Instruction: Generate impression based on findings.

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

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


Instruction: Generate impression based on findings.

Input: There are postoperative findings related to right retrosigmoid craniotomy for resection of an internal auditory canal and cerebellopontine angle mass. There is subjacent unchanged CSF signal intensity extra-axial fluid collection resulting in mild mass effect on the right cerebellar hemisphere as well as the right CN V and VII and VIII. There is a rounded focus of enhancing tissue within the right internal auditory canal that measures approximately 6 x 5 mm, previously 7 x 6 mm. There is also a rind of enhancing tissue along the resection margins in the right cerebellopontine angle that appears slightly thicker anteriorly (3 mm vs. 2 mm on the prior exam) although resolved medially and posteriorly.There is persistent ventriculomegaly that is improved from the prior exam. There is no evidence of acute infarct. There are a few unchanged scattered patchy foci of T2 intensity within the supratentorial white matter are most compatible with mild chronic small vessel ischemic disease. There are no areas of abnormal parenchymal signal. There is no midline shift or herniation. The major cerebral flow voids are intact, although, there are unchanged findings of a right middle cerebral artery bifurcation aneurysm and a left M1 segment aneurysm that are not well assessed on this exam.

Output: 1.Postoperative findings related to partial resection of a right vestibular schwannoma with residual intracanalicular and cisternal enhancing presumed tumor that is not significantly changed. 2.Persistent but improved ventriculomegaly.3.Bilateral middle cerebral artery aneurysms that are not well assessed on this exam.


Instruction: Generate impression based on findings.

Input: Metastatic squamous cell carcinoma of the lung: AMS. There is interval increase in size a right precentral gyrus lesion now measures up to 7 mm, previously 4 mm. In addition, there are several newly apparent bilateral brain metastases. There is also interval increase in size of the left frontal bone metastasis with epidural extension. There is an unchanged background of mild cerebral white matter T2 hyperintensity, which may represent chronic small vessel ischemia and a chronic left caudate lacunar infarct. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is a chronic right lamina papyracea fracture. There is fluid in the right mastoid air cells.

Output: 1. Interval progression of the brain metastases.2. Increase in size of the left frontal bone metastasis with epidural extension.


Instruction: Generate impression based on findings.

Input: Right lower occipital weakness. Progressive back pain L3 fracture, stable L1 fracture, severe L3-L4 stenosis. Five lumbar type vertebral bodies are presumed to be present. There is a transitional anatomy at the L5 level with pseudoarticulation involving the left L5 transverse process with the sacrum with superimposed degenerative changes. Again seen is compression fracture involving the L1 vertebral body with approximately 50% loss of height. There is a severe compression fracture involving the L3 vertebral body with particular height loss in its mid aspect as seen on recent CT from 11/1/2016 and progressed since prior MRI from 6/5/2016. There is mild osseous retropulsion at both of these levels. Edema involving the L3 vertebral body is decreased compared to prior. There is a mild compression fracture involving the superior endplate of the L4 vertebral body with 20% loss of height which is new since prior from 6/5/2016 and grossly similar from recent CT. There is mild edema involving the superior L4 endplate. There is T1 shortening involving the L1 vertebral body as well as the pelvis which may be related to prior radiation.There is moderate to severe spinal canal stenosis at the L3-L4 level which is progressed since prior. There is fairly mild spinal canal narrowing at the L2-L3 and L4-L5 levels.Additional details as described below:L1-L2: No spinal canal stenosis. There is mild bilateral neural foraminal narrowing related to minimal disc bulge and bilateral facet arthropathy.L2-L3: There is mild spinal canal narrowing. There is mild right neural foraminal stenosis related to prominent right-sided facet arthropathy. Left neural foramen is patent.L3-L4: There is moderate to severe spinal canal stenosis related to combination of osseous retropulsion, disc bulge, ligamentum flavum thickening, and facet arthropathy. There is also severe right and moderate left neural foraminal stenosis, which have also progressed. L4-L5: Mild disc bulge and advanced facet arthropathy. There is mild narrowing of the spinal canal. There is moderate left and mild right neural foraminal stenosis similar to prior.L5-S1: There is a disc bulge and bilateral facet arthropathy, worse on the left. There is no spinal canal stenosis. There is mild to moderate, left relatively greater than right, neural foraminal stenosis which is similar to prior.No definite evidence of metastatic disease is evident within the limits of noncontrast study.

Output: 1. Compared to prior MRI from 6/5/2016, there is progression of a severe compression fracture of L3, new mild compression fracture of the L4 vertebral body, and unchanged moderate L1 compression fracture. These findings are similar to recent CT from 11/1/2016.2. At L3-L4, there is moderate to severe spinal canal stenosis, severe right neural foraminal stenosis, and moderate left neural foraminal stenosis. These findings have all significantly progressed since prior MRI from 6/5/2016.3. No definite evidence of metastatic disease is evident within the limits of noncontrast study. Additional levels as above.


Instruction: Generate impression based on findings.

Input: Re evaluate lesion in right middle temporal gyrus. There is an unchanged area of subcortical radial linear high T2 signal in the right middle temporal gyrus with perhaps slight overlying cortical thickening, but no associated enhancement. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable. There is mild mucosal thickening and suggestion of a small air-fluid level in the right maxillary sinus. The orbits are unchanged.

Output: An unchanged area of signal abnormality in the right middle temporal gyrus may represent focal cortical dysplasia or perhaps a low-grade neoplasm, for example.


Instruction: Generate impression based on findings.

Input: 32 years Female (DOB:11/16/1983)Reason: 3T scanner, please evaluate for aneurysms (family hx of aneurysms) History: Fam history of aneurysms (sister had ruptured aneurysm in 20s)PROVIDER/ATTENDING NAME: ISSAM A AWAD ISSAM A AWAD Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. The cerebellar tonsils extend approximately 5 mm below the level of the foramen magnum. The cerebellar tonsils are rounded there is straightening of the normal cervical curvature.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina. There is mild disc desiccation present at this level. At C4-5 there is no significant compromise to the spinal canal or neural foramina. There is mild disc desiccation and a minor disc bulge at this level.At C5-6 there is no significant compromise to the spinal canal or neural foramina. There is mild disc desiccation and a minor disc bulge at this level.At C6-7 there is no significant compromise to the spinal canal or neural foramina. There is a minor disc bulge at this level.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.MRI thoracic spine:The thoracic vertebral bodies are appropriate in the overall alignment and height. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots. 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. The posterior communicating arteries are small to medium-sized. The anterior communicating artery is small.There is no evidence for intracranial aneurysm or cerebrovascular occlusion. The left vertebral artery is larger than the right vertebral artery. There is extracranial origin of the right posterior inferior cerebellar artery.CSF flow study:CSF flow study demonstrates normal biphasic flow. The cerebellar tonsils extend approximately 5 mm below the level of the foramen magnum.

Output: 1.There are mild degenerative changes present in the cervical spine without significant compromise to the spinal canal or exiting nerve roots. Please note that straightening of the normal cervical curvature on MRI is nonspecific finding which could relate to muscle spasm or patient positioning.2.There is no compromise to the thoracic spinal cord or cervical spinal cord. No lesions are identified in the spinal cord.3.There is no evidence for intracranial aneurysm or intracranial stenosis.4.The cerebellar tonsils are low lying. CSF flow study at the level of foramen magnum is within normal limits.


Instruction: Generate impression based on findings.

Input: 58-year-old man with history of HCV and liver lesion on CT. ABDOMEN:LIVER, BILIARY TRACT: Liver is cirrhotic in morphology. In segment 6 of the liver (3/21) there is a 17 mm T1 hypointense, T2 hyperintense lesion without signal loss on opposed phase imaging. Otherwise, no focal hepatic lesion is identified.The gallbladder appears normal. There is no intra or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Atrophic kidneys with innumerable bilateral cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Enteric duplication cyst is noted arising from the jejunum in the mid abdomen.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Segment 6 liver lesion which remains indeterminate on this nonenhanced study but could be benign or malignant in etiology (including a focal nodular hyperplasia, sclerosed hemangioma, or hepatocellular carcinoma). Further evaluation with an enhanced MR or direct tissue sampling can be considered, recommendations forwarded to ordering provider (Melanie Samardzija) through the EMR at time of dictation.


Instruction: Generate impression based on findings.

Input: Following a discussion of the procedure with the patient, including its risks, benefits, alternatives and steps to prevent infection, informed written consent was obtained and documented in the patient's chart. The time-out form was completed to confirm patient identity and side/type of procedure. All operators present for the case performed standard preprocedural prep including hand washing, sterile gloves, mask and cap. The patient was prepped and draped in the usual aseptic fashion. Local anesthesia over the target area was obtained by 1% lidocaine. Localizing CT examination demonstrated a oval soft tissue mass along the anterior aspect of the subscapularis muscle corresponding to the findings on recent PET/CT and MRI examinations. Using CT guidance, a 16-gauge Achieve core biopsy needle was advanced into the lesion. Four 16-gauge core needle biopsy specimens were obtained and placed in formalin. Touch preparations were performed and handed to cytopathology to evaluate for specimen adequacy.The core biopsy specimens were hand carried to the Surgical Pathology labThe patient tolerated the procedure well without immediate complication. Routine post procedure instructions were communicated to the patient.ESTIMATED BLOOD LOSS: Less than 5cc. An adhesive bandage was placed on the patient’s skin.

