Instruction: Generate impression based on findings.

Input: Renal cell carcinoma status post nephrectomy in June 2013 (clear cell papillary type, stage T2b). Evaluate for recurrence or distant metastasis. 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. There is no evidence of recurrence within the nephrectomy bed. Within the right lower pole there is a 1.1 cm simple cyst, unchanged from prior. There is no right hydronephrosis. No suspicious lesion is identified within the right kidney.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: 46-year-old male with history of total proctocolectomy with IPAA with perforation indeterminate colitis. PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Small left medial rectus stone measuring 8 mm.BOWEL, MESENTERY: IPAA anastomosis is noted without evidence of complication.BONES, SOFT TISSUES: There is an enhancing fistula arising from the 6:00 position of the anus below the external sphincter extending to the left gluteal cleft measuring approximately 3.4 cm in length. No abscess is evident. There is presacral edema.OTHER: No significant abnormality noted.

Output: 1.Perianal fistula as described above without abscess.


Instruction: Generate impression based on findings.

Input: There has been persistent reduction in the size of the enhancing pineal region mass which now measures 10 x 10 mm in AP and transverse dimensions, compared to 17 x 14 mm previously, and 7 mm craniocaudal currently which has been remeasured to be 8 mm previously. However, please note that a complete set of thin section pineal region images was inadvertently not obtained. No significant mass effect or ventricular dilatation is noted. Again seen is a prior biopsy tract along the right frontal lobe extending to the frontal horn of the right lateral ventricle but with interval decreased T2/FLAIR hyperintensity and enhancement. Foci of susceptibility are noted within the occipital horns of the lateral ventricles which may be related to the previous biopsy procedure. There are stable areas of FLAIR abnormality within the white matter posteriorly with some areas of cystic encephalomalacia which favors gliosis, less likely enlarged perivascular spaces.There is no evidence of intracranial acute infarct. There is no midline shift or herniation. The major cerebral flow voids are intact. The nasal sinuses and mastoid air cells are clear.

Output: 1.Persistent decrease in the size of the pineal region mass.2.Interval decreased T2 hyperintensity and enhancement along the previous biopsy tract coursing through the right frontal lobe.3.Normal sized ventricles.


Instruction: Generate impression based on findings.

Input: 51-year-old male with history of shoulder pain. ROTATOR CUFF: There is intermediate signal abnormality of the supraspinatus tendon at its insertion, however we see no discrete fluid filled tear. The remaining muscles and tendons of the infraspinatus, teres minor, and subscapularis are unremarkable.SUPRASPINATUS OUTLET: There is no evidence of fluid within the subacromial or subdeltoid bursa. Minimal osteoarthritis affects the AC joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenoid labrum is intact. Minimal osteoarthritis affects the glenohumeral joint.BICEPS TENDON: The biceps tendon is unremarkable. ADDITIONAL

Output: Mild supraspinatus tendinopathy without discrete tear. The glenoid labrum is intact.


Instruction: Generate impression based on findings.

Input: Re-evaluate abnormal T2/Flair signal in the white matter. There is no evidence of intracranial hemorrhage, mass, or acute infarct. Redemonstrated are multiple scattered foci of non-enhancing T2 hyperintensity in the bilateral cerebral periventricular and subcortical white matter, which are grossly unchanged since 2013, accounting for differences in technique. A previously demonstrated enhancing focus adjacent to the right anterior clinoid process is compatible with mildly prominent venous structures and is unchanged. 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. There is fluid within the right mastoid air cells.

Output: 1. No evidence of intracranial hemorrhage, mass, or acute infarct. 2. Multiple scattered T2 hyperintensity in the bilateral cerebral hemispheres are nonspecific and appear to be unchanged since 2013.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Adenoid cystic carcinoma of the right pterygopalatine fossa with right V2 numbness treated with chemoradiation. There is unchanged enhancing tumor within the right cavernous sinus extending from the right foramen rotundum and pterygopalatine fossa, measuring up to 5 mm in width. The skull base and adjacent internal carotid artery flow voids are otherwise intact. Likewise, the Meckel caves and cisternal trigeminal nerves are intact. There is no evidence of acute infarction or midline shift. The ventricles are normal in size and configuration. There is moderate mucosal thickening and fluid in the right maxillary sinus, mild mucosal thickening in the left maxillary sinus, and secretions in the nasal cavity. There is fluid signal within the bilateral mastoid air cells. There are scattered foci of T2 hyperintensity in the cerebral white matter.

Output: 1. Unchanged treated perineural tumor involving the second division of the right trigeminal nerve with extension in the cavernous sinus.2. Findings suggestive of acute rhinosinusitis.


