Instruction: Generate impression based on findings.

Input: 27 year old female complaining of abdominal pain with history of Crohn's disease status post two bowel resections and planned placement of Seton tube for drainage treatment of multiply recurring high-spreading extrasphincteric perianal fistula. Evaluate for perianal abscess. ABDOMEN:LUNG BASES: No pleural effusions. LIVER, BILIARY TRACT: Periportal low attenuation compatible with periportal edema was seen on the prior exam, but this has resolved. No focal liver lesions. SPLEEN: No significant abnormality notedKIDNEYS, URETERS: Bilateral hypodense lesions are too small to characterize.ADRENAL GLANDS: There is a 0.8 x 1.7 cm cystic lesion associated with the left postero-lateral adrenal limb on axial image 19/145. This was present on the prior examination and appears unchanged. If indicated, further evaluation with dedicated adrenal CT or preferably, MRI examination would be helpful to characterize this lesion.PANCREAS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Mild wall thickening of the terminal ileum and cecum identified. This is near the anastomosis. No surrounding fluid collections.BONES, SOFT TISSUES: No significant abnormality notedPELVIS:UTERUS, ADNEXA: An IUD is in place. Minimal free fluid identified within the pelvis.There is a relatively hypodense object in the right vagina / adnexa on coronal image 53/109 measuring 1.7 x 5 cm which may be a tampon or other foreign object. This appears unchanged in position and size since the prior exam. BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Minimal wall thickening of the descending colon seen on the prior exam has resolved without evidence of abscess formation. No free air or pneumatosis.In the interval since the prior examination, multiple air collections which extend posteriorly towards the sacrum and extend to the left lateral aspect of the rectum have developed. These are seen best on axial image 128/145 and coronal image 41/109. No abscess was found.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: New air collections in in presacral and left lateral aspect of the rectum have developed since the prior examination. No abscess was found. Exam is stable otherwise. Probable tampon in vagina - see above.


Instruction: Generate impression based on findings.

Input: Metastatic esophageal cancer: please assess for CNS involvement. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are numerous scattered T2 hyperintense foci within the cerebral white matter. There is no abnormal intracranial enhancement. There is mild cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is a small right sphenoid sinus retention cyst.

Output: Numerous nonspecific scattered T2 hyperintense foci within the cerebral white matter, but no evidence of intracranial metastases.


Instruction: Generate impression based on findings.

Input: 72-year-old female. Right lateral hip pain. Evaluate for possible greater trochanter tendinitis. There is mild fatty atrophy of the right gluteus minimus muscle relative to that on the left but the gluteus medius and minimus tendons appear normal. The musculature of the hip otherwise appears normal. The bone marrow signal intensity is within normal limits. Moderate osteoarthritis affects the right hip with cartilage loss particularly noticeable along the posterior superior aspect of the hip. The edge of the anterior labrum is poorly defined and has increased signal intensity likely reflecting degenerative fraying/tearing. On the large field of view images, mild osteoarthritis affects the left hip. The pubic symphysis and sacroiliac joints are normal for patient age. Degenerative disk disease affects the visualized lower lumbar spine with narrowing of the spinal canal at L4-L5.

Output: 1. Mild fatty atrophy of the right gluteus minimus muscle but no evidence of tendon pathology or peritrochanteric bursitis. 2. Degenerative arthritic changes, as described above.


Instruction: Generate impression based on findings.

Input: evaluate for c-spine injury after trauma The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. 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.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.Minor opacity is present in the sphenoid sinus which is better seen on the recent CT of the maxillofacial bones.

Output: 1.Straightening of the normal cervical curvature could be related to muscle spasm or patient positioning. It is nonspecific.2.There is no evidence for spinal cord injury.


Instruction: Generate impression based on findings.

Input: Headaches. Childhood history of craniosynostosis. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears unremarkable, and there are no areas of abnormal signal. There is no abnormal parenchymal or leptomeningeal enhancement. The midline structures and craniocervical junction are within normal limits. The ventricles and basal cisterns are normal in size and configuration. There is a cavum septum pellucidum. There is no midline shift or herniation. The major cerebral flow voids are intact. There is slight cranial asymmetry, related to a history of craniosynostosis and reconstructive surgery. The orbits and scalp soft tissues are grossly unremarkable. There are small right maxillary sinus mucus retention cysts.

Output: 1. Slight cranial asymmetry, related to a history of craniosynostosis and associated reconstructive surgery.2. No evidence of intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: 39 year-old female with painless jaundice. Rule out pancreatic mass. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Cholelithiasis without cholecystitis. Several small gallstones are present in the neck of the gallbladder. Infiltrative changes in the periportal fat and lymphadenopathy in the hepatic hilum. There is extensive periportal edema. These infiltrative findings surround the superior mesenteric artery and vein, confluence and main portal vein, possibly representing infiltrative neoplasm. The hepatic vasculature is patent. No biliary duct dilatation.SPLEEN: No significant abnormality notedPANCREAS: There is an area of ill-defined hypoenhancement in the pancreatic head seen on axial image 40/161 of series 4, which could represent a primary pancreatic neoplasm. For further evaluation with contrast-enhanced MRI and M.R.C.P. may be helpful, if indicated.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Large right upper pole simple benign cyst. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS: UTERUS, 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: Ill-defined hypodensity in pancreatic head with associated fat infiltration and lymphadenopathy in the hepatic hilum. Periportal edema. Findings may be due to pancreatic neoplasm. Cholelithiasis without cholecystitis.


Instruction: Generate impression based on findings.

Input: Numbness, pain, burning, fasciculations in the lower extremities. Evaluate for infiltrating pachymeningitis. Five lumbar type vertebral bodies are presumed to be present. Again seen is levoscoliosis of the lumbar spine with apex at the L2-L3 level. Vertebral body heights are within normal limits. Bone marrow signal is benign with T1 hyperintense focus at the T11 vertebral body compatible with focal fat or hemangioma. The conus medullaris is normal in position.Minimal degenerative changes are seen, as described below:L1-L2: Minimal disc bulge. No spinal canal or neural foraminal stenosis.L2-L3: There is a disc bulge without significant spinal canal or neural foraminal stenosis. Facet arthropathy on the right.L3-L4: Minimal disc bulge. No spinal canal or neural foraminal stenosis.L4-L5: Minimal disc bulge. No spinal canal or neural foraminal stenosis. Mild facet arthropathy and ligamentum flavum thickening.L5-S1: Minimal disc bulge eccentric to the left with mild left neural foraminal stenosis. No spinal canal or right neural foraminal stenosis. There is facet arthropathy particularly on the left and ligamentum flavum thickening.Cauda equina nerve roots in the upper lumbar spine are rightward deviated due to the levoscoliosis. No abnormal enhancement is seen involving the cauda equina nerve roots or the epidural space. Paraspinous soft tissues are within normal limits.

Output: 1. No abnormal mass or enhancement to suggest pachymeningitis as questioned.2. Moderate levoscoliosis of the lumbar spine with apex at the L2-L3 level as seen previously.3. Mild degenerative changes with mild left L5-S1 neural foraminal narrowing. No significant spinal canal or foraminal stenosis in the remainder of the lumbar spine.


Instruction: Generate impression based on findings.

Input: Reason: eval interval changes History: weakness Nonenhanced CT of brain:Examination again demonstrate large area of left frontal -- temporal craniectomy with resultant slight bulge of brain parenchyma through the bony defect. The entire left anterior temporal lobe, left inferior frontal lobe has uniformly high density compared to the rest of brain parenchyma which remains stable and is concerning for petechial hemorrhage. A follow-up with an MRI is recommended. This finding remains stable since prior exam. Subtle encephalomalacia/edema in the left basal ganglia is again noted with no change. Extra-axial fluid density at the site of craniectomy and extension posterior to the posterior edge of craniectomy is again noted. There is slight increase in the fluid collection at this site since prior exam.

Output: 1.No definitive evidence of new intracranial findings since prior study. Please see above comments.2.Slight interval increase in the extra-axial fluid collection at the craniectomy site with extension posterior to the dorsal edge of craniectomy.


Instruction: Generate impression based on findings.

Input: patient with posterior epidural fluid collection. Please aspirate sample. 61 yo female Serial CT images obtained during the aspiration procedure demonstrate the needle placement within the fluid collection. Following needle removal images obtained demonstrate no complications . Air was present in the remaining cavity.

Output: Epidural fluid collection aspiration under CT guidance.


Instruction: Generate impression based on findings.

Input: 47 year-old female with strong family history of breast cancer, personal history of breast reduction surgery There is heterogeneous amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.A few benign appearing foci are present in both breasts.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. Annual breast MRI is recommended.BIRADS: 2 - Benign finding.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Exam is limited by significant motion artifact. Within these limitations there is no definite evidence of cord compression. The vertebral body heights are maintained. There is disc space narrowing with posterior disc bulge and hypertrophy of the ligamentum flavum at C5-6. There is no definite cord signal abnormality. There is no significant spinal canal narrowing in the thoracic or lumbar spine. There is mild edema in the paraspinal soft tissues in the left lower lumbar region, of uncertain etiology.

Output: Limited study due to motion artifact. Multilevel spondylosis, with moderate spinal canal narrowing at C5-6. No definite evidence of cord compression or cord signal abnormality.