Output: CT guided biopsy of left shoulder soft tissue mass.


Instruction: Generate impression based on findings.

Input: Left hemiparesis.. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are few punctate T2/FLAIR-hyperintense foci in the frontal white-matter without associated diffusion restriction or susceptibility effect. The brain parenchyma and pituitary gland appear unremarkable, otherwise. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is very minimal mucosal thickening in the maxillary and ethmoid sinuses without fluid. The other paranasal sinuses are clear. The orbits, skull and scalp soft tissues are grossly unremarkable.

Output: No evidence of acute intracranial hemorrhage, mass, or acute infarct. Few punctate frontal white-matter lesions are very nonspecific but may reflect minimal microvascular ischemia.


Instruction: Generate impression based on findings.

Input: Right upper extremity pain and weakness. The bones and soft tissues of the forearm appear normal without findings to account for the patient's pain or weakness.

Output: Normal-appearing forearm without findings to account for the patient's pain and weakness.


Instruction: Generate impression based on findings.

Input: There are several scattered foci of restricted diffusion in the bilateral cerebral hemispheres. These include the right superior frontal gyrus, bilateral corona radiata and centrum semiovale, right thalamus, left temporal lobe, as well as a splenule of the corpus callosum on the right. There is a background of patchy T2/FLAIR hyperintensity in the bilateral periventricular and subcortical white matter consistent with chronic small vessel ischemic disease. Multiple chronic lacunar infarcts including the bilateral centrum semiovale as well as the pons are evident. There are numerous foci of susceptibility compatible with chronic microhemorrhages throughout the brain. Relatively larger areas of chronic hemorrhage including the right cerebellar hemisphere as well as the left greater than right basal ganglia which may be be related to chronic hypertension. More peripheral foci of chronic hemorrhage may be related to amyloid angiopathy but are nonspecific. There is no intracranial mass or mass effect, midline shift, or herniation. No hydrocephalus. There is mild degree of global parenchymal volume loss which is advanced for age. MRA HEAD

Output: 1. Multiple scattered acute infarcts in the bilateral cerebral hemispheres superimposed on a background of moderate chronic small vessel ischemic disease with multiple chronic lacunar infarcts.2. Numerous foci of chronic microhemorrhage as well as relatively larger areas of chronic hemorrhage involving the right cerebellar hemisphere and left basal ganglia. Distribution is nonspecific but suggests chronic hypertension and possibly also amyloid angiopathy.3. Major intracranial arteries are patent.4. No high-grade stenosis or occlusion involving the bilateral common carotid, internal carotid, or left vertebral arteries. Right vertebral artery is diminutive which may be related to hypoplasia and/or stenosis. Motion degradation and lack of contrast limits evaluation. If further evaluation is warranted, suggest postcontrast MRA or CTA.5. Mild multilevel degenerative changes in the cervical spine without high-grade spinal canal stenosis or cord signal abnormality.


Instruction: Generate impression based on findings.

Input: Dysphagia after deep brain stimulator electrode placement for Parkinson's disease. There are bilateral deep brain stimulators in position for Parkinson disease, without evidence of acute infarction or hemorrhage. There is blurring of the bilateral substantia nigrosomes. There is mild nonspecific periventricular white matter T2 hyperintensity. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable. There is fluid within the bilateral mastoid air cells and scattered mild paranasal sinus mucosal thickening.

Output: Unremarkable bilateral deep brain stimulators for Parkinson disease, without evidence of acute infarction or intracranial hemorrhage.


Instruction: Generate impression based on findings.

Input: Male, 52 years old, with history of left T2 N2 nasopharyngeal carcinoma status post treatment, follow-up examination. Slight distortion of the mucosal contour of the nasopharynx is unchanged. No masslike lesions are identified. There may be mild edema of the supraglottic larynx which is unchanged, but the remainder of the aerodigestive mucosa is unremarkable.No pathologic adenopathy is detected by size criteria. The salivary glands and the thyroid are unremarkable. The marrow space of the cervical spine shows evidence of prior radiation treatment. Otherwise, the osseous structures are unremarkable.The globes are round and symmetric. The extraocular muscles and optic nerves demonstrate normal morphology and signal characteristics. No intraorbital masses are seen.

Output: No evidence of recurrent nasopharyngeal tumor or pathologic adenopathy is seen.


Instruction: Generate impression based on findings.

Input: Recurrent vulvar cancer with probable spread to rectum. PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Prominent right external iliac lymph node, not pathologically enlarged by size criteria.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: 3.9 x 1.8 cm soft tissue mass in the perineal region at the vaginal introitus (axial series 1201, image 88) (sagittal series 601, image 25). This mass abuts the anterior wall of the anus with questionable extension along the left lateral wall. There is obliteration of the fat planes between the vagina and anus suspicious for bowel wall invasion. There is no bowel obstruction.

Output: Perineal soft tissue mass at the vaginal introitus with findings suspicious for bowel wall invasion of the anus


Instruction: Generate impression based on findings.

Input: Left shoulder pain ROTATOR CUFF: There is partial articular tearing of the supraspinatus tendon at its insertion upon the greater tuberosity which measures approximately 8 mm in the AP dimension. This is superimposed upon mild tendinosis of the supraspinatus tendon. Additionally, there is mild insertional tearing and tendinosis of the subscapularis. The teres minor and infraspinatus tendons are intact. The rotator cuff musculature is relatively preserved in caliber although there is perhaps minimal fatty atrophy along the myotendinous junction of the supraspinatus, infraspinatus, and teres minor tendons.SUPRASPINATUS OUTLET: Moderate osteoarthritis affects the acromioclavicular joint. An os acromiale is noted with degenerative changes and mild edema across the articulation. There is no significant subacromial subdeltoid fluid.GLENOHUMERAL JOINT AND GLENOID LABRUM: Mild to moderate osteoarthritis affects the glenohumeral joint and there is diffuse degeneration and tearing of the labrum is likely age-related.BICEPS TENDON: There is split tearing of the intra-articular portion of the long head of the biceps tendon. Its proximal portion is partially perched on the greater tubercle possibly reflecting a split tear of the distal subscapularis tendon.ADDITIONAL

Output: 1. Partial articular surface tearing of the supraspinatus tendon at its insertion which appears slightly progressed from an exam dated 3/17/2011. There is additional insertional tearing/tendinosis of subscapularis tendon but there is no evidence of a full-thickness rotator cuff tear.2. Osteoarthritis of the glenohumeral and acromioclavicular joints with mild degenerative change across an os acromiale.3. Split tearing of the intra-articular portion of the long head of the biceps tendon.4. Diffuse degeneration and tearing anterior labrum which is likely age-related.


Instruction: Generate impression based on findings.

Input: 46-year-old female with cerebral cavernous malformation, annual surveillance. Please note the patient declined the research scan portions of the study. Artifact from a right frontal approach ventriculostomy catheter somewhat obscures adjacent structures.There is redemonstration of a cerebral cavernous malformation in the right paramedian quadrigeminal plate, again measuring approximately 9 x 9 x 9 mm, without significant appreciable change. Surrounding hemosiderin laden parenchyma is stable, and there is no perilesional edema. As before, there is very subtle mass effect on the aqueduct without change. There is revisualization of a previously seen associated developmental venous anomaly with recruitment of the left perimesencephalic and basal vein of Rosenthal which is stable in appearance. There are no MR findings of other similar appearing foci.There is no restricted diffusion to suggest acute ischemia. A right frontal approach ventriculostomy catheter is present with the tip projecting into the basilar cistern, unchanged. The ventricles are stable in size and configuration. There is revisualization of a stable small right frontal developmental venous anomaly. There are a few punctate nonspecific foci of increased T2 hyperintensity in bilateral frontal lobes which appear unchanged. There is minimal gliosis along the right frontal approach ventricular catheter, unchanged. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1.No significant interval change in appearance of right paramedian quadrigeminal plate cavernoma and its associative developmental venous anomaly.2.Shunted ventricles stable in size and configuration.


Instruction: Generate impression based on findings.

Input: History of liver mass. ABDOMEN:LIVER, BILIARY TRACT: There is a dominant 14.2 x 9.5 cm T2-weighted heterogeneously hyperintense mass infiltrating the right hepatic lobe with numerous adjacent smaller lesions in the right and caudate lobe. The mass extends into a branch of the right hepatic vein to the level of the IVC, compatible with tumor thrombus. The mass demonstrates restricted diffusion and thick peripheral enhancement with central nonenhancement suggesting central necrosis. On delayed imaging there is no significant washout.Cholelithiasis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted. Free pelvic fluid is noted on the sagittal images. Moderate size hiatal hernia.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Neoplastic tumor infiltration of the right hepatic lobe with right hepatic vein tumor thrombus extending to the level of the intrahepatic IVC.


Instruction: Generate impression based on findings.