Instruction: Generate impression based on findings.

Input: Diagnosis: WeaknessClinical question: evaluate for myelopathy, L hemisensory / hemi-motor symptomsSigns and Symptoms: evaluate for myelopathy, L hemisensory / hemi-motor symptoms MRI thoracic spine:The thoracic vertebral bodies are appropriate in the overall alignment and height. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots. There is multilevel disc desiccation present.There is a disc bulge present at T3-4. There is a mild disc bulge present at T5-6, T6-7, T7-8, T9-T10 and T10-11. A Schmorl's node is present at the superior endplate of T8 associated with some reactive change.. Some endplate reactive changes are identified at T6-7 with high signal on T2 and low signal on T1.Lumbar spine: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 a minor disc bulge present at this level. At L4-5 there is no significant compromise to spinal canal or neural foramina. There is a disc bulge present at this level associated with bilateral ligamentum flavum hypertrophy. The fat at the lateral recesses sees is not effaced.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is a right far lateral disc protrusion at this level which mildly encroaches on the right-sided exiting nerve roots as they exit the 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.There are cystic lesions present in the kidneys. One in the left kidney measures approximately 6 8-mm in diameter

Output: 1.There are multilevel degenerative changes present in the thoracic spine without significant compromise to the spinal canal or exiting nerve roots. Similar degenerative changes appear to be in the subacute stage in the midthoracic spine at the T7-8.2.There are degenerative changes present in the lumbar spine without significant compromise to the spinal canal or neural foramina as detailed above. There is a right far lateral disc protrusion at L3-4 which encroaches on the right exiting nerve root.3.There is a tiny lesion in the left kidney which is suspected to represent a cyst but is not adequately imaged.


Instruction: Generate impression based on findings.

Input: 26-year-old male with left knee pain, swelling and decreased range of motion. Evaluate for ligament injury. MENISCI: There is linear branching signal abnormality within the posterior horn of the medial meniscus which extends anteriorly into the body of the medial meniscus consistent with a complex tear with both vertical and horizontal components. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: No full-thickness or near full-thickness articular cartilage defects are identified. No bone marrow signal abnormality is seen.LIGAMENTS: The cruciate and collateral ligaments appear intact EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: Complex tear of the medial meniscus and joint effusion as described above.


Instruction: Generate impression based on findings.

Input: 69-year-old female with history of pain. ROTATOR CUFF: There is a complete tear of the supraspinatus tendon with retraction to the level of the glenohumeral joint. There is moderate fatty atrophy of the supraspinatus muscle (Goutallier Stage 3). There is a near-complete to complete tear of the infraspinatus tendon with retraction of the majority of the fibers to the medial aspect of the humeral head. There is severe fatty atrophy of the infraspinatus muscle (Goutallier stage 4). The teres minor can be traced to its insertion on the humeral head, although there is increased signal intensity within and along its fibers which may represent partial thickness attritional tearing. There is also a full-thickness tear of the subscapularis tendon with retraction of the superior fibers to the level of the coracoid. Some of the inferior fibers of the tendon can be traced to their insertion on the humerus. The coracohumeral interval measures 5 mm. There is severe fatty atrophy of the superior portion of the subscapularis muscle.SUPRASPINATUS OUTLET: Moderate osteoarthritis affects the AC joint. There is a trace amount of fluid within the subacromial/subdeltoid bursal. The acromiohumeral interval is markedly narrowed. There is a small ossicle along the anterior margin of the acromion process. GLENOHUMERAL JOINT AND GLENOID LABRUM: The humeral head is high riding. Mild osteoarthritis affects the glenohumeral joint. There is increased signal intensity and blunting of the superior labrum likely representing degeneration and tearing. The inferior labrum is grossly intact.BICEPS TENDON: The tendon of the long head of the biceps is visible anterior to the proximal humeral diaphysis with abnormal signal intensity within its substance indicating tearing. We suspect the tendon is completely ruptured more proximally as we do not see it within the rotator cuff interval.

Output: Massive rotator cuff tear and other findings as above.


Instruction: Generate impression based on findings.