Instruction: Generate impression based on findings.

Input: Other headache syndrome [G44.89], Reason for Study: ^Reason: evaluation for worsening frontal headache x 9 months History: constant frontal headache No evidence of acute ischemic or hemorrhagic lesionThere are nonspecific T2/FLAIR high signal intensity lesions on white matter, one on the left frontal lobe superior frontal gyrus and another on the right inferior lobule of parietal lobe. The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: No evidence of acute ischemic or hemorrhagic lesion.Nonspecific T2/flair high signal intensity lesions as described above.


Instruction: Generate impression based on findings.

Input: Per EPIC, Cushing's disease secondary to ACTH-secreting microadenoma status post transsphenoidal hypophysectomy on 6/1. Fever and elevated white count. Evaluate for abscess in the sella. There are postoperative findings related to transsphenoidal hypophysectomy. There is a small rim-enhancing fluid collection at the left aspect of the sella measuring approximately 4 x 7 x 5 mm (AP x TR x CC) with prominent surrounding enhancement in the sella. There is no evidence of acute intracranial hemorrhage, mass effect, or acute infarct. There is no evidence of parenchymal abscess or empyema. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable. There are acute on chronic changes with diffuse mucosal thickening of the paranasal sinuses.

Output: 1.Please note examination was performed as a brain MRI and suboptimal for evaluation of the sella. There is however a discrete 4 x 7 x 5 mm fluid collection in the left aspect of the sella with prominent surrounding enhancement. Although some of these changes can be seen postoperatively, the possibility of abscess can not be excluded. 2.No evidence of parenchymal edema, parenchymal abscess, or extra-axial collection to suggest empyema.


Instruction: Generate impression based on findings.

Input: 59 yo male with VT Left VentricleThe left ventricle is mildly enlarged. The overall LV ejection fraction is 56%, the LV end diastolic volume index is 113 ml/m2 (normal range: 74+/-15), the LVEDV is 228 ml (normal range 142+/-34), the LV end systolic volume index is 50 ml/m2 (normal range 25+/-9), the LVESV is 100 ml (normal range 47+/-19). There are no regional wall motion abnormalities present. . There is patchy late gadolinium enhancement in the mid and basal lateral wall and basal inferolateral wall which suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process. THis pattern is not suggestive of ischemic heart disease (MI).Left AtriumThe left atrium is dilated. Right VentricleThe right ventricle is normal in size. The overall RV ejection fraction is 54%, the RV end diastolic volume index is 81 ml/m2 (normal range 82+/-16), the RVEDV is 162 ml (normal range 142+/-31), the RV end systolic volume index is 37 ml/m2 (normal range 31+/-9), and the RVESV is 74 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly dilated .Aortic ValveThe aortic valve opens widely and there is mild aortic regurgitation, but the severity of aortic regurgitation can be underestimated by the MRI pulse sequence used in this study.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation, but the severity of mitral regurgitation can be underestimated by the MRI pulse sequence used in this study.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation, but the severity of pulmonic regurgitation can be underestimated by the MRI pulse sequence used in this study.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation, but the severity of tricuspid regurgitation can be underestimated by the MRI pulse sequence used in this study.AortaThe aortic root at the level of the SOV is 4.3 cm.. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac Findings . This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Lower normal LV systolic function without evidence of infarct. 2. Patchy delayed enhancement in the lateral and info lateral wall.3. Normal RV size and function without evidence for ARVD.4. Aortic SOV 4.3 cm with mild AR


Instruction: Generate impression based on findings.

Input: There has been interval further partial glossectomy. There are unchanged post-treatment findings related to neck dissection and radiation therapy. The previously demonstrated T2 hyperintense enhancing lesion along the left dorsum of the tongue is no longer evident. Scattered small cervical lymph nodes are identified, but there is no lymphadenopathy. There is mild degenerative changes involving the lower cervical spine with disc osteophyte complexes. The remaining salivary glands and thyroid are unchanged. The orbits and imaged intracranial structures are unremarkable. There is fluid in the left mastoid air cells.

Output: 1. No definite evidence of residual locoregional tumor or significant cervical lymphadenopathy.2. Left mastoid effusion.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Male 42 years old Reason: Right knee pain History: Right knee pain Normal appearance of the right knee. The left knee also appears normal as seen on the frontal view.

Output: Normal appearance of the right knee. Please refer to MRI report 04/11/15 for additional findings.


Instruction: Generate impression based on findings.

Input: Ms. Cyrus is a 40-year-old female with a family history of breast cancer in sister (diagnosed at the age of 40) and a maternal aunt. Personal history of benign left breast MRI guided biopsy in 2014 for fibroadenomatoid change. There is heterogeneous amount of fibroglandular tissue in both breasts. Mild background parenchymal enhancement is noted bilaterally.Scattered T2 intense nonenhancing cysts are identified bilaterally. Scattered foci of enhancement are seen in both breasts, including at site of benign left breast biopsy, all of which are stable compared to prior examinations. No abnormal enhancement is seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.Stable T2 hyperintense hepatic lesion.

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


Instruction: Generate impression based on findings.

Input: 56-year-old male with pain ROTATOR CUFF: There is mild increased intermediate signal within the supraspinatus tendon suggesting tendinosis although we see no tear. Mild increased intermediate signal intensity distally in the infraspinatus suggesting tendinosis with cyst formation in the underlying bone at its insertion. There is increased signal intensity more proximally at the myotendinous junction that may represent a strain. No discrete tear is evident. The teres minor muscle and tendon appear normal.Although some fibers of the subscapularis tendon can be traced to the lesser tuberosity, there is thinning of the tendon likely reflecting chronic attritional tearing as well as what appears to be frank detachment of the inferior fibers of the tendon from the lesser tuberosity suggesting a full-thickness but incomplete tear. The subscapularis muscle is within normal limits.SUPRASPINATUS OUTLET: The acromioclavicular joint is within normal limits. There is a trace amount of fluid within the anterior aspect of the subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral alignment is within normal limits. Although no fluid signal intensity is seen entering the labrum, branching intermediate signal intensity is noted in the superior labrum suggestive of a tear that probably extends into the superior fibers of the anterior labrum.BICEPS TENDON: Signal intensity of the tendon of the long head of the biceps is within normal limits. Small amount of fluid within the sheath may simply represent extension of the glenohumeral joint.ADDITIONAL

Output: 1.Findings compatible with attritional tearing of the subscapularis tendon with a full-thickness defect of the tendon inferiorly.2.Mild tendinosis affects the supraspinatus and infraspinous tendons. Mild signal at the myotendinous junction of the infraspinatus may represent a strain.3.Findings suggestive of a superior labral tear as described above of questionable clinical significance.


Instruction: Generate impression based on findings.

Input: 40 year old man with tetralogy of Fallot referred for evaluation of RV size/ function and severity of pulmonic regurgitation. Left VentricleThe left ventricle is mildly dilated with normal systolic function. The overall LV ejection fraction is 57%, the LV end diastolic volume index is 110 ml/m2 (normal range: 74+/-15), the LVEDV is 206 ml (normal range 142+/-34), the LV end systolic volume index is 47 ml/m2 (normal range 25+/-9), the LVESV is 89 ml (normal range 47+/-19), the LV mass index is 72 g/m2 (normal range 85+/-15), and the LV mass is 136 g (normal range 164+/-36). There is mild hypokinesis of the mid inferior and inferolateral walls. There is a large patch repair of the membranous interventricular septum without evidence of residual ventricular septal defect. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is severely dilated with mild to moderately reduced systolic function. The overall RV ejection fraction is 40%, the RV end diastolic volume index is 224 ml/m2 (normal range 82+/-16), the RVEDV is 423 ml (normal range 142+/-31), the RV end systolic volume index is 135 ml/m2 (normal range 31+/-9), and the RVESV is 254 ml (normal range 54+/-17). The RVOT is aneurysmal consistent with outflow tract patch.Right AtriumThe right atrium is severely dilated.Aortic ValveThe aortic valve is trileaflet opens widely and there is mild aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is severe pulmonic valve regurgitation. The regurgitant fraction is 52% and the regurgitant volume is 80ml. Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThere is a right sided aortic arch with a mirror image brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is moderately dilated 36mm. The RPA is mild to moderately dilated (25mm) with 21ml of forward flow. The LPA is mildly narrowed (16mm) with forward flow of 23ml.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. The innominate vein travels inferior to the aortic arch before entering the SVC.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThere is evidence of ascites. Additionally, there is low signal of the liver on SSFP imaging which would suggest the presence of hepatic iron overload; however, dedicated T2-star iron imaging was not performed. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Mild LV dilation with normal systolic function (LVEF 57%) with evidence of VSD repair. There is mild hypokinesis of the mid inferior and inferolateral walls.2. Severe RV dilation with mild to moderately reduced systolic function (RVEF 40%). The RVOT is aneurysmal consistent with outflow tract repair.3. Severe right atrial dilation.4. Severe pulmonic valve regurgitation.5. The main pulmonary artery is moderately dilated. The RPA is moderately dilated and the LPA is mildly stenosed. There is equal flow to both lungs.6. Right sided aortic arch with mirror imaging and variant venous anatomy, as described above. 7. See extra-cardiac findings.