Input: Altered mental status [780.97], Reason for Study: ^Reason: PT with recent bacteremia now altered mental status. Concern for CNS infection. History: PT with recent bacteremia now altered mental status. Concern for CNS infection. Motion artifacts degraded exam quality.There are restricted diffusion areas including on the left caudate nucleus head and bilateral internal capsule as well as right thalamus mesial aspect indicating acute ischemic infarct.There is no evidence of acute hemorrhagic lesion on the scan.Focal susceptibility artifacts on the left frontal lobe, no change since prior exam. Underlying brain shows minimal to mild diffuse brain atrophy which is age appropriate.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses are clear. There is opacification on the left mastoid air cell.

Output: Acute ischemic infarcts without hemorrhagic transformation on bilateral internal capsule, left caudate nucleus and right thalamus mesial aspect as described above.


Instruction: Generate impression based on findings.

Input: Brain MRI:The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain. Incidental note is made of prominent choroid plexus involving temporal horns and foramina of Luschka bilaterally which appears symmetric, without cysts or masses, and is felt to most likely represent an anatomic variant. Cervical spine MRI:Alignment is normal. The marrow signal is benign. The cervical and upper thoracic cord is normal in signal and morphology. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable. There are no stenoses. There is no abnormal enhancement.

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


Instruction: Generate impression based on findings.

Input: Other visual disturbances [H53.8], Reason for Study: ^Reason: vasculitis? History: neuro deficit Brain MRIThere is no evidence of acute ischemic or hemorrhagic lesion.Left side basal ganglia including external capsule shows encephalomalacia with gliotic changes indicating chronic ischemic infarct, unchanged since prior scan.The left lateral ventricle shows ex vacuo changes, otherwise unremarkable.There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.Brain MRAMotion artifact degraded exam quality. 3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate irregular and small diameter of the left internal carotid artery with nonvisualization of left ACA A1 segment. Normal appearance of right ICA, MCA and ACA. Vertebrobasilar system appears to be normal. Comparing to prior scan obtained on Dec 26 2014, the intracranial portion of the left ICA especially from the level of the carotid canal appear to be recanalized. Neck MRA3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate non visualization of the left CCA. Extracranial left carotid system is visualized at the level of carotid bifurcation with demonstration of small caliber both ICA and ECA branches.Left subclavian artery proximal portion is not demonstrated either but reconstituted at the level of left vertebral artery origin.The brachiocephalic artery also shows significant luminal stenosis.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. Chronic ischemic infarction on the left basal ganglia and external capsule.3. Multifocal both intra and extracranial arterial luminal stenosis involving brachiocephalic artery and left intracranial ICA especially cavernous sinus segment. There is also complete occlusion of the left CCA and left subclavian artery origin. These findings may suggest idiopathic arteritis such as Takayasu's disease or vasculitis. 4. Interval recanalization of the left ICA intracranial portion.Rec: Considering the feature of both extracranial and intracranial arterial system which suggest possibility of vasculitis, brain MRI with and without contrast enhancement to assess any intracranial inflammatory foci can be considered if clinically indicated.


Instruction: Generate impression based on findings.

Input: 56-year-old male with increased back pain and urinary dribbling. Evaluate for lumbar stenosis. Again seen is minimal retrolisthesis of L4 on L5 and L5 on S1which is unchanged. There is also posterior spinal instrumentation involving the L3-4 vertebral levels which is new since prior MRI from 5/2/2014 but present on the CT lumbar spine from 6/19/2015. The known caudal migration of the rods are better seen on the recent previous lumbar CT from 6/19/2015 and multiple radiographs. Again seen are degenerative marrow signal changes from L3 through S1 with unchanged severe disc height loss at the L5-S1 level. The distal spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable. Degenerative changes are seen in the cervical spine as described below:T12-L1: There is no significant compromise to spinal canal or neural foramina.L1-L2: There is no significant compromise to spinal canal or neural foramina.L2-L3: There is no significant compromise to spinal canal or neural foramina.L3-L4: There has been interval bilateral laminectomy, discectomy and spacer placement with improvement in the disc space height and significant improvement in the spinal canal narrowing at this level. Evaluation of the neuroforamina is slightly limited given the susceptibility artifact from the hardware but there is no high-grade stenosis.L4-5: There has been a left-sided laminectomy with increased T2/STIR signal within the disc compatible with edema. There has been interval removal of the left lateral extruded disc with decompression of the left side of the spinal canal. There remains facet hypertrophy bilaterally and right-sided thickened ligamentum flavum along with the prominent asymmetric right-sided posterior epidural lipomatosis which causes some mild narrowing and displacement of the thecal sac; but overall there is no significant central spinal canal stenosis. However, prominent anterior epidural fat just inferiorly at mid L4 level causes moderate central spinal canal stenosis at this level although this was present previously and is unchanged. The degenerative changes at the L4-5 level cause at least moderate bilateral neuroforaminal stenosis greater on the left which is caused by bony osteophytes which are better seen on the recent previous lumbar CT. On postcontrast images, there is some enhancement involving the posterior aspect of the L4-5 disc and also minimally involving the ventral epidural space which is related to granulation tissue and which does not contribute to any spinal canal narrowing.L5-S1: Again seen is advanced degenerative disc disease with facet hypertrophy and ligamentum flavum thickening. Bony spurs better seen on the recent lumbar CT contributes to at least moderate bilateral neural foraminal stenosis greater on the left. Similar to the mid L4 level, there is prominent anterior epidural lipomatosis at the mid L5 level which causes moderate central spinal canal stenosis at this level but this is unchanged from the previous exam.

Output: 1.Multilevel degenerative disease of the lower lumbar spine with a posterior spinal fusion involving L3-L4 with discectomy and spacer placement at the L3-4 level and left lateral discectomy at the L4-5 level, all of which results significant improvement in the previous spinal canal stenosis at these levels. There are no findings to indicate disc reherniation.2.There is moderate spinal canal stenosis involving the mid L4 and mid L5 levels where there is prominent anterior epidural lipomatosis. There is also some asymmetric posterior epidural lipomatosis at the L4-5 level which along with right-sided ligamentum flavum thickening mildly displaces the thecal sac but there is no overall spinal canal stenosis at L4-5 disc level.3.There remains and at least moderate left greater than right L4-5 and L5-S1 neural foraminal stenosis related to degenerative changes and osteophytic components which are better seen on the lumbar CT from 6/19/2015.4.The known caudal migration of the vertical rods are better seen on the recent previous lumbar CT and lumbar radiographs.


Instruction: Generate impression based on findings.

Input: Right thumb pain; Male 20 years old Reason: evaluate for right thumb MCP ulnar collateral ligament tear LIGAMENTS: No significant abnormality noted. Specifically, the ulnar collateral ligament is intact.TENDONS: There is a mild amount of fluid surrounding the flexor pollicis longus tendon at the level of the MCP joint. Otherwise no significant abnormality noted. BONES: There is a nondisplaced fracture of the base of the second metacarpal with intra-articular extension. Additional areas of increased signal are noted within the base of the third and the underlying carpal bones likely relating to contusions.ADDITIONAL

Output: 1. Nondisplaced subacute fracture of the base of the second metacarpal with intra-articular extension.2. Probable contusions of the base of the third metacarpal and the underlying trapezium and trapezoid.3. Mild tenosynovitis of the flexor pollicis longus.4. Collateral ligament is intact


Instruction: Generate impression based on findings.

Input: Twisted knee playing football. Pain and swelling MENISCI: Bilateral menisci appear intact without abnormalityARTICULAR CARTILAGE AND BONE: Minimal signal abnormality in the medial facet of the patellar cartilage without discrete focal degeneration or contour irregularity. The peel and lateral compartments are also intact. Red marrow replacement without additional marrow signal abnormality or significant degenerative changesLIGAMENTS: Mild thickening and increased signal in the ACL with otherwise intact fibers running throughout; specifically no discrete findings to suggest a tear. Remaining ligaments are intact and well visualizedEXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Increased signal and mild thickening of the ACL may correlate with inflammation and acute injury without evidence of an associated tear. No additional acute internal abnormalities, specifically the menisci are intact.


Instruction: Generate impression based on findings.

Input: 19-year-old male with a right thigh mass. Evaluate for rectus tear versus neoplasm. Presents with pain to right thigh mass. Note is made of 3 vitamin E capsules overlying the anterior aspect of the right thigh presumably representing the patient's reported palpable area of concern. Note is made of an irregular enhancing lesion within the muscle belly of the rectus femoris muscle with associated T1 and T2 prolongation measuring approximately 2.0 x 1.4 cm, corresponding to the area of decreased attenuation seen on recent CT examination. There is associated focal fatty infiltration of the rectus femoris muscle in the surrounding area. These findings are nonspecific but remain suspicious for neoplasm including a vascular malformation. The remainder of the musculature is normal in appearance. No bone marrow signal abnormality is identified.

Output: 2 cm irregular enhancing lesion within the muscle belly of the rectus femoris which is nonspecific but remains suspicious for neoplasm including a vascular malformation.


Instruction: Generate impression based on findings.