Input: Reason: pain History: pain. MENISCI: There is linear increased signal intensity within the posterior horn of the medial meniscus that extends to the tibial articular surface that likely represents a horizontal degenerative tear. Additional degeneration within the substance of the body of the medial meniscus. Anterior horn appears normal.The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: Moderate to severe thinning of the articular cartilage of the medial facet of the patella with foci of full thickness degeneration and underlying small subchondral cyst. Articular cartilage of the lateral facet appears relatively well preserved. Subjectively, the articular cartilage of the femoral trochlea appears thinned. There is also minimal subjective thinning of the articular cartilage of the tibiofemoral articulations, essentially within normal limits for age.LIGAMENTS: The anterior cruciate ligament and posterior cruciate ligament are intact. The medial collateral ligament is intact. The lateral collateral ligament complex is intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1.Degenerative horizontal undersurface tear of the posterior horn of the medial meniscus.2.Cartilage degeneration, most pronounced along the medial facet of the patella with relatively mild degeneration elsewhere.3.Baker's cyst.


Instruction: Generate impression based on findings.

Input: Thoracic spine:There is a smooth, physiologic thoracic kyphotic curve. The vertebral body heights and disc spaces are maintained. Marrow signal intensity is benign throughout. The spinal cord has a smooth contour and is without focal atrophy, edema, or myelomalacia. There are no masses.T1/2 demonstrates no significant disc bulge or cord encroachment.T2/3 demonstrates no significant disc bulge or cord encroachment. T3/4 demonstrates no significant disc bulge or cord encroachment. T4/5 demonstrates no significant disc bulge or cord encroachment. T5/6 demonstrates no significant disc bulge or cord encroachment.T6/7 demonstrates no significant disc bulge or cord encroachment. T7/8 demonstrates no significant disc bulge or cord encroachment. T8/9 demonstrates no significant disc bulge or cord encroachment. T9/10 demonstrates no significant disc bulge or cord encroachment.T10/11 demonstrates no significant disc bulge or cord encroachment. T11/12 demonstrates no significant disc bulge or cord encroachment. T12/L1 demonstrates no significant disc bulge or cord encroachment. Lumbar spine:Alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign. The conus is normal in signal and morphology and terminates at an appropriate level. The visualized intra-abdominal and paraspinal contents are unremarkable.L1/2: UnremarkableL2/3: UnremarkableL3/4: UnremarkableL4/5: UnremarkableL5/S1:Unremarkable

Output: Negative noncontrast thoracic and lumbar spine MRI without contrast. Specifically, there are no MRI findings to explain the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Female, 68 years old, with left-sided paresthesias and paresis. No restricted diffusion is seen. Numerous scattered foci of predominantly white matter T2 hyperintensity are seen. No edema or mass effect is detected. No evidence of intracranial hemorrhage or any abnormal extra-axial fluid collection is seen. The ventricular size and morphology are within normal limits.

Output: 1.No acute intracranial abnormality.2.Numerous scattered foci of prominently white matter T2 hyperintensity are nonspecific and may reflect chronic microvascular disease, sequelae of demyelinating disease, or sequelae of other prior inflammation.


Instruction: Generate impression based on findings.

Input: Sacral mass, renal cell carcinoma An ill-defined soft tissue mass is noted at the left sacral ala extending from S1 to S2 which represents the known metastatic lesion. The mass is slightly hyperintense to muscle on T1 and hyperintense to muscle on T2/STIR sequence and enhances homogeneously. The mass measures approximately 5.1 x 3.7 x 4.2 cm in the greatest transaxial and craniocaudal dimensions. There is encroachment upon the left S1 neural foramen with the S1 nerve root coursing through the mass and the S2 neural foramen is poorly visualized. Additionally, there is asymmetric enhancement of the dura at this level which may be reactive in nature however the possibility of direct involvement must be considered.No additional soft tissue lesions are identified. There is no suspicious marrow signal throughout the remaining pelvis and lumbar spine.Note is made of a cystic mass within the left hemipelvis measuring 4.9 cm in the region of the left ovary. This is likely functional in nature however given the patient's age, attention on follow-up is recommended. This was present on the outside CT dated 6/10/2016. A similar, smaller focus is seen in the right hemipelvis which is also in close proximity to the right ovary.

Output: 1. Ill-defined soft tissue mass involving the left sacral ala consistent with known biopsy-proven metastatic focus. There is encroachment upon the left S1 neural foramen with poor visualization of the S2 neural foramen, concerning for direct invasion. Additionally, there is asymmetric enhancement of the dura which may be reactive in nature although the possibility of malignant involvement must also be considered.2. No additional soft tissue masses or abnormal marrow signal within the pelvis.3. Cystic foci within the pelvis are likely ovarian and functional in nature however given the patient's age, attention on follow-up is recommended.


Instruction: Generate impression based on findings.