Instruction: Generate impression based on findings.

Input: History of C6-C7 disk replacement with residual left upper extremity pain There is artifact from disc prosthesis at the C6-C7 levels limiting the exam in this area. Vertebral body heights are preserved. Alignment is grossly within normal limits. Bone marrow signal is within normal limits. The visualized spinal cord is normal in signal and morphology.Level by level findings are as follows:C2-C3: No disc bulge, spinal canal stenosis, or neuroforaminal narrowing.C3-C4: No disc bulge, spinal canal stenosis, or neuroforaminal narrowing.C4-C5: Minimal disc bulge. No spinal canal or neural foraminal stenosis.C5-C6: Minimal disc bulge and mild uncovertebral joint hypertrophy. This creates minimal left neural foraminal stenosis, better seen on the oblique sequence. Right neural foramen is patent. No spinal canal stenosis.C6-C7: Evaluation significantly limited by artifact from disc prosthesis. The lateral aspect of the bilateral neural foramen are patent. No high-grade central canal stenosis.C7-T1: Small central disc protrusion. No significant neural foraminal or spinal canal stenosis.

Output: 1. Postoperative changes from placement of C6-7 disc prosthesis. Resulting susceptibility artifact markedly limits evaluation of the C6-7 level. No high-grade neural foraminal or spinal canal stenosis at this level. CT may be helpful to assess the neural foramen if clinically indicated.2. Minimal C5-6 left neural foraminal narrowing.


Instruction: Generate impression based on findings.

Input: 16-year-old male with transverse myelitis. Evaluate for cord compression. There is increased T2 signal intensity within the ventral spinal cord from C3 to C6, which appears similar in distribution when compared to the prior outside examination from 9/17/2015. The spine is otherwise unremarkable. Alignment is within normal limits. Vertebral body heights and intervertebral disc spaces are preserved. No evidence of cord compression or significant spinal canal stenosis in the cervical, thoracic and lumbar spine.

Output: 1. No evidence of acute cord compression.2. Redemonstration of ventral spinal cord signal abnormality from C3 to C6, appearing similar in distribution when compared to the prior outside examination.


Instruction: Generate impression based on findings.

Input: 58-year-old male with PSC. Evaluate for new strictures. ABDOMEN:LIVER, BILIARY TRACT: No significant intrahepatic or extrahepatic biliary duct dilation. Narrowing of the bile ducts at the confluence of the right and left hepatic ducts is similar to prior study. Mild irregularity of the mid common bile duct is also similar to prior study. No new dominant stricture. No new focal hepatic lesions.Stable nonspecific subcentimeter T2 hyperintense lesion in the anterior left hepatic lobe without suspicious enhancement, too small to characterize and possibly due to a cyst.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable right renal cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1.Stable abnormal appearance of the biliary tree, consistent with stated history of PSC. No new dominant stricture.2.No new suspicious hepatic lesions.


Instruction: Generate impression based on findings.

Input: Left ankle pain. Evaluate for AVN of the talar dome. TENDONS: The tendons are intact.LIGAMENTS: The ligaments are intact.ARTICULAR SURFACES AND BONE: Bone marrow signal is within normal limits. ADDITIONAL

Output: 1. No evidence of avascular necrosis.2. Small ankle joint effusion.


Instruction: Generate impression based on findings.

Input: 19-year-old male with left knee pain. Evaluate left knee patellar tendinitis/pain. MENISCI: The medial and lateral menisci are normal.ARTICULAR CARTILAGE AND BONE: The articular cartilage is normal. Bone marrow signal intensity is normal.LIGAMENTS: The anterior and posterior cruciate ligaments as well as the medial and lateral collateral ligaments are morphologically normal.EXTENSOR MECHANISM: The extensor mechanism is intact and morphologically normal.ADDITIONAL

Output: Unremarkable MRI examination of the knee.


Instruction: Generate impression based on findings.

Input: Female 62 years old Reason: Evaluate for HCC History: Recent TACE/RFA for residual tumor ABDOMEN:LIVER, BILIARY TRACT: The liver demonstrates cirrhotic morphology. Posttreatment changes of interval TACE/RFA with a larger cavity in segment 5 which measures approximately 3.7 x 1.2 cm (series 10, image 62). Intrinsic T1 hyperintense signal within the cavity suggests hemorrhage. There is no focal enhancement to suggest residual tumor. Previously described area of enhancement in segment 7 appears stable and again, may represent fibrosis. Patent hepatic vasculature.No new lesions are identified.SPLEEN: The spleen is measured at upper limits of normal.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1.Cirrhotic liver morphology. Status post TACE/ RFA of a segment 5 lesion without residual enhancement to suggest residual or recurrent tumor. No new lesions are identified.


Instruction: Generate impression based on findings.

Input: Abdominal pain ABDOMEN:LUNG BASES: Dependent atelectasis.LIVER, BILIARY TRACT: 8mm nonspecific hypodensity in the liver, most likely benign.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Mild hydronephrosis of the left kidney with associated perinephric fluid. Left ureter is also dilated throughout its course. Two punctate stones in the left UVJ largest measuring 4-mmRight kidney and right ureter are unremarkable.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXAE: 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: Left UVJ stones causing left-sided hydronephrosis.


Instruction: Generate impression based on findings.

Input: Non-small cell lung cancer with brain metastasis. Presurgery (biopsy) planning. Limited exam, for stereotactic guidance. The numerous areas of poorly defined T1 shortening predominantly, previously proved to be partly hemorrhagic and partly contrast enhancing, involving the cortex but also the deep brain structures have not significantly changed since the previous examination, accounting for technique differences. Some areas of associated heterogeneous T2 signal are seen with the parenchymal lesions, consistent with blood products. Scattered subtle contrast enhancement on the surface of the cerebellum in the interfolial spaces represents leptomeningeal metastatic involvement and is again unchanged. They are not associated with mass effect, midline shift or herniation. There has been no other significant changes since the previous examination on this limited.

Output: This study was obtained for surgical planning and shows no significant change when compared to the recent August 21, 2015 examination regarding the numerous parenchymal and leptomeningeal metastatic lesions.


Instruction: Generate impression based on findings.

Input: There are no abnormal masses or evidence of pathologic enhancement. The parotid and submandibular glands are normal in size and symmetric bilaterally. There are small bilateral intraparotid, submental and cervical lymph nodes, normal in morphology. The thyroid gland is unremarkable. No pathologically enlarged or necrotic lymph nodes are seen. The airway remains patent. The major cervical vessels are patent. The left vertebral artery is hypoplastic. No suspicion osseous lesions are seen. The temporomandibular joints are unremarkable within limitations of neck MRI acquisition.The imaged intracranial structures are unremarkable. There are varying degrees of central stenosis due to disc herniations at C2-3, C3-4, C4-5, and C6-7, and disc osteophyte complex at C5-6.

Output: 1.Unremarkable soft tissue neck MRI. 2.The temporomandibular joints are unremarkable within limitations of neck MRI acquisition.3.Varying degrees of central canal stenosis due to disc herniations and disc osteophyte complex.


Instruction: Generate impression based on findings.

Input: Secondary malignant neoplasm of brain [C79.31], Reason for Study: ^Reason: brain met. Preop planning for tumor resection. #6876 for fiducials History: preop planning The scan was performed with multiple fiducial markers attached. There is about 17 mm sized well but inhomogeneously enhancing intra-axial mass at the right precentral gyrus with the surrounding edema.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: Inhomogeneously enhancing intra-axial mass with the surrounding edema on the right frontal lobe precentral gyrus. Differential diagnosis including metastasis or primary high grade glioma.


Instruction: Generate impression based on findings.

Input: Female, 73 years old, with dull bilateral high pain and pressure, not typical for optic neuritis. Assess for retro-orbital mass or optic neuritis. Numerous scattered periventricular and subcortical white matter T2 hyperintensities are redemonstrated. Allowing for technical differences, there has been no significant interval change in the appearance of these lesions since the prior MRI.No evidence of restricted diffusion is seen. No parenchymal edema or mass effect is detected. No pathologic parenchymal or extra-axial enhancement is seen.There is no evidence of any significant intracranial hemorrhage. No abnormal extra-axial fluid collections are detected. Ventricles are normal in size and morphology.Dedicated orbital imaging reveals no intraorbital mass, inflammation or pathologic enhancement. The globes are round and symmetric and demonstrate normal signal characteristics. The extraocular muscles are normal and symmetric in size. The optic nerves are likewise symmetric in size morphology and free of pathologic signal abnormality and enhancement. The remainder the optic pathway is also unremarkable. Limited views of the pituitary are unremarkable in the suprasellar cistern is patent.

Output: 1.Stable examination of the brain. No acute intracranial abnormalities are detected.2.Unremarkable evaluation of the orbits with no specific findings seen to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: There is transitional lumbosacral anatomy with 6 lumbar vertebral bodies. For the purposes of this exam the last fully formed disc is L6-S1.The conus medullaris ends at the level of lower L2. The cord is of normal caliber and signal. Normal alignment of the vertebral bodies. There is no abnormal enhancement.There is a tiny dorsally projecting synovial cyst in the right L4-L5 facet. There are mild facet degenerative changes in the lower lumbar spine.In the visualized right lower lobe, there is a 4 mm nodule along the posterior pleural surface. Recommend follow-up.