Input: The risks (including, but not limited to, those of bleeding, infection, allergic reaction, temporary nerve block, pain, and inability to access the joint) and benefits of the procedure were explained to the patient, and informed written consent was obtained. A pre-procedural “time-out” form was completed.The patient was placed supine on the fluoroscopy table. The right hip was localized fluoroscopically, and a spot radiograph was obtained. The course of the femoral artery was noted on the patient's skin using an ink marker. The skin was cleansed and covered with a sterile drape. The skin and subcutaneous tissues were anesthetized with 1% lidocaine using 25-gauge and 22-gauge needles.Under fluoroscopic guidance, a 20-gauge spinal needle was advanced into the joint. Attempted aspiration yielded no fluid. Next, 12 ml of a 50/50 mixture of Omnipaque 240 (to confirm the intra-articular position of the needle) and dilute Multihance (0.1 cc in a 10 cc vial of saline, for subsequent MR imaging) were injected into the joint. Contrast opacified the joint in the expected manner. A spot radiograph was obtained for documentation. The needle was withdrawn. Blood loss was negligible (<1cc), and patient tolerated the procedure well without immediate complication. An adhesive bandage was placed on the patient’s skin. Routine post procedure instructions were communicated to the patient. The patient was escorted to the MRI suite for further imaging in stable condition. Please refer to the subsequent MRI report for further information.Exposure time: 20 seconds.

Output: Successful fluoroscopic guided injection of dilute gadolinium into the right hip for subsequent MR arthrogram examination.


Instruction: Generate impression based on findings.

Input: Reason: Evaluate for PCA stroke History: Persistent dizziness, nausea, and vomiting1/11/194967 yearsFemale MRI of the brainOn diffusion-weighted imaging some subtle signal hyperintensity projecting along the thalami and centrum semiovale and frontal lobes is most likely related to artifact.Examination is mildly degraded due to patient motion.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.On T2 and FLAIR MRI there is a high signal intensity focus involving the posterior limb of the right internal capsule extending to the right centrum semiovale. There are punctate T2 and FLAIR hyperintense foci present in the brainstem and thalami.On susceptibility weighted imaging there are multiple punctate and medium-sized foci of signal loss throughout the brainstem and thalami.There is a 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 visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin.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 a 2 mm aneurysm present along the distal right internal carotid artery at the origin of the right posterior communicating artery.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. The posterior communicating arteries are very small. The vertebral arteries are similar in size.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries. A weblike defect present within the proximal left internal carotid artery is suspected to be artifactual .

Output: 1.A weblike defect present within the proximal left internal carotid artery is suspected to be artifactual , however, it does give the appearance of the dissection flap. As a result of follow-up exam such as ultrasound or CT angiography may be of further benefit to help confirm this is an artifact.2.Findings are suggestive of a 2 mm aneurysm at the right posterior communicating artery origin. This can be confirmed via CT angiography.3.There are multiple microhemorrhages present throughout the brainstem and thalami whose pattern suggests these are associated with hypertension.4.Findings are compatible with an old lacunar infarct in the right posterior limb of internal capsule.5.Periventricular and subcortical white matter lesions of a moderate degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: Redemonstration of an enhancing dural based metastatic lesion along the left frontal convexity which appears intimately associated to the cortical surface; there may be subtle underlying parenchymal invasion. The lesion now measures up to 1.4 cm in thickness, previously 7 mm, and causes mass effect on the underlying frontal lobe with new low T1 signal within the surrounding white matter consistent with vasogenic edema. The lesion extends along the dura anteriorly and inferiorly involving the left temporal convexity with mild mass effect of the underlying temporal lobe. There is non-suppression of CSF on the FLAIR sequence along the frontal cortical sulci which may represent congestion or leptomeningeal disease. There is also minimal leptomeningeal enhancement in this region. There is susceptibility associated with the extra-axial lesion as well as trace susceptibility involving the left frontotemporal sulci. No frank intraperitoneal hematoma is evident. There otherwise is no evidence of acute infarct or intracranial hemorrhage. Mild nonspecific periventricular and subcortical abnormal T2 signal is again noted. There is no midline shift or herniation.The low T1 signal, low T2 signal, and enhancing lesion within the left calvarium overlying the dural metastasis appears increased in size in the longitudinal dimension. Although there is no large destructive component, CT would be more sensitive in evaluating for bony destruction. There is mildly increased thickening and enhancement involving the left temporalis muscle and along the left scalp overlying the lesion in the bone.

Output: 1. Interval progression of disease with increasing size of the dural based metastatic lesion with new mass effect and vasogenic edema within the left frontotemporal lobe, larger calvarial lesion, and increased scalp thickening. 2. Susceptibility effect is noted with above lesion including within the adjacent left frontoparietal sulci related to mineralization and/or blood products. Consider noncontrast head CT to exclude the possibility of acute hemorrhage associated with this lesion.


Instruction: Generate impression based on findings.

Input: There is no evidence of pathologic enhancement, parenchymal edema, or mass effect to suggest intracranial metastases.Scattered foci of T2 hyperintensity within the bilateral cerebral white matter are seen, nonspecific, and not significantly changed when compared to prior MRI. There is no diffusion abnormality. No evidence of intracranial hemorrhage or abnormal extra-axial fluid is seen. The ventricles and sulci are prominent compatible with mild age-related volume loss. Bone marrow signal intensity is within normal limits. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits.

Output: 1. No evidence of intracranial metastases.2. Mild, chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: Male 38 years old Reason: please define margins of plexiform neurofibroma of abdomen History: young man with NF1 who has what appears to be a superificial plexiform neurofibroma on right side of abdomen CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: Multiple small neurofibromas are noted in the pleural space adjacent to the spine. These are mildly T2 hyperintense. CHEST WALL: There multiple T2 hyperintense lesions in the skin representing neurofibromas. The index lesion in the left pectoralis major muscle measures 1.7 x 1.0 cm (image 14/series 16). There are other smaller neurofibromas in the posterior body wall musculature.OTHER: ABDOMEN:LIVER, BILIARY TRACT: Liver is normal morphology. No suspicious hepatic lesions. The gallbladder is filled with gallstones. No pericholecystic fluid. No biliary ductal dilatation.Hepatic vasculature are patent.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Multiple small T2 hyperintense lesions in the skin compatible with small neurofibromas. No dominant lesion.In the pelvis, the neurofibromas are widen the neural foramina.Plaque-like lesion in the right lateral body wall (image 39 is used 25)Multiple small neurofibromas are present in the body wall musculature.OTHER: No ascites.

Output: 1.Multiple small skin and muscular neurofibromas.2.Cholelithiasis.


Instruction: Generate impression based on findings.

Input: Female, 81 years old, with dissection, headache, temporal pain. Evaluate for ischemia. MRI brain:No restricted diffusion is seen. Scattered small foci of T2 hyperintensity are seen within the cerebral hemispheres. No edema or mass effect is detected. No evidence of intracranial hemorrhage or any abnormal extra axial fluid collection is seen. Ventricular size and morphology are within normal limits. The cerebellar tonsils are noted to be low-lying given that they descend as much as 5 mm below the foramen magnum.MRA brain:No significant intracranial vascular stenosis or occlusion is seen. No aneurysm or vascular malformation is suspected.MRA neck:Mild atherosclerotic narrowing is seen at the right carotid bifurcation. No evidence of significant stenosis by NASCET criteria is seen in either carotid distribution. The origins of great vessels are patent.Again seen is an area of narrowing with the suggestion of extrinsic compression affecting the right vertebral artery at the C3-4 level. More distally, an area of narrowing is also redemonstrated affecting the V3 segment on the right just prior to its passing intracranially. Please note that fat-suppressed T1 precontrast images were inadvertently omitted.MRI C-spine:Alignment is anatomic. Vertebral body heights are preserved allowing for endplate irregularity. No evidence of pathologic marrow replacement or marrow edema is seen. The spinal cord is impinged at the C3-4 level due to degenerative findings, discussed more fully below. However, no areas of abnormal spinal cord signal are observed. No evidence of pathologic enhancement is seen.C2-3: Unremarkable. C3-4: Facet arthropathy. Posterior disc-osteophyte complex formation with ligamentum flavum thickening. Moderate spinal canal stenosis with slight flattening of the ventral spinal cord. Moderate bilateral foraminal narrowing. Of note, no specific cyst or mass is evident to account for the apparent narrowing and mass effect on the right vertebral artery. C4-5: Facet arthropathy. Posterior disc-osteophyte complex formation asymmetric to the left paracentral zone. Mild spinal canal stenosis with slight flattening of the left ventral cord. Mild left foraminal narrowing. C5-6: Facet arthropathy. Posterior disc-osteophyte complex formation and ligamentum flavum thickening. Mild spinal canal stenosis with minimal flattening of the ventral cord. Moderate to severe left foraminal narrowing. C6-7: No spinal canal stenosis or neuroforaminal narrowing. C7-T1: No spinal canal stenosis or neuroforaminal narrowing.

Output: 1.No evidence of acute ischemia is seen intracranially. There are findings compatible with mild chronic microvascular ischemic disease. The cerebellar tonsils are low-lying which is likely an incidental finding.2.No significant vascular compromise is detected intracranially. No definite aneurysm or vascular malformation is seen.3.Narrowing of the distal right V3 segment is seen correlating with findings on prior CTA. No additional information is obtained on this examination to support the possibility of a dissection at this site.4.Again seen is focal narrowing of the right vertebral artery at the C3-4 level. No obvious cyst or mass is demonstrated to account for this finding.5.Multilevel disc degeneration is seen. The C3-4 level is most severely affected where there is a moderate spinal canal stenosis and some degree of cord impingement. No cord edema is observed. Mild narrowing of the spinal canal is also evident at C5-6.