Input: 73 years Female (DOB: 4/17/1943)Reason: r/o stenosis History: neck painPROVIDER/ATTENDING NAME: HELENE G. RUBEIZ HELENE G. RUBEIZ The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is multilevel disc desiccation present.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. There are endplate uncovertebral osteophytes present this level associated with disc desiccation and loss of disc space height. There is encroachment of the right-sided exiting nerve roots related to osteophytes and disc material. There is mild ligamentum flavum hypertrophy at this level.At C6-7 there is no significant compromise to the spinal canal. There is right-sided facet hypertrophy present at this level as well as endplate and uncovertebral osteophytes with some narrowing of the right neural foramen.. There is ligamentum flavum hypertrophy at this level.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.Along the right anterior chest wall there appears to be a large T1 signal hyperintense mass which suppresses on the fat suppressed images. This is not entirely included on this exam. It displaces adjacent structures including the thyroid gland being displaced towards the left and displaces the right sternocleidomastoid muscle anteriorly. The subclavian artery and subclavian vein are deep to the lesion.

Output: 1.There are degenerative changes present in the cervical spine with encroachment of right-sided exiting nerve roots at C5-6.2.Fatty lesion possibly a lipoma is present along the right anterior chest wall and lower right neck which is located underneath the sternocleidomastoid muscle is not adequately included on this exam. It appears to displace adjacent structures. Please correlate with physical findings on clinical exam.


Instruction: Generate impression based on findings.

Input: Crohn's disease status post ileocecectomy x2. Evaluate for stricture or adhesions and active inflammation. ABDOMEN:LIVER, BILIARY TRACT: Right hepatic lobe cyst. Otherwise unremarkable liver.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: The small bowel is adequately distended with oral contrast. The small bowel fold pattern is unremarkable.There are postsurgical changes from an ileocecectomy. The small bowel including the terminal ileum is normal in caliber, wall thickness and demonstrates normal postcontrast enhancement without restricted diffusion or adjacent inflammatory changes. No free or loculated fluid. No evidence of sinus tract or fistula formation. No fixed stricture or prestenotic dilatation.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Left adnexal bilobed cystic lesion measuring 5.4 x 2.6 cm without suspicious imaging features.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The small bowel is adequately distended with oral contrast. The small bowel fold pattern is unremarkable.There are postsurgical changes from an ileocecectomy. The small bowel including the terminal ileum is normal in caliber, wall thickness and demonstrates normal postcontrast enhancement without restricted diffusion or adjacent inflammatory changes. No free or loculated fluid. No evidence of sinus tract or fistula formation. No fixed stricture or prestenotic dilatation.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No specific findings of active small bowel inflammation or fibro-stenotic disease.2.5.4 cm left adnexal cystic lesion. Follow-up ultrasound in 4-6 weeks is recommended to document resolution.


Instruction: Generate impression based on findings.

Input: Female; 30 years old. Reason: Brachytherapy planning History: Brachytherapy planning PELVIS:UTERUS, ADNEXA: Eccentric soft tissue wall thickening of the cervix anteriorly on the right, consistent with known cervical carcinoma, has further significantly decreased with no discretely measurable tumor on the current exam. Brachytherapy therapy sleeve is in place within the endometrial and endocervical canal.BLADDER: No significant abnormality noted.LYMPH NODES: Prominent left common iliac lymph nodes are not significantly changed with reference node measuring up to 12 x 9 mm (series 1105/770), previously 13 x 9 mm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Significantly decreased size of cervical carcinoma with no discretely measurable tumor evident.2. Stable prominent left common iliac lymph nodes.


Instruction: Generate impression based on findings.

Input: 3-year-old female with history of intermediate-risk neuroblastoma, off therapy evaluation. Please visualize area of consolidation noted on MRI performed 10/20/10. LUNGS AND PLEURA: Nodular pleural thickening posteromedially in the left apex measures 8 x 6 mm (image 14/59, series #4). This is in the previous location of the large left paraspinal mass. Previously seen consolidation in the right lung base on prior MRI is no longer evident. There are no pulmonary consolidations, nodules, or pleural effusions.MEDIASTINUM AND HILA: Soft tissue density mass in the anterior mediastinum with concave margins and conforming to the contour of the aorta is not significantly changed and consistent with normal thymus. No lymphadenopathy. Normal heart size. No pericardial effusion.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: No significant abnormality noted.

Output: 1. Consolidation in the right lung base on prior MRI has resolved.2. Residual nodular left pleural thickening in the region of the previously described paraspinal mass.


Instruction: Generate impression based on findings.