Output: 1. Transitional lumbosacral anatomy with 6 lumbar vertebral bodies. For the purpose of this exam the last fully formed disc is at least L6-S1. If surgery is to be contemplated, please correlate with imaging of the entire spine.2. No evidence of intrathecal metastases.3. Nonspecific subcentimeter nodule is seen in the right lower lobe along the posterior pleural surface. Recommend follow-up CT chest for a complete evaluation.


Instruction: Generate impression based on findings.

Input: 3-year-old female with retrognathia and oligoarticular JIA with knee and ankle swelling Right temporomandibular joint: Limited study with the patient under sedation limiting ability to obtain dedicated open and closed mouth views. The meniscus of the right TMJ is appropriately situated between the mandibular condyle and the articular eminence on the closed mouth view. The meniscus remains appropriately situated between the condyle and articular eminence on the limited open mouth view. Minimal enhancement of the synovium of the TMJ may reflect a very mild synovitis although this is equivocal. No erosions or abnormal marrow signal is evident. Partial opacification of right mastoid air cells with enhancement indicating inflammation.Left temporomandibular joint: Limited study with the patient under sedation limiting ability to obtain dedicated open and closed mouth views. The meniscus of the right TMJ is appropriately situated between the mandibular condyle and the articular eminence on the closed mouth view. The meniscus remains appropriately situated between the condyle and articular eminence on the limited open mouth view. Minimal enhancement of the synovium of the TMJ may reflect a very mild synovitis although this is equivocal. No erosions or abnormal marrow signal is evident.

Output: 1.Limited examination as described above.2.Minimal enhancement of the TMJs bilaterally may reflect a very mild synovitis, but this is equivocal. No erosions or bone marrow enhancement.3.Opacification/inflammation of the right mastoid air cells.


Instruction: Generate impression based on findings.

Input: Reason: rule out renal recurrence History: hx of renal cell carcinoma sp nephrectomy ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Status post left nephrectomy. No evidence of recurrent disease in the operative bed.Stable small right renal lower pole cyst. No right hydronephrosis or suspicious lesion.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: Status post left nephrectomy without evidence of recurrent disease.


Instruction: Generate impression based on findings.

Input: Acute posttraumatic headache, not intractable. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is scattered cerebral white matter T2 hyperintensity. There may also be a posterior insular cortex punctate focus of high T2 signal versus artifact. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No evidence of acute intracranial hemorrhage, mass, or acute infarct. Scattered cerebral white matter T2 hyperintensity is nonspecific and may represent chronic small vessel ischemic disease among other possibilities. A posterior insular cortex punctate focus of high T2 signal may represent prior ischemia versus artifact.


Instruction: Generate impression based on findings.

Input: Reason: Right shoulder pain with concern for SLAP tear; History: recent football injury ROTATOR CUFF: The supraspinatus, infraspinatus, subscapularis, and teres minor tendons are intact. There is no muscular atrophy.SUPRASPINATUS OUTLET: The acromioclavicular joint appears normal. There is no fluid in the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Although we see no fluid signal intensity within the superior labrum, there is intermediate signal intensity within the anterior portion of the superior labrum that likely represents a SLAP tear. Supporting this diagnosis are small cysts adjacent to the anterior superior labrum (see image #16 of series 9). Furthermore, the superior half of the anterior labrum is separated from the underlying glenoid which we expect represents an extension of the SLAP tear but could represent a normal variant sublabral foramen. The labrum appears intact inferiorly. We see no joint effusion. The glenohumeral joint alignment is normal.BICEPS TENDON: The biceps tendon appears intact. ADDITIONAL

Output: SLAP tear and other findings as described above.


Instruction: Generate impression based on findings.

Input: 47 years Male (DOB:5/31/1968)Reason: eval for tumor History: eval for tumorPROVIDER/ATTENDING NAME: FERNANDO D GOLDENBERG FERNANDO D GOLDENBERG There is a 36x60mm axial dimension heterogeneously enhancing mass centered in the right thalamus protruding into the right lateral ventricle present. There is a central hemorrhage within the mass. There is associated mild ventriculomegaly with dilation of the temporal horns. The mass displaces the third ventricle to the left and creates midline shift with shift of the septum pellucidum 12 mm left of midline. It appears to encase the right thalamostriate vein. The body of the choroid is visually contiguous with this mass.There is gyral signal hyperintensity along the right inferior parietal lobule on FLAIR imaging associated with some minor leptomeningeal enhancement.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Large hemorrhagic mass centered in the right thalamus exophytic into the right lateral ventricle associated with ventriculomegaly. It appears to encase the right thalamostriate vein and involves right choroid plexus.2.Gyral signal abnormality centered along the right inferior parietal lobule is non-specific. It could be paraneoplastic or related to encephalitis.


Instruction: Generate impression based on findings.

Input: The intracranial internal carotid arteries are normal in course and caliber. The middle and anterior cerebral arteries are unremarkable. The vertebral arteries, basilar artery, and posterior cerebral arteries are normal in course and caliber. The bilateral posterior communicating arteries are diminutive, a normal variant. There is no evidence of flow-limiting stenosis or aneurysm.MRA NECK

Output: 1.No evidence of diffusion abnormality, intracranial hemorrhage, or mass effect.2.Mild chronic small vessel ischemic disease.3.No evidence of flow-limiting stenosis or occlusion in the head or neck.


Instruction: Generate impression based on findings.

Input: 81-year-old female with pain, swelling, and decreased range of motion. MENISCI: There is a complete radial tear through the posterior horn of the medial meniscus near its root. There is minimal medial extrusion of the body of the medial meniscus. The anterior horn appears intact. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is diffuse thinning of the articular cartilage of the patella, particularly along the medial facet, with areas of near full-thickness cartilage degeneration. There is also partial thickness degeneration of the articular cartilage of the femoral trochlea. There is moderate diffuse thinning of the articular cartilage of the medial compartment with foci of near full thickness degeneration. The articular cartilage of the lateral compartment is relatively spared. The bone marrow signal intensity is within normal limits.LIGAMENTS: The MCL is perhaps slightly thickened, proximally, which may represent an old injury, but the ligament otherwise appears normal. The ACL appears intact. The PCL appears intact. The LCL appears intact.EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Complete radial tear of the posterior horn of the medial meniscus.2. Osteoarthritis, joint effusion, and Baker's cyst.3. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Clinical question: Stroke. Signs and symptoms: Right-sided weakness. Nonenhanced CT of brain:Subacute nonhemorrhagic right cerebellar and right medullary region in the distribution of right pica stroke is again identified. There is only subtle mass effect with effacement of sulci and no evidence of mass effect on the fourth ventricle.Well demarcated nonhemorrhagic lacunar infarct of right thalamus as was noted on prior MRI exam.Small vessel disease of indeterminate age is subcortical white matter of bilateral cerebral hemispheres (left greater than right). Overall this appearance also is similar to prior MRI examination. No evidence of hemorrhage.CTA of the cervical region:Right carotid, circumferential plaque at the origin of right internal carotid artery with no hemodynamically significant stenosis is noted. The right common carotid artery including its origin and the rest of the cervical portion of right internal carotid artery is unremarkable.Left carotid, circumferential complex plaque at the origin of left internal right artery with no minimal calcification is noted. This results in significant high-grade stenosis of left internal carotid artery at this site. The left common carotid artery and including its origin and the rest of the cervical portion of the left internal carotid artery is unremarkable and widely patent.Right vertebral artery is small in caliber and is believed to represent a non-dominant vertebral (and normal anatomical variation). There is no evidence of a stenotic lesion.Left vertebral artery, there is a non-calcific circumferential plaque at the origin of the dominant the left vertebral artery is noted. There appears to be more than 50% stenosis at this site. The rest of left vertebral artery is unremarkable.Limited view of lower tic origin the origin of major vessels are essentially unremarkable.CTA of intracranial circulation:Carotid system, patent bilateral supraclinoid internal carotid arteries. Minimal atherosclerotic irregularities noted.Middle cerebral arteries and their branches demonstrate mild atherosclerotic disease however but no evidence of any large vessel vascular occlusion or high-grade stenosis.Bilateral anterior cerebral arteries demonstrate multiple foci of high-grade stenosis and ectatic changes. Findings are secondary to atherosclerotic disease. Vertebral basilar system, diffuse atherosclerotic disease of the basilar artery with multi-level areas of mild vascular lumen compromise. Similar findings are noted in the intracranial component of dominant left vertebral artery in particular in its distal component.The right vertebral artery is the nondominant vessel. There is discontinuity of the distal component of the right vertebral artery. This represents occlusion of this vessel proximal to its junction with the basilar artery. The very distal portion of right vertebral artery is visualized and shows significant decrease in its caliber to its patent more proximal component.