Instruction: Generate impression based on findings.

Input: Contrast is seen opacifying the joint space of the wrist there is no discrete contrast extravasation to suggest TFCC or lunotriquetral ligament disruption however please refer to the subsequent MRI report for further information.Exposure time: 35 seconds

Output: Successful right wrist arthrogram in preparation for MRI.


Instruction: Generate impression based on findings.

Input: Glioblastoma status post resection and chemoradiation. There are postoperative findings related to right frontotemporal craniotomy. There is no significant change in the irregular peripherally-enhancing mass in the right temporal, with apparent elevated perfusion in the enhancing component, although, the extent of adjacent ependymal enhancement has increased. There is no significant interval change in the irregular peripherally-enhancing mass in the right frontal lobe, but the more lateral adjacent solidly-enhancing tumor has decreased in size. The presence of susceptibility effect in this region limits assessment of the perfusion characteristics. However, there is increased surrounding confluent white matter T2 hyperintensity with associated slight increase the right uncal herniation and effacement of the right lateral and third ventricles since December 2015. There is 6 mm of midline shift to the left. There is no evidence of acute intracranial hemorrhage or infarction. There is unchanged nonspecific patchy cerebral white matter hypoattenuation in the left cerebral hemisphere. The orbits, paranasal sinuses, and scalp soft tissues are grossly unchanged.

Output: 1. No significant change in the irregular peripherally-enhancing mass in the right temporal, with apparent elevated perfusion in the enhancing component, although, the extent of adjacent ependymal enhancement has increased2. No significant interval change in the irregular peripherally-enhancing mass in the right frontal lobe, but the more lateral adjacent solidly-enhancing tumor has decreased in size. 3. Confluent white matter abnormality surrounding the tumor foci has increased since December 2015, which may represent tumor infiltration and/or edema related to treatment.


Instruction: Generate impression based on findings.

Input: Male, 64 years old, with GBM, status post two cycles immunotherapy. Postoperative changes are again seen in left occipital lobe. A small area of encephalomalacia is unchanged. Enhancing nodules are redemonstrated, including two small nodules and a dominant nodule with associated rim-enhancing cyst. The smaller nodules are stable or at most minimally increased in size. The dominant nodule, however, has mildly increased in size, now measuring up to 20 mm in axial short axis, previously 17 mm. As before, enhancement from this lesion spreads to the ependyma of the left atrium. Susceptibility artifact somewhat limits evaluation on perfusion sequences, but there is clear elevated rCBV correlating to the dominant nodule and at least one of the smaller nodules.T2 hyperintensity surrounding this lesion has progressed with further extension of this signal abnormality anteriorly into the temporal lobe. The left splenium of the corpus callosum is involved, but no definite contralateral spread is seen. The left lateral ventricle is partially effaced similar to prior. The remaining ventricles are unremarkable.

Output: Multiple nodular enhancing lesions are redemonstrated within the left parieto-occipital junction. The dominant lesion demonstrates a mild interval increase in size. Extensive T2 hyperintensity surrounding these lesions has also progressed. Given that subtle progressive findings were suspected on the prior examination, the possibility that this represents slowly growing tumor is raised.


Instruction: Generate impression based on findings.

Input: 72-year-old male with right knee instability and giving way episodes. Evaluate right knee for loose body versus unstable meniscal tear. MENISCI: There is marked signal abnormality and degeneration of the medial meniscus. A portion of the medial meniscus appears partially adherent along the posterior and anterior insertion. There is a horizontal tear through the body of the lateral meniscus with continuation into the posterior horn. The tear extends to the inferior articular surface with fraying of the inner edge. ARTICULAR CARTILAGE AND BONE: There is minimal bone marrow edema along the medial tibial plateau. The articular cartilage is absent along the medial compartment. There is abnormal signal and thinning within the articular cartilage of the lateral compartment with numerous defects throughout. The articular cartilage of the patellofemoral compartment is thinned with abnormal signal and fraying.LIGAMENTS: There is degeneration of the ACL with complete tear. The PCL is thickened with increased signal. The PCL appears deformed with buckling. The MCL is intact, however, there is increased signal within it. The lateral collateral ligament appears intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: Complete tear of the ACL with cartilage and meniscal defects as above.


Instruction: Generate impression based on findings.

Input: With history of mesothelioma. Status post radiation please evaluate for disease Using mesothelioma protocol and compared to previous study ABDOMEN:LUNG BASES: Linear scarring at the right lung baseLIVER, BILIARY TRACT: Hepatic cyst is unchanged. Fat deep air, free of the right lobe. There is a linear large hypodense area associated with nodular enhancement measuring 18 x 19 mm bested on image number 34, series number 3. This is more prominent compared to previous CT. MRI of the liver is recommended to differentiate between perfusion artifact versus intrahepatic or perihepatic lesion.SPLEEN: No significant abnormality notedPANCREAS: 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: Linear large hypodense area at the periphery of the right lobe and possible focal enhancing lesion in the right lobe. MRI of the liver is recommended for further characterization of this heterogeneous area of the liver. Differential diagnosis includes perfusion abnormality, intrahepatic lesion versus perihepatic involvement in this patient with mesothelioma.


Instruction: Generate impression based on findings.

Input: 68 years, Male, Reason: liver lesion ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: There is increased intrahepatic biliary ductal dilatation extending from the Klatskin point. This is particularly prominent in the left hepatic lobe. A hypointense lesion identified on the prior exam is not evident on this exam and in that region of the left hepatic lobe, there is now increased ductal dilatation. There may be subtle ill-defined T2 signal within the hepatic hilum at the Klatskin point, however no discrete mass can be identified. The common bile duct in this region appears mildly irregular and there appears to be mass effect on the left portal vein.Small amount of debris in the gallbladder. Cirrhotic nodular liver contour.SPLEEN: Splenomegaly is unchanged.PANCREAS: Prominent pancreatic duct measuring up to 6 mm. Normal appearing pancreatic parenchyma.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter right upper pole hemorrhagic cyst.RETROPERITONEUM, LYMPH NODES: Mildly enlarged periportal node measuring 1.4 x 1.5 cm (7/60).BOWEL, MESENTERY: Mild bowel wall thickening of the ascending colon is unchanged.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Diffuse abdominal ascites is unchanged.

Output: 1.Increased intrahepatic biliary ductal dilatation. While this may be due to progression of patient's known primary sclerosing cholangitis, the degree of change raises concern for an obstructing lesion at the Klatskin point. A discrete lesion is not identified on this exam, however there may be subtle T2 abnormality and findings suggesting mass effect.2.Hypointense lesion identified on the prior exam is not evident.3.Stable ascites.4.Colonic wall thickening is stable and may be secondary to portal colopathy.


Instruction: Generate impression based on findings.

Input: 64-year-old female with history of HCC, status post TACE/RFA. Assess for recurrence of HCC. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic morphology. Stable small ablation cavity in hepatic segment 5 (series 10 image 142) without evidence of arterial hyperenhancement or washout. Capsular rim enhancement on the delayed phase (series 11 image 37) is unchanged and likely represents fibrous tissue.A subcentimeter focus of arterial enhancement in the peripheral hepatic segment 6 (series 10 image 26) is isointense on the remaining series and favored to represent a perfusional variant.Abutting a punctate cyst in hepatic segment 6 (series 7 image 21) is a sub 5 mm T2 hyperintense enhancing focus that persists on the delayed phase (series 11 image 45). The cyst is unchanged since the 2014 MRI exam, however this small area of enhancement abutting the cyst is new.No intra or extrahepatic biliary ductal dilatation. Status post cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small left renal cyst. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Bilateral breast prostheses noted.OTHER: No significant abnormality noted.

Output: 1.Stable small hepatic segment 5 ablation cavity without evidence for local recurrence or new enhancing lesion with washout.2.Abutting a punctate cyst in hepatic segment 6 is a sub 5mm T2 hyperintense enhancing focus that persists on the delayed phase. The cyst is unchanged since the 2014 MRI exam, however the small area of adjacent enhancement is new. This may represent a vascular flow effect but unlikely to represent hemangioma as not seen on prior. Attention on follow-up imaging is recommended.


Instruction: Generate impression based on findings.

Input: cT1N0 nasopharynx squamous cell carcinoma status post treatment. There are post-treatment findings in the neck. The right nasopharyngeal mass is no longer measurable. There is no evidence of significant cervical lymphadenopathy based on size criteria. The thyroid and major salivary glands are unremarkable. The major cervical arterial flow voids appear to be intact. The osseous structures are unchanged. The imaged intracranial structures are unremarkable.

Output: Post-treatment findings in the neck without measurable residual nasopharyngeal carcinoma.


Instruction: Generate impression based on findings.

Input: 22-year-old with paresthesias. Concern for multiple sclerosis. Brain:No abnormal signal is seen on the T2 or FLAIR images. There is no abnormal enhancement. There is no evidence of mass or edema. The cerebral volume is preserved.The ventricles and basal cisterns are normal in size and configuration. The expected intracranial vascular flow voids are present. The paranasal sinuses are clear. The visualized mastoid air cells are clear. The orbits are unremarkable.Cervical spine:Marked motion artifact limits evaluation of the cervical spine.Straightening of the cervical lordosis likely related to positioning. Vertebral body and intervertebral heights are maintained. No significant neural foraminal or spinal canal stenosis. The spinal cord is normal in signal and morphology throughout. No abnormal enhancement is present on the postcontrast images.