Input: 18 year-old male with rupture of previous left knee ACL reconstruction. Evaluate tunnel position.IMAGE ACQUISITIONS: CT of the left knee; IV administration of 80 cc of iodinated contrast at 2 cc/sec. Transverse, coronal, sagittal re-formations provided. Patient is status post ACL reconstruction, although the graft appears disrupted as seen on recent MRI study. The tibial tunnel begins at the intercondylar eminence between the medial and lateral tibial spines and courses anteriorly and medially through the proximal tibia, breaching the anteromedial cortex. The slope of the tunnel is greater than that of Blumenstadt's line.The femoral tunnel originates near the junction of the physeal scar and posterior femoral cortex and courses superomedially, where it intersects with two tunnels created by crossed pins.Please note that the ACL itself is not well seen on this CT study nor are the menisci. The PCL is seen on the sagittal reformatted images. A small joint effusion is noted. The remaining visualized bone and soft tissue structures are within normal limits.

Output: Postoperative changes as described above.


Instruction: Generate impression based on findings.

Input: 21-year-old male with hip pain. Evaluate for AVN. Note is made of increased heterogeneous signal abnormality in the left femoral head consistent with avascular necrosis. There is no evidence of femoral head collapse or fracture. There is also increased serpiginous signal abnormality within the right femoral head consistent with avascular necrosis. No evidence of femoral head collapse or fracture. There is diffuse bone marrow signal abnormality consistent with the patient's history of sickle cell disease. There is residual fatty marrow in the greater trochanters. There is also increased signal abnormality within the sacrum, left inferior pubic ramus and posterior right acetabulum which may represent bone infarcts. There is deformity of multiple vertebral bodies of the incompletely imaged lower lumbar spine also consistent with the patient's history of sickle cell disease. Large amount of fluid is identified within the bladder. There is a small amount of fluid within the left hip joint which is not necessarily of any current clinical significance.

Output: Findings compatible with avascular necrosis of the hips and other findings as described above.


Instruction: Generate impression based on findings.

Input: 60 year old male with persistent atrial fibrillation after ablation. Referred for cardiac MRI prior to redo PVI and to assess pulmonary vein anatomy and LVEF. Left VentricleThe left ventricle is normal in size with mildly reduced systolic function. The overall LV ejection fraction is 48%. The LVEDV is 139 ml (normal range 142+/-34), the LV end diastolic volume index is 67 ml/m2 (normal range: 74+/-15), the LVESV is 73 ml (normal range 47+/-19) and the LV end systolic volume index is 35 ml/m2 (normal range 25+/-9). The LV mass is 72 g (normal range 164+/-36) and the LV mass index is 35 g/m2 (normal range 85+/-15). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.The native T1 myocardial relaxation time is <1000 ms (normal), suggestive of absence of underlying diffuse fibrosis or infiltration.There is no myocardial iron overload. Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size with mildly depressed systolic function. The overall RV ejection fraction is 48%. The RVEDV is 161 ml (normal range 142+/-31), RV end diastolic volume index is 77 ml/m2 (normal range 82+/-16), the RVESV is 84 ml (normal range 54+/-17), and the RV end systolic volume index is 40 ml/m2 (normal range 31+/-9).Right AtriumThe right atrium is mildly dilated.Aortic ValveThe aortic valve is trileaflet, opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThere is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size. The descending thoracic aorta is severely tortuous.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium. The right middle lobe pulmonary vein drains independently into the left atrium, just anterior to the right lower pulmonary vein ostium. There is no apparent pulmonary vein stenosis.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 FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1.Normal sized LV with mildly depressed systolic function (LVEF 48%).2.Normal sized RV with mildly depressed systolic function (RVEF 48%).3.No pulmonary vein stenosis. The right middle lobe pulmonary vein drains independently into the left atrium just adjacent to the right lower pulmonary vein ostium. 4.The left ventricular myocardium is completely viable.5.Mild biatrial dilation.


Instruction: Generate impression based on findings.

Input: 61 year-old female with cognitive changes and memory loss. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. Right cerebellar hemispheric encephalomalacia, compatible with remote infarction with mild associated vacuo dilatation of the fourth ventricle. There is complete loss of the flow void of the distal right V3 segment of the vertebral artery with partial distal reconstitution along the right V4 segment likely representing retrograde flow.Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, pons and medulla which are nonspecific, but compatible with chronic small vessel ischemic changes. Sella and orbits are grossly within normal limits. Trace fluid in the right mastoid air cells. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: 1. No evidence of intracranial hemorrhage, mass, or acute infarct.2. Moderate chronic small vessel ischemic changes as described above.3. Stable remote extensive right cerebellar infarction.4. Loss of the right vertebral artery (V3 segment) flow void flow as seen on prior ultrasound with partial distal reconstitution of right V4 segment likely representing retrograde flow. If further evaluation of the vasculature is clinically warranted, CTA or MRA may be considered.