Output: 1.Revisualization of multiple small vessel strokes, lacunar strokes and a right cerebellar -- medullary stroke in the distribution of right pica branch. No evidence of hemorrhagic transformation.2.Atherosclerotic plaque with minimal calcification however no hemodynamically significant stenosis at the origin of right internal carotid origin.3.Significant atherosclerotic disease of the left internal carotid artery origin with very high-grade stenoses.4.More than 50% stenosis at the origin of the dominant left vertebral artery and otherwise unremarkable vertebral arteries bilaterally in the neck.5.Atherosclerotic disease of supraclinoid internal carotid arteries, bilateral middle cerebral arteries with areas of mild to moderate vascular compromise. Atherosclerotic disease results in high-grade stenosis and ectatic changes of bilateral anterior cerebral arteries.6.Patent dominant left vertebral artery intracranially with minimal atherosclerotic disease.7.Patent basilar artery however but extensive atherosclerotic disease and mild vascular lumen compromise.8.Complete occlusion of the mid section of the intracranial component of the nondominant right vertebral artery. There is significant decrease in the caliber of visualized very distal right vertebral artery compared to patent a proximal component. If further evaluation is required for management a conventional angiogram would improve detection and the cause of occlusion and morphology of this vessel evaluation.


Instruction: Generate impression based on findings.

Input: Left arm weakness, chronic basilar invagination with dens extending through the foramen magnum seen on CT head Redemonstration of minimal dens protrusion into the foramen magnum without adjacent cervicomedullary junction signal abnormality. There is developmental narrowing of the cervical spinal canal. Diffuse T1 and T2 hyperintensity of the clivus and vertebrae, compatible with radiation changes.Spinal cord is without evidence of cord signal abnormality. No intraspinal hematoma. Alignment is anatomic. Preservation of cervical lordosis. Multilevel diffuse moderate disc height loss. Vertebral body heights are preserved.C1/2: No significant spinal canal stenosis or foraminal narrowing.C2/3: Ligamentum flavum thickening without significant spinal canal stenosis or foraminal narrowing.C3/4: Small posterior disc osteophyte complex. Uncovertebral hypertrophy, right greater than left. Endplate degenerative changes. Mild spinal canal stenosis. Moderate right and mild left foraminal narrowing. C4/5: Trace diffuse disc bulge. Ligamentum flavum thickening with right greater than uncovertebral arthropathy. Mild to moderate stenosis of the spinal canal. Moderate right foraminal narrowing. Mild left foraminal narrowing.C5/6: Trace disc bulge. Ligamentum flavum thickening with right uncovertebral arthropathy. Moderate stenosis of the spinal canal. Moderate to severe right foraminal narrowing.C6/7: Trace disc bulge with superimposed right paracentral shallow disc protrusion. Ligamentum flavum thickening with right uncovertebral arthropathy. Moderate stenosis of the spinal canal.C7/T1: Mild ligamentum flavum thickening with mild disc bulge. Mild stenosis of the spinal canal. Mild left foraminal narrowing.

Output: 1.Redemonstration of minimal dens protrusion into the foramen magnum without adjacent cervicomedullary junction signal abnormality. 2.Developmental narrowing of the spinal canal. Degenerative joint disease of the cervical spine most the thickened at C5/6 level, with moderate central spinal canal stenosis and moderate-severe right foraminal narrowing. Additional moderate central spinal canal stenosis at C4-C5 and C6-C7.


Instruction: Generate impression based on findings.

Input: Reason: ? Scaphoid fracture History: snuff box pain 3 weeks after injury LIGAMENTS: Given the limitations of a non-arthrogram study, the scapholunate and lunotriquetral ligaments are intact. TRIANGULAR FIBROCARTILAGE COMPLEX: Also given the limitations of a non-arthrogram study, there appears to be a small perforation in the articular disc of the triangle fibrocartilage complex, just medial to the radial attachment.TENDONS: There is slight increased signal intensity within the extensor carpi ulnaris tendon which suggests mild tendinosis. BONES: There is edema in the distal radius, with band-like T1 signal hypointensity contacting the articular surface, which is compatible with a comminuted, but nondisplaced fracture with intra-articular extension. There is a well-circumscribed subchondral cyst in the capitate, likely degenerative. Additional degenerative cysts are seen in the triquetrum. The scaphoid is normal.ADDITIONAL

Output: 1.Comminuted, intra-articular, but nondisplaced fracture of the distal radius.2.Small tear of the triangular fibrocartilage complex, and other findings as above.


Instruction: Generate impression based on findings.

Input: 77-year-old male with soft tissue infection of the right foot, ulceration of the right first toe and elevated CRP. Evaluate for osteomyelitis. There is increased bone marrow signal abnormality on fluid sensitive sequences within the distal phalanx of the great toe which is associated with decreased bone marrow signal abnormality on T1-weighted images. There is increased signal abnormality on fluid sensitive sequences within the soft tissues along the dorsal aspect of the IP joint/nailbed of the great toe which extends from the skin surface to the level of the distal phalanx, consistent with the stated history of ulceration. There is diffuse increased signal abnormality within the plantar musculature of the midfoot which enhances on post contrast sequences may represent inflammatory changes related to infection, although no definite fluid collection is identified to suggest abscess formation.

Output: Findings consistent with osteomyelitis of the distal phalanx of the great toe. Other findings as described above.


Instruction: Generate impression based on findings.

Input: 30-year-old female with vaginal bleeding. Evaluate for AVM, which was suspected on recent pelvic ultrasound. PELVIS:UTERUS, ADNEXA: New 2.2 x 1.6 cm dark T2 signal lesion in the left uterine fundus with round and curvilinear morphology in a somewhat serpiginous appearance, suspicious for vascular flow voids. The lesion is centered within the myometrium with probable subendometrial extension. Lesion demonstrates avid arterial enhancement. Overall, findings are suspicious for arteriovenous malformation. Contrast opacification of the right gonadal vein on arterial phase images raises the question of venous shunting. There is a small amount of low T2, high T1 signal hemorrhage in the adjacent endometrial canal within the fundus. No suspicious adnexal masses.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Findings suspicious for arteriovenous malformation within the left uterine fundus, as detailed above. Additional considerations for enhancing uterine mass, such as retained products of conception, are considered less likely given the T2 appearance of the lesion. These findings should be correlated with recent pelvic ultrasound.


Instruction: Generate impression based on findings.

Input: Redemonstrated is enlargement and enhancement of a mass within the tectal plate, exerting mass effect upon the adjacent aqueduct. The lateral and third ventricles are enlarged, unchanged. A right frontal approach ventriculostomy catheter is again noted, however its tip now lies along the lateral aspect of the right frontal horn, previously medially. Fluid seen about the shunt reservoir suggests interval manipulation or revision. Pneumocephalus demonstrated on the prior exam from procedure has resolved. There is now right holohemispheric subdural fluid of CSF intensity which measures up to 11 mm in maximal depth, exerting some mild flattening of adjacent gyri. New sinuses and mastoid air cells are clear. Expected vascular flow voids are demonstrated.

Output: 1.Redemonstrated is enlargement and enhancement of a mass within the tectal plate, exerting mass effect upon the adjacent aqueduct. 2.The lateral and third ventricles are enlarged, unchanged. A right frontal approach ventriculostomy catheter is again noted, however its tip now lies along the lateral aspect of the right frontal horn, previously medially. Fluid seen about the shunt reservoir suggests interval manipulation or revision. 3.There is now right holohemispheric subdural fluid of CSF intensity which measures up to 11 mm in maximal depth, exerting some mild flattening of adjacent gyri.


Instruction: Generate impression based on findings.

Input: No. New onset of aphasia. Rule out bleed or mass. Examination demonstrates a mass within the posterior fossa with minimal amount of hemorrhage or calcification. There is surrounding vasogenic edema and mass effect on the fourth ventricle and minimally on the quadrigeminal plate. No evidence of hydrocephalus is detected. Further follow-up with an MRI examination is recommended. The mass measures approximately 26.2 mm x 41.This examination is otherwise unremarkable.

Output: Mass within the left cerebellum with minimal possible hemorrhage or calcification. Further follow-up with an MRI is recommended.


Instruction: Generate impression based on findings.