Output: 1. Normal contrast enhanced MRI of brain. No evidence of demyelinating disease or findings to account for the patient's symptoms.2. Normal contrast enhanced MRI cervical spine within the limitations of extensive motion artifact. No evidence of demyelinating disease.


Instruction: Generate impression based on findings.

Input: Female 21 years old Reason: Hx of pancreatic cyst, recent CT showing enlargement History: Pancreatic cyst ABDOMEN:LIVER, BILIARY TRACT: Diffuse hepatic steatosis.SPLEEN: No significant abnormality noted.PANCREAS: There is a 4.7 x 5.3 cm T2 hyperintense lesion centered on the distal pancreatic body/pancreatic tail which does not demonstrate definite communication with the pancreatic duct. There is a 1.1-cm nonenhancing nodular focus on the nondependent wall (series 7, image 23) that is isointense to the remainder of the lesion. This is nonspecific but may represent a mucin globule. There is a nonenhancing septation in the inferior aspect (series 4, image 16). There is no debris within the lesion. There is no pancreatic duct dilatation. Post administration of secretin the pancreatic duct demonstrates normal physiologic response. The pancreatic parenchyma upstream from the cystic lesion demonstrates loss of normal intrinsic T1 hyperintensity, mildly increased T2 signal and is relatively hyperenhancing and appears to retain contrast relative to the remainder of the pancreas. There are no surrounding peripancreatic inflammatory changes.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Mildly prominent juxtaphrenic lymph node is nonspecific.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1.Cystic pancreatic lesion with nonenhancing internal nodule and septation. The appearance is worrisome for a mucinous cystic neoplasm. While pancreatic pseudocyst is a differential consideration, given the absence of a definite history of prior acute pancreatitis this is felt to be much less likely. 2.Abnormal signal in the upstream pancreas is likely due to a combination of edema and perfusional variation secondary to element and an element of obstruction from the above described cystic lesion. While very early acute pancreatitis could have a similar appearance this is felt much less likely given the absence of peri-pancreatic inflammatory changes.


Instruction: Generate impression based on findings.

Input: Bifrontal glioblastoma treated with RT/TMZ+TMZ, but off all treatment currently. There are post-surgical findings in the left frontal lobe. There is a subcentimeter focus of enhancement along the surface of the left middle frontal gyrus., which appears to be new. Otherwise, there is no significant change in the confluent areas of T2 hyperintensity surrounding the left frontal lobe resection cavity and elsewhere in the right cerebral white matter. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are unchanged. There is a left maxillary sinus retention cyst.

Output: Nonspecific subcentimeter focus of enhancement along the surface of the left middle frontal gyrus, which appears to be new. Otherwise, no significant change in the confluent areas of T2 hyperintensity surrounding the left frontal lobe resection cavity and elsewhere in the right cerebral white matter.


Instruction: Generate impression based on findings.

Input: Subdural hematomas. 73-year-old female Patient is status-post of left and right craniotomies.There is redemonstration of bilateral subdural hematomas which have decreased in density since previous exam.. These are unchanged in thickness since the prior exam measuring approximately 9 mm in the right and 13 mm on the left. There is an intracranial pressure monitor present.Along the left inferior frontal gyrus and anterior temporal lobe. There is hypodensity present. This was also present on the prior CT exam. It is suspicious for infarction.Some blood products are present in the occipital horn of the right lateral ventricle. The temporal horns the lateral ventricles are mildly dilated. The sulci are not effaced. In general, the lateral ventricles are larger on the current exam versus the prior CT exam. They are similar in size to the recent MRI exam of 12/30/09.There is opacification of the mastoid air cells and middle ears status-post intubation.There is mucosal thickening along the sphenoid sinus and ethmoid air cells.Opacification of a mastoid air cells is and partial opacification of paranasal sinuses is associated with intubation. Atherosclerotic calcifications of a moderate to marked degree are present in the distal internal carotid arteries.

Output: 1.The bilateral subdural hematomas have gradually decreased in size since exams dating back to 12/16/09.2.The lateral ventricles are mildly dilated, as described above.3.Findings are compatible with a foci of infarction in the left frontal lobe and temporal lobe.


Instruction: Generate impression based on findings.

Input: 50-year-old female with pain in left ASIS and left iliac crest after fall in June 2015. Evaluate for occult fracture. The anterior superior iliac spine as well as the sartorius origin and the iliotibial band appear intact. The bone marrow signal intensity is within normal limits. Evaluation of the acetabular labrum is limited due to the lack of intra-articular contrast, however, there is a thin band of intermediate signal intensity traversing the anterior labrum at approximately the 2 o'clock position, suggestive of a tear. There is mild degeneration of the articular cartilage of the hip. There is a small focus of heterotopic ossification seen within the gluteus minimus muscle, lateral to the femoral head, which may reflect old trauma. The gluteus minimus tendon itself appears intact. The sacroiliac joints are within normal limits. There are mild peritrochanteric inflammatory changes identified bilaterally which are not necessarily of clinical significance. There is a collection of near fluid signal intensity, posterior to the uterus, which may represent an adnexal cyst, but this is nonspecific on this nonenhanced examination.

Output: 1. Mild osteoarthritis of the left hip with a tear of the anterior labrum. We see no occult fracture or other findings to account for the patient's left iliac crest or ASIS pain.2. Nonspecific collection of near fluid signal intensity posterior to the uterus, which may represent an adnexal cyst, but is nonspecific on this nonenhanced exam. Further evaluation with dedicated transvaginal pelvic ultrasound examination is recommended.3. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Reason: Check MPFL, trochlear dysplasia, measure TT-TG distance, check for loose bodies History: R patellar instability Multiple sequences are degraded by patient motion artifact resulting in suboptimal image quality.MENISCI: The medial and lateral meniscus appear intact. There is a subcentimeter lobulated focus of fluid signal intensity along the posterior aspect of the posterior horn of the medial meniscus which likely represents ganglion formation.ARTICULAR CARTILAGE AND BONE: Signal abnormality within the medial aspect of the patella and lateral aspect of the lateral femoral condyle indicating bone contusions from prior lateral transient patellar dislocation. The femoral trochlea appears shallow superiorly and the medial facet appears diminutive, indicating femoral trochlear dysplasia. There is near full-thickness chondromalacia affecting the articular cartilage along the lateral facet of the patella. No full-thickness defects are identified. The articular cartilage of the medial and lateral tibiofemoral compartment appears relatively spared.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The quadriceps and patellar tendons appear intact.ADDITIONAL

Output: 1. Findings indicating prior lateral transient patellar dislocation with bone contusions and complete disruption of the distal fibers of the medial retinaculum.2. Femoral trochlear dysplasia and edema within the superolateral aspect of Hoffa's fat pad can be seen in patients with patellofemoral instability.3. The tibial tubercle to trochlear groove distance and Insall Salvati ratio are within normal limits.4. Moderate size joint effusion. No definite loose bodies are identified.5. Chondromalacia affecting the patellofemoral articulation, however, no full-thickness or near full-thickness articular cartilage defects are seen.


Instruction: Generate impression based on findings.

Input: Female, 21 years old, with paresthesias and history of multiple sclerosis. Multiple scattered corpus callosum, periventricular and juxtacortical T2 hyperintense lesions are again seen. The lesions have not significantly changed in size, distribution or signal characteristics. Most are associated with mild to moderate T1 hypointensity. No definite new lesions are seen. The corpus callosum is of normal thickness and the volume of the cerebral hemispheres is preserved. No evidence of parenchymal edema or mass effect is seen. No abnormal extra-axial collections are detected. The ventricles are normal in size and morphology.

Output: Stable size and distribution of lesions compatible with multiple sclerosis.


Instruction: Generate impression based on findings.

Input: Clinical question: Normal cavernous sinus pathology/posterior communicating artery aneurysm. Signs and symptoms: Right retro-orbital pain, head CT from outside hospital showed the right frontal hyperdense area. None infuse CT of brain:Examination demonstrates a small area of approximately 8mm times 8mm increased density within the cortex of right frontal lobe. This is not associated with any detectable edema or mass effect. The finding is believed to represent subtle calcification and likely a cavernoma. Further evaluation with a dedicated MRI examination is recommended.Examination the right no additional area of abnormal density, edema, hemorrhage, mass-effect, midline shift or hydrocephalus. Images at the level of the cavernous sinuses demonstrate no pathology. Calvarium, limited real paranasal sinuses, mastoid air cells and middle ear cavities are unremarkable. CTA of intracranial circulation:Carotid system.Supraclinoid internal carotids, bilateral anterior and middle cerebral arteries and their branches are visualized and no evidence of abnormality.There is no evidence of aneurysm of the posterior communicating arteries as clinically is questioned. Very small bilateral posterior communicating arteries can be detected only on MIP 2-D images and is not visualized on reformatted 3-D images.Vertebral basilar system:There is no evidence of aneurysm. Both intracranial vertebral arteries are visualized and unremarkable. Basilar artery is widely patent. Bilateral superior cerebellar arteries and posterior cerebral arteries are also unremarkable.Extensive motion artifact obscures some of the detail in both carotid systems and vertebral basilar system. The motion artifact causes significant irregularity and apparent narrowing of intracranial vertebral arteries bilaterally and irregularity of basilar artery.This examination demonstrates no detectable abnormality of cavernous sinuses as clinically is questioned. However note should be made that cavernous sinuses can be significantly better evaluated by an MRI examination read in the CTA. If clinical concern for cavernous sinus abnormality persist an MRI examination of brain is recommended which will also help for further evaluation of small calcific lesion in the right frontal lobe.

