etiology or due to the patient's underlying neurofibromatosis. Moderate osteoarthritis affects the knee.

Output: Radiographic features of neurofibromatosis as described above with chronic pressure erosions of the proximal femur, and old fracture deformity of the distal femur.


Instruction: Generate impression based on findings.

Input: Vision loss L>R, concern for giant cell arteritis. Brain MRI: There appears to be a punctate focus of cortical restricted diffusion in the right parietal lobe with high T2 signal. There are otherwise several scattered foci of high T2 signal in the cerebral hemisphere white matter bilaterally. There is no evidence of intracranial hemorrhage or mass. There is diffuse cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. Indeed, there is no evidence of enhancement surrounding the scalp vessels.Brain MRA: The anterior branch of the left superficial temporal artery and left ophthalmic artery appear relatively diminutive. There is no evidence of significant cerebral steno-occlusive lesions or aneurysms.Orbits MRI: There are bilateral lens implants. The lacrimal glands, optic nerve, orbital fat, and extraocular muscles otherwise appear unremarkable bilaterally. There is no evidence of intraorbital tumors.

Output: 1. Apparent punctate acute infarct in the cortex of the right parietal lobe superimposed upon a background of probable chronic small vessel ischemic white matter disease.2. The anterior branch of the left superficial temporal artery and left ophthalmic artery appear relatively diminutive, which may represent manifestations of giant cell temporal arteritis, anatomic variants, and/or technical effects of the scan, which is not particularly optimal for evaluating such small caliber vessels. Furthermore, there is no discernible inflammation associated with the vessels. Doppler ultrasound may be useful for further interrogation.


Instruction: Generate impression based on findings.

Input: Clinical question: Follow-up subdural hematoma. Signs and symptoms: History of subdural hematoma. CT of brain without the infusion:In comparison with the prior examination there is complete resolution of patient's bilateral subdural hematomas. The cortical sulci are better visualized on this study secondary to lack of mass effect by subdural. Patchy areas of periventricular and subcortical low attenuation are consistent with small vessel disease of indeterminate age. No hemorrhage is detected. A calcific density at the level of the left leaf of tentorium (axial image 10) is consistent with a small meningioma and was noted on prior MRI examination. This lesion measures 7.8-mm times 16-mm. Meningioma is in contact with the pons however with no mass effect or deviation.

Output: 1.No evidence of residual subdural or any new bleed.2.Small vessel disease of indeterminate age.3.Small meningioma along the edge of the left tentorial leaf with no change since prior MRI.