Input: There are postoperative findings related to L3-L4 laminectomies and posterior spinal fusion at L2-L5 utilizing bilateral pedicle screws and stabilizing rods with posterior paraspinal fluid collection. There is evidence of L2-L5 kyphoplasty. Susceptibility artifact from metallic hardware and lack of intravenous contrast limits evaluation. There is mild anterolisthesis of L4 on L5. The vertebral bone marrow signal is heterogeneous with multiple lesions throughout the imaged axial skeleton. There is mild anterior wedge deformity of the T11 vertebra without significant retropulsion. There is loss of vertebral body heights at T12 through L5 vertebral bodies with posterior retropulsion with epidural tumor extension. There is moderate loss of disc height at T11-12, with mild loss of disc height at the remaining lumbar levels. There is a left prevertebral mass anterior to L3-L5, centered at L4, measuring approximately 2.2 x 5.0 x 9.0 cm (AP x TR x CC), previously 1.4 x 4.7 x 6.8 cm. The distal spinal cord and conus are within normal limits with the conus terminating at the L1 level. There is a mass arising from the right iliac wing, measuring up to 5.7 cm in AP dimension (5.5 cm on 3/31/2015 and 4.4 cm on 3/13/2015), which is partially imaged. Incidentally noted is mildly prominent common bile duct measuring up to 1.4 cm. Please correlate for cholecystectomy. A 5 cm wide T2 hyperintense lesion in the right kidney, likely represents a cyst, but is incompletely characterized. The bladder is distended.T12-L1: Approximately 25% loss of vertebral body height at T12 with slightly progressed retropulsion compared to 3/13/2015, but similar compared to 3/31/2015, contributing to mild spinal canal stenosis. Small central disc protrusion. No significant neural foramen stenosis. L1-L2: Approximately 25% loss of vertebral body height at L1 with progression of retropulsion compared to 3/13/2015, but similar compared to 3/31/2015, bilateral facet degeneration, and thickening of the ligamentum flavum, contributing to mild spinal canal stenosis and mild left neural foramen stenosis. L2-L3: Approximately 25% loss of vertebral body height at L2 with progression of retropulsion compared to 3/13/2015, but similar compared to 3/31/2015, disc bulge, bilateral facet degeneration, and thickening of the ligamentum flavum, contributing to moderate spinal canal stenosis and moderate right and mild left neural foramen stenosis. L3-L4: Status post laminectomy. Approximately 25% loss of vertebral body height at L3 with retropulsion, disc bulge, bilateral facet degeneration, and thickening of the ligamentum flavum, contributing to severe spinal canal stenosis and moderate bilateral neural foramen stenosis. L4-L5: Status post laminectomy. Approximately 25% loss of vertebral body height at L4 with retropulsion, disc bulge, bilateral facet degeneration, and thickening of the ligamentum flavum, contributing to severe spinal canal stenosis and moderate bilateral neural foramen stenosis. L5-S1: Disc bulge, bilateral facet degeneration, and thickening of the ligamentum flavum, contributing to mild spinal canal stenosis and mild to moderate bilateral neural foramen stenosis.

Output: 1. Status post posterior spinal fusion at L2-L5 with L3-L4 laminectomies.2. Extensive tumor burden involving the imaged axial skeleton with pathologic fractures and retropulsion with epidural tumor extension involving the T12 through L4 vertebral bodies, most prominent at L3-L4 and L4-5 with severe spinal canal stenosis, and variable degrees of multilevel neural foramen stenosis. The degree of retropulsion and spinal stenosis is slightly progressed compared to 3/13/2015, but similar to 3/31/2015.3. A 5.6 cm right iliac wing mass with progression in size compared to 3/13/2015 is compatible with the known leiomyosarcoma deposit.  Important findings conveyed to Dr. Zimmerman through EPIC mail on 4/9/2015 at the time of dictation.


Instruction: Generate impression based on findings.

Input: Female, 60 years old, with migraine. A single small focus of juxtacortical T2 hyperintensity is seen within the right parietal operculum, a nonspecific finding. No other definite or significant signal abnormality, edema or mass effect is seen. No restricted diffusion is evident. There are no enhancing lesions identified. No findings to suggest acute intracranial hemorrhage or any abnormal extra axial fluid collection are observed. The dural venous sinuses and deep venous structures demonstrate normal caliber and morphology. No venous sinus thrombosis is detected.

Output: No significant abnormality of the brain or dural venous sinuses is seen. No other specific findings are noted to account for the patient's migraines.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for stroke. Signs and symptoms: Left-sided weakness, left facial droop. Nonenhanced CT of brain:No evidence of intracranial hemorrhage, edema, mass-effect, midline shift or hydrocephalus.Paucity of cortical sulci is within normal for patient stated age. Ventricular system, CSF cisterns and gray -- white matter differentiation remains within normal.Considering provided clinical data recommend further follow-up with an MRI examination since subtle findings of early acute stroke can be missed on non-infused head CT.Calvarium is intact.Visualized mastoid air cells and paranasal sinuses demonstrate extensive opacification.

Output: 1.No evidence of acute intracranial findings. Considering provided clinical data follow-up with an MRI is recommended to exclude early onset of acute stroke.2.Unremarkable CT examination of brain without contrast.3.Extensive opacification of visualized paranasal sinuses and mastoid air cells.


Instruction: Generate impression based on findings.

Input: History of Crohn's disease with indeterminate liver mass seen on prior CT. MR for further evaluation. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology. No focal hepatic lesion. At the site of the questionable left lobe lesion, there is no signal abnormality and this may have represented volume averaging on the prior CT. There is mild dilatation of multiple right intrahepatic bile ducts, but no obstructing lesion is evident. There is also a questionable filling defect in the distal common bile duct (series 701 image 22) which may represent a stone or debris. The gallbladder is unremarkable.SPLEEN: The spleen is upper limit of normal in size. There are multiple focal lesions in the spleen the largest of which measures 2.7 x 2.6 cm. These have increased T2 signal, do not restricted diffusion, and do not demonstrate enhancement on the postcontrast images. The smaller lesions appear to have thin internal septations or central dots.PANCREAS: Mild parenchymal atrophy. The main pancreatic duct is nondilated.ADRENAL GLANDS: 12 mm right adrenal nodule which demonstrates dropout on the out of phase images compatible with an adenoma.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No focal hepatic lesion at the site of clinical interest in the left hepatic lobe. Appearance on prior CT may have reflected volume averaging at the porta hepatis.2.Stable mild right intrahepatic ductal dilatation without obvious obstructing lesion. There is an apparent filling defect in the distal common bile duct which may represent debris or a small stone. This can be further evaluated with MRCP or ERCP as clinically warranted.3.Right adrenal adenoma.4.Multiple splenic lesions with benign imaging features, possibly cysts. These can be followed as clinically warranted.


Instruction: Generate impression based on findings.

Input: Other amnesia [R41.3], Reason for Study: ^Reason: r/o mets History: problems with memory No evidence of acute ischemic or hemorrhagic lesion.Underlying brain shows multiple scattered high signal intensity lesions on bilateral periventricular white matter on FLAIR images indicating non specific small vessel ischemic disease.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses are clear.Partial opacifications on bilateral mastoid air cells.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion. No abnormal enhancement.2. Non specific small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: Reason: ?cervical radiculopathy History: pain in axilla and shoulder. Per technologist note patient has right-sided neck pain radiating down the right shoulder and arm. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained. Bone marrow signal is within normal limits. The cervical spinal cord has normal signal characteristics and overall morphology.Degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: Minimal disc bulge. No significant compromise to the spinal canal or neural foramina.C4-5: Mild disc bulge and mild right-sided uncovertebral hypertrophy. No significant compromise to the spinal canal or neural foramina.C5-6: Small disc osteophyte complex with right greater than left uncovertebral hypertrophy. There is no significant spinal canal stenosis. There is mild to moderate right neural foraminal stenosis. No significant left neural foraminal narrowing. C6-7: Small central disc extrusion without significant narrowing of the spinal canal. There is possible small amount of disc material in the right neural foramen, as seen on sagittal oblique sequence series 9 image 5 of 11. There is uncovertebral hypertrophy on the right. There is mild to moderate neural foraminal stenosis at this level. No significant left neural foraminal narrowing.C7-T1: No significant compromise to the spinal canal or right neural foramen. Mild left neural foraminal narrowing.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits. Secretions noted within the trachea. Partial opacification of the right mastoid air cells also noted.

Output: 1. Multilevel degenerative changes in the cervical spine. There is mild to moderate right C5-C6 and right C6-C7 neural foraminal stenosis which may be affecting the C6 and C7 nerve roots. Please see details above. 2. No significant spinal canal stenosis in the cervical spine.


Instruction: Generate impression based on findings.

Input: Male 69 years old Reason: evaluate lateral meniscus History: lateral joint line pain, locking MENISCI: The lateral meniscus is intact. The anterior horn of the medial meniscus is extruded anteriorly. The remainder of the medial meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is marked cartilage loss about the medial femoral condyle. The remainder of the articular cartilage is intact. There is T2 hyperintense edema type signal about the lateral femoral condyle.LIGAMENTS: Cruciate ligaments are intact. MCL is intact. There is T2 hyperintense signal about the lateral collateral ligament complex which may represent mild strain, with no frank tear. EXTENSOR MECHANISM: Extensor mechanism is intact.ADDITIONAL

Output: 1.Lateral femoral condyle bone edema. 2.Small to moderate joint effusion, and inflammation in the lateral soft tissues of the knee. 3.Anterior extrusion of the anterior horn of the medial meniscus.


Instruction: Generate impression based on findings.

Input: 53-year-old female status post anterior exenteration, RPLND, neobladder ABDOMEN:LIVER, BILIARY TRACT: Unchanged subcentimeter hepatic cysts. No new suspicious lesions or pathologic enhancement. Cholelithiasis without evidence of cholecystitis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left midpole subcentimeter renal cyst is unchanged. RETROPERITONEUM, LYMPH NODES: No abdominal lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Tarlov cysts are noted in the spine.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: Postsurgical appearance of cystectomy with neobladder creation.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No specific evidence of recurrent or metastatic disease.2.Cholelithiasis without MR evidence of cholecystitis.


Instruction: Generate impression based on findings.