Output: 1.Small area of cortical increased density in the right frontal lobe is highly suspected of calcification of a small cavernoma. Follow-up with an MRI exam is recommended. Unremarkable CT of brain without contrast otherwise.2.Essentially unremarkable CTA of intracranial circulation.3.Motion artifact in particular through the images of posterior fossa creates significant irregularity and apparent stenosis of vertebral arteries.4.MRI examination is recommended for further evaluation of a small calcific lesion within the right frontal lobe (likely a cavernoma) as well as cavernous sinuses which cannot be properly Vater that on CTA.


Instruction: Generate impression based on findings.

Input: 44 year old with history of right breast biopsy with results of ADH and LCIS. Family history of breast cancer in her mother at age 42. There is extreme amount of fibroglandular tissue in both breasts. A few scattered cysts are seen in each breast.Moderate parenchymal enhancement is noted bilaterally.No suspicious enhancement is seen in either breast. Biopsy clip artifacts in the right outer breast again noted. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Diagnosis: Multiple sclerosis. Transient alteration of awarenessClinical question: Assess status of MS, identify possible lesions that may have caused seizures or confusion in generalSigns and Symptoms: History of MS, acute confusional state The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a moderate degree of periventricular and subcortical white matter T2 and FLAIR hyperintense lesions present some of which are perpendicularly oriented to the lateral ventricles. Additional lesions are present in the brainstem and cerebellar hemispheresNo abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.There is a cystic lesion just beneath the floor of the left maxillary sinus which this forms the floor of the left maxillary sinus and is associated with patient's dentition.

Output: 1.There are multiple lesions scattered in both hemispheres of the brain as well as the brainstem and cerebellum which are compatible patient's clinical diagnosis of demyelinating disorder. No enhancing lesions are appreciated to suggest acute demyelination.2.Findings are suggestive of a radicular cyst involving the left maxillary dentition.


Instruction: Generate impression based on findings.

Input: The thoracic spine is in normal alignment. The vertebral body and disk heights are well maintained. There is diffuse T1 hypointensity involving the bone marrow without a discrete destructive osseous lesion evident. Small T1 hyperintense foci are compatible with fat or small hemangiomas. There is a 7 mm enhancing focus at the junction of the transverse process and lamina at the right T6 level, possibly atypical hemangioma but nonspecific. The spinal cord is of normal caliber and signal. There are minimal degenerative changes in the thoracic spine including a small right central disc protrusion at T10-T11 which partially effaces the right ventral aspect of the thecal sac. There is otherwise no significant disk bulge, herniation, spinal canal or foraminal stenosis within the thoracic spine.Multiple renal cysts, better assessed on prior abdominal MRI.

Output: 1. No significant spinal canal stenosis at any level or cord signal abnormality.2. Diffuse T1 hypointense marrow signal which is nonspecific but compatible with history of myelofibrosis.


Instruction: Generate impression based on findings.

Input: 46 years Female (DOB:10/16/1969)Reason: Having back pain with radiculopathy down to big toe, assessment for disc disease History: back pain with radiculopathyPROVIDER/ATTENDING NAME: TARIQ M MALIK SERVICES ANCILLARY Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is mild ligamentum flavum hypertrophy present at this level. There is a disc bulge present associated with disc desiccation. There is T2 hyperintensity along the posterior aspect of the annulus of the disc. Since the prior exam there is greater desiccation of the disc.At L4-5 there is loss of disc space height, disc desiccation and a broad-based left lateral recess disc extrusion associated with effacement of the fat at the left lateral recess. Some disc material extends behind the superior endplate of L5 at the left lateral recess and compresses the nerve roots at the left lateral recess. Disc extends across the midline to the right lateral recess and mildly encroaches on the nerve roots of the right lateral recess. These findings were present on the prior exam however there is a little more desiccation of the extruded fragment on the current exam versus the prior exam. There is mild ligamentum flavum hypertrophy at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.Since the prior exam the main differences somewhat more disc desiccation the current versus the prior exam as detailed above. There is redemonstration of a left lateral recess broad-based disc extrusion at L4-5 which encroaches on the nerve roots at the left lateral recess.


Instruction: Generate impression based on findings.

Input: 48-year-old woman with history of abdominal pain, altered bowel habits, and elevated inflammatory markers. ABDOMEN:LIVER, BILIARY TRACT: The dome of the liver is not included within the field-of-view. The visualized liver is unremarkable. There is no intrahepatic biliary duct dilatation. The patient is status post cholecystectomy. The common bile duct appears normal.SPLEEN: There is a 54 x 51 mm, lobulated, septated T2 intense, nonenhancing lesion in the spleen (series 4, image 8). The splenic vein is normal.PANCREAS: The pancreas is normal.ADRENAL GLANDS: The adrenal glands are normal.KIDNEYS, URETERS: Kidneys are normal and enhance symmetrically.RETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: The small bowel including the terminal ileum appears normal without wall thickening, dilation, or abnormal enhancement. The colon is normal.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Uterus and adnexa appear normal and there is a right ovarian cyst.BLADDER: The bladder is normal.LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Small Tarlov cysts are noted.OTHER: No significant abnormality noted.

Output: 1.No abnormality of the small bowel or colon. Specifically, normal terminal ileum.2.Benign-appearing cystic lesion in the spleen, probably a lymphangioma.


Instruction: Generate impression based on findings.

Input: Female, 61 years old, with left-sided weakness. Evaluate for stroke. A large region of restricted diffusion is evident in the right MCA territory involving portions of the posterior frontal lobe, the parietal lobe, the temporal lobe and the insula. No significant associated hemorrhage is suspected on the basis of the T1-weighted images. Also noted is a single 3 mm focus of restricted diffusion in the right cerebellum.

Output: Large right MCA distribution acute infarct with a single punctate focus of acute ischemia in the right cerebellum.


Instruction: Generate impression based on findings.

Input: Clinical question: Eval progressive grade III oligodendroglioma s/p recent resection w/ adenoviral vector injection on clinical trial.Signs and Symptoms: grade III oligodendroglioma.Comments: Grade III oligodendroglioma s/p resection w/ adenoviral vector injection 2 weeks ago on a clinical trial. | The patient status post right frontal craniotomy for removal of a right frontal lobe mass. There is signal hyperintensity present along the right frontal lobe within the subcortical and periventricular white matter adjacent to the right superior middle and inferior frontal gyrus as well as the right external capsule. The extent of the white matter signal abnormality remains stable and compared to the previous exam from October 6, however, this white matter signal change appears to be more extensive than on the 7/23/2015 exam. Compared to the 9/15/2015 exam - which is preoperative- the outer extent of the white matter signal change appears very similar. There are punctate foci of susceptibility effect present within the white matter signal change adjacent to the resection site. These were also present on the 9/15/2015 exam. There is redemonstration of ill-defined enhancement were these punctate foci of susceptibility are surrounding the surgical margins .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: Since the previous exam is no substantial change. There is redemonstration of status post right frontal lobe surgery. The possibility of a residual neoplasm in the remaining right frontal lobe cannot be excluded.


Instruction: Generate impression based on findings.

Input: Brain MRI:There are a few bifrontal subcortical foci of T2 hyperintensity, which although present with FLAIR technique, when correlating with their appearance on proton density demonstrate a linearity that is most suggestive of a lack of fluid suppression within a perivascular space. There is a solitary focus of linear T2 hyperintensity within the leftward anterior corpus callosal body. The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. Cervical spine MRI:Alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign. The cervical and upper thoracic cord are normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.C2/3: UnremarkableC3/4: UnremarkableC4/5: UnremarkableC5/6: UnremarkableC6/7: There is a shallow right paracentral disc protrusion which causes minimal anterior right hemicord flattening without intrinsic cord signal abnormality or resulting stenosis.C7/T1: Unremarkable

Output: 1.There are a few bifrontal subcortical foci of T2 hyperintensity, which although present with FLAIR technique, when correlating with their appearance on proton density demonstrate a linearity that is most suggestive of a lack of fluid suppression within a perivascular space. 2.There is a solitary focus of linear T2 hyperintensity within the leftward anterior corpus callosal body which is nonspecific in appearance.3.C6/7: There is a shallow right paracentral disc protrusion which causes minimal anterior right hemicord flattening without intrinsic cord signal abnormality or resulting stenosis.


Instruction: Generate impression based on findings.