Instruction: Generate impression based on findings.

Input: Reason: HCC screening, follow up pancreatic head cyst History: NASH cirrhosis, panc head cyst ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology. Loss of signal on out of phase images suggest steatosis. Subcentimeter right hepatic cysts are unchanged. Arterial enhancing lesion seen on the prior exam is no longer evident and was likely perfusional. There is a new focus of arterial enhancement (11/57) which is not seen on additional phases which may also be perfusional. Common bile duct appears normal. Vasculature is patent.SPLEEN: Mild splenomegaly, unchanged.PANCREAS: Pancreatic duct is nondilated. Cystic lesion in the pancreatic head measuring 1.1 x 1.5 cm (5/32), is unchanged and likely represents a sidebranch IPMN. Multiple adjacent cystic lesions more medially in the pancreatic head measuring overall 2.5 x 1.6 cm (5/35) with multiple small septations are also unchanged, most likely side branch IPMNs (versus dominant multiseptated lesion). Additional punctate cystic foci in the pancreatic body is also unchanged and likely represents a side branch IPMN. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left hepatic T2 hyperintensity, likely a cyst.RETROPERITONEUM, LYMPH NODES: Prominent portacaval and retroperitoneal lymph nodes are unchanged.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Stable cystic lesions in the pancreatic head, likely a side branch IPMNs; please refer to details above.2.Cirrhotic liver morphology. Arterially enhancing lesion seen on the prior exam is no longer evident and may have been perfusional in etiology.


Instruction: Generate impression based on findings.

Input: 66-year-old male with acute brainstem infarct. Evaluate for further swelling/progression of infarct. There is no evidence of intracranial hemorrhage or midline shift. There is increased hypodensity in the left cerebellar region consistent with an evolving infarct. An area of hypodensity on a single image in the right cerebellar hemisphere is identified. There is a previously described area of encephalomalacia on the image inferior to this slice. This could represent volume averaging versus an additional area of infarct. If clinically indicated, an MRI could be considered for further evaluation.The ventricles and basal cisterns are normal in size and figuration. There is opacification of the ethmoid air cells and mucoperiosteal thickening in the bilateral maxillary and sphenoidal sinuses.

Output: Evolving cerebellar infarct. Area of hypodensity in the right cerebellar hemisphere on a single image may represent volume averaging or an additional area of infarct. An MRI may be considered for further evaluation if clinically indicated.


Instruction: Generate impression based on findings.

Input: Right-sided weakness and cerebellar signs. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is unchanged extensive cerebral white matter T2 hyperintensity and chronic infarcts in the pons, left gyrus rectus, and right basal ganglia. There is unchanged mild diffuse cerebral volume loss. There is no midline shift or herniation. The skull and scalp soft tissues are unremarkable. There are bilateral lens implants.

Output: 1. No evidence of intracranial hemorrhage, mass, or acute infarct.2. Unchanged extensive cerebral white matter T2 hyperintensity that likely represents chronic small vessel disease and chronic infarcts in the pons, left gyrus rectus, and right basal ganglia.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate post op, EVD clumped. Signs and symptoms: postop CT of brain without contrast:Expected postoperative changes of left suboccipital craniectomy.There is evidence of residual low density mass along the medial aspect of the left middle cranial fossa. There is evidence of hemorrhage within the expected location of more dorsal aspect of this tumor which was noted to project over the left petroclinoid ligament into the left cerebellopontine angle. There is also a small hematoma measuring approximately 10 mm times 10-mm which projects over the left cerebral peduncle and left aspect of the pons. I cannot entirely exclude the possibility of hemorrhage within the brain parenchyma however this hemorrhage may be within the residual component of tumor in the left cerebellopontine angle. Further evaluation with an MRI is recommended. There is evidence of residual blood within the prepontine cistern. There is suggestion of edema of the left cerebral peduncle.The fourth ventricle remains patent and no cerebellar abnormalities detectedThere is evidence of blood within the dependent portion of lateral ventricles and right frontal horn. In comparison with the prior examination there is no evidence of change in the above-described findings.There is a slight dilation of the supratentorial ventricular system which also remains stable since prior study.Expected postoperative changes of air within the intracranial space in bifrontal region with minimal interval decrease.

Output: 1.No detectable interval change since prior study of areas of hemorrhage or ventricular size.2.Approximately 10 mm hematoma may be within the residual component of tumor in the right cerebellopontine angle however possibility of hemorrhage within the left cerebral peduncle and pons cannot be ruled out. Further evaluation with an MRI is recommended.3.Residual low density and nonhemorrhagic tumor along the medial aspect of the left meconium fossa.