Input: Clinical question: 26-year-old female with unilateral headache, worsening and increasing photophobia/blind spots. Signs and symptoms: As above. Pre- and post enhanced brain MRI:No diffusion-weighted abnormalities.Examination demonstrate normal anatomical morphology of the brain with normal signal intensity on all MRI sequences.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and grade-white matter differentiation/brain myelination.Negative post enhanced images for any detectable abnormal enhancement of brain parenchyma, leptomeninges, calvarium or the retro-orbital spaces.Normal visualization of signal void of major intracranial arterial branches.All paranasal sinuses and bilateral mastoid air cells and middle ear cavities demonstrate normal pneumatization signal patterns.

Output: Negative pre and post enhanced brain MRI.


Instruction: Generate impression based on findings.

Input: Headaches The signal intensity of the brain parenchyma is normal. There is no evidence of acute intracranial hemorrhage, extra-axial fluid collections, or diffusion abnormality. There is no mass, mass effect, or midline shift. The midline structures are normal. The cerebellar tonsils are normal in position. The ventricles and sulci are normal in size. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain.

Output: Unremarkable MRI brain with no specific findings to account for the patient's headaches.


Instruction: Generate impression based on findings.

Input: 32-year-old female with pain following a fall, area in the right calcaneus concerning for lipoma on x-ray. TENDONS: The Achilles' tendon is intact. The anterior, peroneal, and medial tendons are intact. There is a small amount of fluid along the distal tibialis posterior tendon which may not be of any clinical significance.LIGAMENTS: The anterior and posterior talofibular ligaments appear intact. The calcaneofibular ligament appears slightly thickened which could conceivably represent a mild sprain but we suspect this is not of current clinical significance as there is no adjacent edema. The distal tibiofibular syndesmotic ligaments and the deltoid ligament complex appear intact.ARTICULAR SURFACES AND BONE: A heterogeneous lesion in the anterior aspect of the body of the calcaneus containing fat is consistent with an intraosseous lipoma. Additional nonadipose contents are seen within lipoma but overall this has the appearance of a benign lesion of no significance.Edema within the head, neck, and body of the talus most conspicuous in the lateral aspect of the head of the talus with there is suggestion of a linear component may represent a nondisplaced fracture, but this is equivocal. Edema is also concentrated along the medial aspect of the posterior process of the talus but we see no discrete fracture. Mild edema is also noted in the medial aspect of the tibial plafond, navicular tuberosity, medial calcaneus, cuboid, and medial aspect of the fifth metatarsal base without fracture evident.ADDITIONAL

Output: 1.Intraosseous lipoma of the calcaneus as described above.2.Multiple foci of marrow edema may reflect bone contusions with a possible nondisplaced fracture of the inferolateral head of the talus.


Instruction: Generate impression based on findings.

Input: Small paraaortic mass seen on prior chest CT. Further characterization. Again seen is a well-defined left paraortic lesion localized in the left retrocrural space at the level of T12 which is stable in size and morphology compared to the prior chest CT. Reference measurements are provided below. The lesion has well-defined countors and is in close proximity to the paravertebral neurovascular bundles. It demonstrates slightly hyperintense signal on T2-weighted imaging with mild restricted diffusion and heterogeneous, predominantly peripheral enhancement on the arterial phase which washes out on the delayed phases acquired. Preserved fat planes between the lesion and the adjacent descending thoracic aorta, left diaphragmatic crura and adjacent vertebral body. No signs of local invasion.No additional lesions are identified.The visualized portions of the mediastinum, pleura, lungs and chest wall are within normal limits, considering limitations of technique.INDEX LESION MEASUREMENTS (Current exam date/time: 11/4/2016 10:00:00)LEFT PARA-AORTIC LESION: 1.7 x 0.9 cm (Image 4, Series 401); 1.9 x 1.0 cm on prior (8/3/2016) (Image 61, Series 3).

Output: Stable small left paraortic mass which demonstrates imaging features suggestive of a small peripheral neurogenic tumor such as schwannoma, neurofibroma or paraganglioma. No evidence of local invasion or aggressive features at this point of time. In the absence of comparison images and indeterminate nature of this lesion, consider imaging follow-up (Spine MRI) to ensure stability.


Instruction: Generate impression based on findings.

Input: Diagnosis: Other disturbances of skin sensation. Other symptoms and signs involving the musculoskeletal system HyperesthesiaClinical question: Evaluate for new acute or subacute stroke.Signs and Symptoms: Sudden onset of left facial and shoulder numbness, left arm weakness and hyperesthesia left face and arm. There is a mild to moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. These are stable since the prior examThere is a moderate degree of punctate hyperintense lesions within the brainstem, thalami, basal ganglia and deep cerebellar structures on the FLAIR and T2 images. There are a few more on this exam compared to the prior.There are multiple punctate SWI hypointense foci in the pons, thalami, basal ganglia and hippocampi which have accumulated further since the prior exam.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 left eye lens is thin.

Output: 1.Multiple microhemorrhages within the basal ganglia, medial temporal lobes, thalami and brainstem have mildly increased since the prior exam. The pattern suggest hypertension related microhemorrhages.2.Multiple lesions in the brainstem, thalami and basal ganglia have slightly increased since the prior exam. At this age they are most likely vascular related. 3.Periventricular and subcortical white matter lesions of a mild to moderate degree are nonspecific. At this age they are most likely vascular related. 4.No evidence for acute ischemic cerebral infarction.


Instruction: Generate impression based on findings.

Input: Recent partial resection of a pituitary tumor. There are recent postoperative findings related to left frontal craniotomy for debulking of a sellar and suprasellar mass, which is unchanged in size overall. There is high T2 and intermediate to high T1 signal hemorrhage surrounding and primarily within the remaining suprasellar portion of the tumor, which appears similar in extent as on the recent CT, accounting for differences in technique. There is extensive confluent vasogenic edema and up to 15 mm of midline shift to the right. Apparent restricted diffusion along the surgical margins is likely attributable to the underlying susceptibility effect from hemorrhage rather than actual ischemia. The ventricular system appears unchanged, with partial effacement of the left lateral ventricle and mild dilatation of the right lateral ventricle. The skull, with a markedly expanded sella appears unchanged. The left subgaleal fluid collection appears to be slightly larger, measuring up to 20 mm in thickness, previously 15 mm.

Output: 1. Recent postoperative findings related to left frontal craniotomy for debulking of a sellar and suprasellar mass, which is unchanged in size. Likewise, the acute hemorrhage surrounding and primarily within the remaining suprasellar portion of the tumor appears to be similar in extent as on the recent CT, accounting for differences in technique. 2. Unchanged vasogenic edema and up to 15 mm of midline shift to the right. 3. The ventricular system appears unchanged.4. The left subgaleal fluid collection appears to have increased in size.


Instruction: Generate impression based on findings.

Input: 23-year-old male with pain and giving way. Presents with meniscus injury. MENISCI: There is a bucket-handle tear or inner margin tear of the medial meniscus with an apparent meniscal fragment displaced posteriorly, near the medial femoral condyle. There is linear increased signal abnormality within the body of the lateral meniscus which extends to the tibial and femoral articular surface consistent with a complex tear. The anterior and posterior horn appear intact.ARTICULAR CARTILAGE AND BONE: There is focal full-thickness articular cartilage degeneration along the weightbearing surface of the lateral femoral condyle with underlying subchondral signal abnormality. There is also focal full-thickness articular cartilage degeneration along the posterior aspect of the lateral tibial plateau and medial tibial plateau with underlying subchondral signal abnormality. LIGAMENTS: There is complete disruption of the ACL. There is no increased signal abnormality on fluid sensitive sequences suggesting that this may be chronic in etiology. The PCL appears intact. The MCL and LCL appear intact.EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Chronic appearing disruption of the ACL. 2. Complex tear of the lateral meniscus and bucket handle tear of the medial meniscus as described above.3. Full thickness articular cartilage degeneration as described above.


Instruction: Generate impression based on findings.

Input: Female, 62 years old, with low back pain and history of breast cancer. Evaluate for lesions. Spinal alignment is anatomic. Vertebral body height is preserved. Extensive disc degeneration is seen at L5-S1 with endplate irregularity, edema and enhancement. No associated fluid collection or paraspinal inflammation is seen. Elsewhere, no pathologic marrow replacement or enhancement is seen.The visualized distal spinal cord and conus are within normal limits. No pathologic intrathecal enhancement is seen. No epidural abnormalities are suspected.T12-L1: Disc bulging and a tiny right paracentral protrusion. No spinal canal or foraminal stenosis.L1-2: Small right foraminal disc protrusion. No significant spinal canal stenosis. Minimal right foraminal narrowing. L2-3: Facet arthropathy and ligamentum flavum thickening. Minimal disc bulging. No significant spinal canal stenosis. Mild bilateral foraminal narrowing. L3-4: Facet arthropathy and ligamentum flavum thickening. Minimal disc bulging. No significant spinal canal stenosis. Mild right foraminal narrowing. L4-5: Facet arthropathy and ligamentum flavum thickening. Bulging disc. No significant spinal canal stenosis. Mild right foraminal narrowing. L5-S1: Facet arthropathy. Bulging disc. Effacement of the ventral thecal sac but no significant generalized spinal canal stenosis. Moderate right and mild left foraminal narrowing. A prominent perineural root sleeve cyst is seen along the left S2 foramen.