Input: 22-year-old woman with history of high-risk neuroblastoma, jaundice, pruritus, and increasing bilirubin levels. ABDOMEN:LIVER, BILIARY TRACT: Diffusely low parenchymal signal in the liver is noted. No focal hepatic lesion is identified.There is moderate intrahepatic biliary ductal dilatation. The peripheral common bile duct measures up to 9 mm in diameter and terminates in the hepatic hilum (401/22). Within the hepatic hilum, there is confluent soft tissue measuring approximately 65 x 37 mm. The portal vein, splenic vein, and superior mesenteric vein are also attenuated by this confluent soft tissue.No significant intra or extrahepatic biliary ductal dilatation. The gallbladder contains sludge but appears otherwise normal.SPLEEN: Diffusely low parenchymal signal is noted without focal splenic lesion.PANCREAS: 19 x 14 mm T2 hyperintense lesion in the pancreatic body (401/22). The T1 signal of the pancreas is diffusely decreased and heterogeneous suggestive of infiltrative tumor.ADRENAL GLANDS: The patient is status post left adrenalectomy. The right adrenal gland appears normal.KIDNEYS, URETERS: There is soft tissue invading the hilum of the left kidney. The right kidney appears normal.RETROPERITONEUM, LYMPH NODES: Numerous enlarged bilateral retroperitoneal lymph nodes noted.BOWEL, MESENTERY: Partially visualized small bowel and colon appear normal.BONES, SOFT TISSUES: There is abnormal heterogeneous signal throughout the pelvis and vertebral bodies.OTHER: Moderate bilateral pleural effusions are seen and there is nodularity along the pleural surfaces.

Output: 1.Confluent porta hepatis malignant lymphadenopathy resulting in moderate intrahepatic biliary ductal dilatation with occlusion of the common bile duct.2.Portal vein, SMV, and splenic vein also occluded by malignant lymphadenopathy.3.Additional findings of diffuse metastatic disease involving retroperitoneal lymph nodes, bones, and pleural surfaces.


Instruction: Generate impression based on findings.

Input: 20 years, Female, Reason: History of Crohn's, assess for small bowel inflammation History: abdominal pain. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No bowel wall thickening or dilatation. No abnormal enhancement or diffusion restriction. No abscesses or fistulaes identified.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS: FemaleUTERUS, ADNEXA: 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: No evidence of active inflammation or complications of Crohn's disease.


Instruction: Generate impression based on findings.

Input: 57-year-old male with headache. Evaluate for stroke. Foci of hypoattenuation in the left cerebellar hemisphere compatible with known infarcts seen on MRI. Periventricular hypoattenuating foci are consistent with minimal ischemic small vessel disease, age indeterminate. The cerebral and cerebellar hemispheres and the brain stem are otherwise normal morphologically and have normal CT attenuation. The ventricles are normal volume.No abnormal extra axial fluid collections, mass, intracranial hemorrhage. The calvaria and skull base are radiographically normal. Bilateral opacification of the maxillary sinuses. The mastoid air cells are normally pneumatized.There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: No acute intracranial abnormality. If there is clinical concern for an acute stroke, an MRI may be obtained.


Instruction: Generate impression based on findings.

Input: Eval growth of anaplastic astrocytoma. Pt on Avastin+CCNU. Along the posterior right superior frontal gyrus, there is increased extent and confluence of DWI hyperintensity with ADC isointensity in the location of previous focal DWI hyperintensity. This lesion measures 1.8 x 1.3 cm (series 11 image 27). There is corresponding increase in FLAIR/T2 signal and enhancement of this lesion. Questionable mild hyperperfusion conforming to the signal abnormality.There is mild residual patchy speckled enhancement remaining of the previously seen left paracentral lobule lesion. There is corresponding focal diffusion restriction appearing similar to prior study. Compared to more remote prior exams there is increase confluence of the T2/FLAIR hyperintensity in the left centrum semiovale. Compared to most recent prior exam, this region appears similar without enhancement or hyperperfusion.There is redemonstration of a small focus of enhancement with associated T2/FLAIR hyperintensity laterally adjacent to the left occipital horn, with stable post-contrast appearance, and stable to minimally progressed FLAIR abnormality. There is more conspicuous progression when compared to remote exams. It is associated with a faint susceptibility.Ill-defined gyriform enhancement along the posterior aspect of the left temporal lobe appears similar to the most recent comparison, with associated ill-defined FLAIR hyperintensity which is overall decreased immediately in the area of enhancement, although appears similar with gyral thickening as well as focal sulcal effacement just inferiorly.There are two new tiny nodular foci of enhancement seen adjacent to the left occipital periventricular and left posterior temporal lobe lesions with FLAIR abnormality, as seen on 11/15.Other scattered non-enhancing foci of FLAIR hyperintensity in the bifrontal and right parietal subcortical white matter appear unchanged, and are nonspecific. Susceptibility artifacts along the left frontal craniotomy site and left thalamus, stable from prior study. There is stable intrinsic T1 hyperintensity along the left thalamus, with subtle minimal superimposed enhancement especially along the medial left thalamus.Right ethmoid mucous retention cyst.

Output: Redemonstration of multiple scattered ill-defined enhancing lesions scattered in both cerebral hemispheres of the brain, with some findings stable, although there are others which are progressed such as in the posterior right superior frontal gyrus with mild diffusion restriction and questioned hyperperfusion, as well as a few new tiny lesions in the left temporo-occipital white matter.


Instruction: Generate impression based on findings.

Input: Status post craniectomy for resection of brain metastasis. There has been interval evolution of postoperative findings related to right parietal craniotomy for resection of a right parieto-occipital region mass. There is persistent confluent cerebral white matter T2 hyperintensity surrounding the resection cavity, which appears to communicate with the atrium of the right lateral ventricle. There is no evidence of acute intracranial hemorrhage, mass, or acute infarct. There are unchanged punctate foci of susceptibility in the cerebral white matter, which are likely treatment-related. There is unchanged encephalomalacia in the right cerebellar hemisphere. The ventricles are unchanged in size and configuration. There is an unchanged nonspecific background of scattered white matter T2 hyperintensity. There is no midline shift or herniation. There skull and scalp appear unchanged. There is a small right maxillary sinus retention cyst.

Output: Stable post-treatment findings in the right parieto-occipital lobe region without definite evidence of recurrent tumor, although the assessment is limited by the lack of contrast administration.


Instruction: Generate impression based on findings.

Input: 52-year-old male with known hepatic carcinoma now with recurrent fevers presents with right thigh pain and mass on recent CT examination. Note is made of a lobulated heterogeneous collection within the muscle belly of the biceps femoris measuring 8.7 x 4.9 x 6.7 cm (TR x AP x CC). There are foci of increased signal intensity on T1-weighted imaging consistent with blood products. Additional smaller collections are identified more superiorly within the muscle belly of the biceps femoris. There is minimal, if any, thin peripheral enhancement on postcontrast sequences. These findings are most consistent with a hematoma, however, follow-up examination is recommended to establish interval resolution/evaluate for interval change. The remainder of the imaged musculature of the right thigh demonstrates diffuse fatty infiltration. There is nonspecific subcutaneous edema about the thigh. No bone marrow signal abnormality is identified. A marker is in place along the posterior aspect of the right thigh presumably corresponding to the patient's palpable area of concern.

Output: Large heterogeneous collection within the muscle belly of the biceps femoris appearing most consistent with a hematoma, however, follow-up examination is recommended to establish resolution/evaluate for interval change.


Instruction: Generate impression based on findings.

Input: History of hepatocellular carcinoma status post TACE RFA. ABDOMEN:LIVER, BILIARY TRACT: Nodular cirrhotic liver morphology. The segment 5 ablation cavity measures 3.4 x 3.1 cm, unchanged. Intrinsic high T1 weighted signal intensity is compatible with proteinaceous/hemorrhagic debris.Just inferior to the ablation cavity there is a new conglomerate of enhancing nodules measuring up to 3.7 x 3.0 cm extending inferiorly. There are multiple additional arterially enhancing nodules in both lobes of the liver which are new and/or more conspicuous than on the prior study. These are associated with mild T2 weighted hyperintensity and restricted diffusion. No definite washout is seen of these lesions.The more central segment 5 lesion demonstrates peripheral nodular discontinuous enhancement which gradually increases centrally measuring 3.0 x 3.0 cm, compatible with a hemangioma.The hepatic vasculature is patent.Distended gallbladder without specific evidence of gallbladder inflammation.No intrahepatic or extrahepatic biliary ductal dilatation.SPLEEN: Normal splenic size with perisplenic varices.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Multiple new and more conspicuous arterial enhancing lesions in both lobes of the liver including a 3.7 x 3.0 cm conglomerate of small nodules adjacent to the ablation cavity are highly suspicious for multifocal hepatocellular carcinoma, however these do not meet imaging criteria for HCC as there is no definite washout of these arterial enhancing lesions.


Instruction: Generate impression based on findings.

Input: Weakness [R53.1] / Cerebral infarction due to unspecified occlusion or stenosis of left middle cerebral artery [I63.512], Reason for Study: ^Reason: stroke History: weakness There are restricted diffusion areas on the left frontal operculum indicating acute ischemic infarct. There is no evidence of hemorrhagic conversion.Underlying brain shows scattered high signal intensity lesions on periventricular white matter and centrum semiovale, suggesting underlying nonspecific small vessel ischemic disease.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.

Output: Acute ischemic infarct, left frontal operculum without evidence of hemorrhagic conversion.Underlying nonspecific small vessel ischemic disease, minimal to mild.