Instruction: Generate impression based on findings.

Input: Evaluate possible bony lesion, calcification at C5-6IMAGE ACQUISITIONS: Cervical spine CT without contrast Cervical spine alignment is normal. Intervertebral disk spaces and vertebral body heights are normal.At C4-5, there is a small bony growth extending from posterior element of C4 into the spinal canal.At C5-6, there is a larger bony growth extending from the posterior element of C5 to the spinal canal with mass effect on the cord at C5 on the left.Both lesions appear to have cortical and medullary continuity suggesting osteochondroma. MRI is recommended to evaluate for any cord abnormality.

Output: Bony growths extending from the posterior elements of C4 and C5 into the spinal canal. While there is mass effect on the cord at the C5 level, we cannot assess for cord injury. MRI is recommended to further evaluate.


Instruction: Generate impression based on findings.

Input: Reason: Evaluate disc and stenosis History: lower back pain with bilateral LE radiculopathy Vertebral body heights are within normal limits. Minimal straightening of the lumbar spine, otherwise alignment is within normal limits. Mild endplate degenerative changes at L4-L5, unchanged. Multilevel disc desiccation with mild degenerative disc disease at L4-L5 is unchanged. No abnormal signal within the cord or conus which terminates at the lower L2 level at the lower limits of normal.T12-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. Mild facet arthropathy and ligamentum flavum thickening. No spinal canal or neural foraminal stenosis.L3-L4: No significant disc disease. Mild facet arthropathy and ligamentum flavum thickening. No spinal canal or neural foraminal stenosis.L4-L5: Broad-based disc bulge the superimposed right paracentral and foraminal extrusion which effaces the right lateral recess with possible impingement on the descending right L5 nerve root. This represents an increase from the prior exam, where a left-sided protrusion was noted, which is now less prominent. A dorsal annular fissure is noted. Ligamentum flavum thickening and facet arthropathy. Mild-to-moderate spinal stenosis is slightly increased. Mild to moderate right neural foraminal stenosis is slightly increased. Mild left neural foraminal stenosis is unchanged.L5-S1: Small central disc extrusion extending inferiorly. Mild ligamentum flavum thickening. No spinal stenosis. Minimal bilateral neural foraminal stenosis.Paraspinous soft tissues are within normal limits.

Output: Right paracentral disc extrusion with mild foraminal extension at L4-L5 has increased from the prior exam. There is significantly increased effacement of the right lateral recess where there may be impingement of the descending right L5 nerve root. There is mild to moderate central spinal canal stenosis at this level which appears slightly worse.


Instruction: Generate impression based on findings.

Input: Status post liver transplant with biliary biliary stricture status post dilation. Increasing alkaline phosphatase. ABDOMEN:LIVER, BILIARY TRACT: Status post liver transplant. The liver is normal in morphology. There are several scattered subcentimeter hepatic cysts.There is mild intrahepatic biliary ductal dilatation. The donor duct measures 5 mm and the recipient duct measures 9 mm. There is focal narrowing at the anastomosis. The hepatic artery appears diminutive at the level of the porta hepatis. The portal and hepatic veins are patent.No focal suspicious lesion. The vessels appear patent. The gallbladder is surgically absent.SPLEEN: The spleen is normal in size.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Focal narrowing at the biliary duct anastomosis with mild intrahepatic biliary ductal dilatation. The hepatic artery appears diminutive at the level of the porta hepatis.


Instruction: Generate impression based on findings.

Input: Clinical question: MS, new L weakness, falls. Signs and Symptoms: L weakness, falls Unenhanced brain MRI:Negative diffusion weighted series.Examination demonstrate minimal findings of demyelinating disease with suggestion of subtle interval progression since prior MRI exam from 7 -- 1 -- 2013.The new small new lesions are identified in the subcortical white matter of left temporal and flair T2 series 8 image 16, left superior cerebellar peduncle on flair series 8 image 19 and a tiny lesion in the anterior medulla on flair series 8 image 22. Note should be made that this examination is performed without intravenous contrast.Previously noted focus of flair hyperintensity in the lower medulla is again identified on flair/T2 series and without convincing evidence of any change in size. This finding also is not associated with any change in the caliber of the medulla. There is slight generalized prominence of the cerebral cortical sulci for patient's stated age of 39 which appears more pronounced compared to prior exam however this observation may be secondary to better quality current exam.Signal void of major intracranial arterial branches are identified.Unremarkable images through the orbits, paranasal sinuses and mastoid air cells.

Output: White matter foci of flair hyperintensity consistent with mild demyelinating disease with evidence of few tiny new lesions since prior study as detailed.