Output: 1.Severe disc degeneration at L5-S1 with evidence of edema and inflammation. Lack of associated fluid collections and paraspinal edema suggest that this is most likely purely degenerative in nature. Correlation with clinical and laboratory findings is suggested to further exclude the possibility of infection.2.Less significant degenerative findings are seen at additional levels with no areas of high-grade spinal canal stenosis.3.No evidence to suggest osseous metastatic disease.


Instruction: Generate impression based on findings.

Input: Reason: Chugai IRB- 14-0593 History: R/O PML prior to study The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and to a greater degree subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Additionally there is a lesion present within the corpus callosum. Compared to the prior exam these remain stable.No abnormally enhancing lesions are appreciated within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: There is redemonstration and no change in the subcortical, periventricular and corpus callosum white matter lesions. These are nonspecific but could be related to a demyelinating process.


Instruction: Generate impression based on findings.

Input: Female 44 years old Reason: 44yo female with evidence of quiescent Crohn's in cecum/ileocecal valve with continue diarrhea and abdominal pain. Evaluate for small bowel Crohn's disease History: diarrhea and abdominal pain ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. No suspicious hepatic lesions. Hepatic and portal veins are patent. Signal loss on out of phase imaging compatible with fatty infiltration.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: Small bowel is normal in caliber and course. The terminal ileum is normal in caliber. The ileocecal valve is patent. No surrounding inflammatory changes or evidence for hyperemia.There is a focal segment of narrowing involving the sigmoid colon measuring 2.5 cm.There are additional segments distal to this that are collapsed but show mucosal hyperenhancement.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Status post hysterectomy.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Please see aboveBONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No evidence of stricture or inflammation involving the terminal ileum..2.Findings of narrowing and mucosal enhancement within the sigmoid colon.


Instruction: Generate impression based on findings.

Input: Unspecified visual disturbance [H53.9], Reason for Study: ^Reason: s/p OLT in October, admitted with thrombocytopenia. Now with vision changes. MRI w/ recommended by neuro consult service History: as above No evidence of acute ischemic or hemorrhagic lesion.Multiple scattered high signal intensity nodular lesions on bilateral periventricular white matter indicate nonspecific small vessel ischemic disease, slightly more prominent on today's scan but grossly no significant interval change since prior scan.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: No evidence of acute ischemic or hemorrhagic lesion.No abnormal contrast enhancing lesion.Nonspecific small vessel ischemic disease, no change since prior scan.


Instruction: Generate impression based on findings.

Input: Male, 19 years old, with history of cerebral cavernous malformation status post resection. Surveillance imaging. Evidence of a left temporal surgical resection is again seen. An obliquely oriented resection cavity traverses the anterior temporal lobe showing interval decrease in size. Encephalomalacia of the surrounding anterior temporal gyri is also seen.Thickening of the left the medulla is again seen with susceptibility effect at the uncus. Ill-defined enhancement on a background of mild intrinsic T1 hyperintensity is also seen centered on the uncus.No new intracranial lesions are detected. No areas of significant parenchymal edema or mass effect are seen. The ventricles remain normal in size and morphology.

Output: Postoperative findings are redemonstrated within the anterior left temporal lobe. Areas of associated parenchymal signal abnormality have not significantly changed from the prior exam. No new intracranial lesions are seen.


Instruction: Generate impression based on findings.

Input: Reason: disc herniation, stenosis History: lowe back pain radiating into both legs R >L 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 bilateral facet hypertrophy present at this level. There is disk desiccation at this level.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is a diffuse disk bulge and disk dessication present at this level associated with bilateral facet and ligamentum flavum hypertrophy. The fat at the lateral recesses is not effaced. The fat surrounding the exiting nerve roots within the neural foramina is not effaced. Overall there is a mild degree of spinal stenosis present 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.There are degenerative changes present in the lower lumbar spine without significant compromise to the spinal canal or exiting nerve roots. There is only mild spinal stenosis at L4-5.


Instruction: Generate impression based on findings.

Input: Male, 56 years old, with testes cancer and worsening multifocal back pain associated with left leg weakness. Cervical:Alignment is anatomic. Vertebral body height and morphology are within normal limits. No concerning marrow replacement or edema is seen. The visualized spinal cord demonstrates normal signal intensity and morphology throughout. No epidural abnormalities are suspected.C2-3: Unremarkable. C3-4: Minimal posterior disc-osteophyte complex formation. No significant spinal canal stenosis or neuroforaminal narrowing. C4-5: Unremarkable. C5-6: Minimal posterior disc-osteophyte complex formation. No significant spinal canal stenosis or neuroforaminal narrowing. C6-7: Unremarkable. C7-T1: Unremarkable. Thoracic:Alignment is anatomic. Vertebral body heights are preserved. A focus of T1/T2 hyperintense, STIR suppressing signal within the T7 vertebral body likely represents a benign hemangioma. Diffuse T1/T2 hyperintense, STIR suppressing signal within the T12 vertebral body likely represents treatment related fatty marrow replacement. The visualized spinal cord demonstrates normal signal intensity and morphology. No epidural abnormalities are suspected. The left kidney is atrophic.Lumbar:Anterior wedging of the L1 vertebral body is unchanged dating back at least to 2012. Diffuse fatty replacement of the lumbar vertebral marrow space is unchanged. A Schmorl's node deformity is evident along the inferior L3 endplate. The remaining vertebral bodies demonstrate preservation of height. No new or worrisome marrow signal abnormality is detected. The distal spinal cord, conus and nerve roots of the cauda equina are unremarkable.L1-2: No significant spinal canal stenosis or neuroforaminal narrowing. L2-3: No significant spinal canal stenosis or neuroforaminal narrowing. L3-4: Minimal disc bulging. No significant spinal canal or neuroforaminal stenosis. L4-5: Disc bulging with a central disc protrusion, unchanged from the prior examination. Mild spinal canal narrowing. Mild bilateral foraminal narrowing. L5-S1: Mild facet arthropathy. Mild disc bulging. No significant spinal canal or foraminal stenosis.

Output: 1.Mild degenerative findings in the cervical and lumbar regions without high-grade spinal canal or foraminal stenosis.2.Presumed treatment related marrow signal changes in the lumbar region without evidence to suggest new or recurrent metastases.


Instruction: Generate impression based on findings.

Input: 50 year old man with a history of ischemic cardiomyopathy, s/p heart transplant (4/30/2015) and antibody mediated rejection, hypertension and diabetes, referred for evaluation of rejection. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 56%, the LV end diastolic volume index is 74 ml/m2 (normal range: 74+/-15), the LVEDV is 161 ml (normal range 142+/-34), the LV end systolic volume index is 33 ml/m2 (normal range 25+/-9), the LVESV is 72 ml (normal range 47+/-19), the LV mass index is 51 g/m2 (normal range 85+/-15), and the LV mass is 110 g (normal range 164+/-36). There are no regional wall motion abnormalities present. T2 edema ratio is >2 (mildly increased), which is suggestive of myocardial edema/inflammation. Global relative enhancement value is 4, which is borderline abnormal (normal <4) which may indicate an underlying inflammatory process. The myocardial native T1 time is 1206ms, which is significantly elevated, which may be indicative of an underlying infiltrative or inflammatory process. However, it is decreased from prior MRI on 2/26/16 (1282ms previously). The extracellular volume fraction is 26%, which is in the normal range. There is a small area of patchy late gadolinium enhancement in the mid inferoseptum, which is better than before. It is atypical of myocardial infarction and suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process. Left AtriumThe left atrium is enlarged consistent with transplant. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 61%, the RV end diastolic volume index is 61 ml/m2 (normal range 82+/-16), the RVEDV is 132 ml (normal range 142+/-31), the RV end systolic volume index is 24 ml/m2 (normal range 31+/-9), and the RVESV is 52 ml (normal range 54+/-17).Right AtriumThe right atrium is enlarged consistent with transplant.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a "psudeo-bovine" brachiocephalic branching pattern (normal variant). The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThe pericardium is essentially normal in thickness. Small portions of the pericardium is mildly bright on T2-weighted imaging suggesting that there is some subtle residual pericarditis. However, the amount of pericardium involved is less than on prior study on 2/26/16 and much less than on the initial cardiac MRI from 2015. Additionally, on the prior study on 2/26/16, the pericardium appeared bright on LGE imaging, however it does not on today's study. These findings indicate improvement of pericardial inflammation from the prior study. There is no obvious pericardial to myocardial tethering noted on the current study. On real-time cine imaging, there is no evidence of respirophasic septal shift. Extracardiac FindingsSternotomy wires are present. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with normal systolic function (LVEF 56%). There is a small area of patchy late gadolinium enhancement in the mid inferoseptum, which is atypical of myocardial infarction and suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process. It was present on prior MRI on 2/26/16 but is now less pronounced.2. The T2 ratio is mildly elevated, the global relative early enhancement is borderline elevated, and the native myocardial T1 relaxation time is significantly elevated. Together these parameters suggest that there may be some underlying myocardial inflammation present. However, the ECV fraction is normal, which would not support myocardial inflammation. When compared to the prior study, the T2 ratio and early global relative enhancement are slightly increased; where as the native myocardial T1 relaxation time is a little improved. Overall, I would conclude that there is no significant change of the myocardium. 3. There is only mild residual pericardial inflammation, which continues to decrease on his serial cardiac MRIs. 4. The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 61%.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.