Instruction: Generate impression based on findings.

Input: The last well formed disk space is referred to as L5-S1. There is normal alignment of the lumbar spine. The vertebral body heights are preserved. There are type I degenerative endplate changes at L4-5 with disk desiccation and severe loss of disk height. There is desiccation and moderate loss of disk height and L3-4, with disk desiccation at L5-S1 without significant loss of disk height. The conus terminates at T12-L1 and is normal.T12-L1: No disk herniation or spinal stenosis.L1-2: No disk herniation or spinal stenosis.L2-3: Mild disk bulge, facet arthrosis and ligamenta flava thickening which along with posterior epidural fat causes mild spinal canal stenosis. No significant interval changes.L3-4: Diffuse disk bulge, ligament flava thickening, mildly prominent posterior epidural fat and moderate facet arthrosis causing severe spinal canal stenosis and moderate to severe bilateral neural foraminal stenosis. Findings have progressed at this level.L4-5: Diffuse disk bulge, ligamenta flava thickening, moderate facet arthrosis causing severe spinal canal and severe neural foraminal stenosis. Findings have progressed at this level.L5-S1: Diffuse disk bulge, moderate facet arthrosis and ligamenta flava thickening causing no significant spinal stenosis. No significant interval changes.

Output: Multilevel lumbar spondylosis, with progressive disease at L4-5 and L3-4 where there are high grade spinal canal and neural foraminal stenoses.


Instruction: Generate impression based on findings.

Input: Altered mental status. There is a rounded T2 hyperintense subcentimeter lesion in the left hippocampus that corresponds to the hyperattenuating lesion demonstrated on CT. There are also nonspecific mild scattered foci of cerebral white matter T2 hyperintensity. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. However, there is an incompletely imaged C4 vertebral lesion. There is fluid in the bilateral ethmoid sinuses.

Output: 1. A subcentimeter lesion in the left hippocampus may represent metastatic disease, although assessment is limited due to the lack of intravenous contrast. 2. Incompletely imaged C4 vertebral metastasis.


Instruction: Generate impression based on findings.

Input: 50yo gentleman with a history of ischemic cardiomyopathy status post heart transplant 4/30/15, HTN, and DM presenting with fevers and L sided pleuritic chest pain now with elevated filling pressures Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 54%, the LV end diastolic volume index is 81 ml/m2 (normal range: 74+/-15), the LVEDV is 177 ml (normal range 142+/-34), the LV end systolic volume index is 38 ml/m2 (normal range 25+/-9), the LVESV is 82 ml (normal range 47+/-19), the LV mass index is 45 g/m2 (normal range 85+/-15), and the LV mass is 99 g (normal range 164+/-36). There is a septal bounce consistent with previous sternotomy. There are no other regional wall motion abnormalities present. The myocardial native T1 time is 1231ms, which is significantly elevated and suggests that there is an intra-myocardial process present.The cardiac output is 8.9L/min and the cardiac index is 4.1L/min/m2.Left AtriumThe left atrium is consistent with transplant. Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 48%, the RV end diastolic volume index is 86 ml/m2 (normal range 82+/-16), the RVEDV is 186 ml (normal range 142+/-31), the RV end systolic volume index is 44 ml/m2 (normal range 31+/-9), and the RVESV is 97 ml (normal range 54+/-17).Right AtriumThe right atrium is 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 trace 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 combined right innominate and left common carotid or "pseudo-bovine" branching pattern, which is a 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 are normal in size and drain normally into the right atrium.PericardiumThe pericardium is thickened (7 mm maximal). The pericardium is bright on T2-weighted imaging suggesting that it is edematous/ inflamed. The pericardium is somewhat tethered to the posterior wall based on myocardial tagging. On real-time cine imaging, there is no evidence of interventricular dependence. There is a small loculated pericardial effusion adjacent to the right atrium. There is a significant amount of pericardial fat present.Extracardiac FindingsThere are sternotomy wires present. There is gynecomastia. 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 and systolic function. The overall LV ejection fraction is 54%. The native myocardial T1 time is significantly elevated suggesting that there may be an intramyocardial process present.2. The right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 48%3. The pericardium is thickened with evidence of edema/ inflammation. It is additionally tethered to the posterior wall of the myocardium. However, based on real-time cine imaging, there does not appear to be interventricular dependence. These finding suggest that there is ongoing pericarditis but the abnormality does not appear to be causing constrictive physiology.4. There is a small loculated pericardial effusion adjacent to the right atrium. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate prior ICH. Patient with recent diagnosis of multiple myeloma. Signs and symptoms: ICH. Pre and post enhanced brain MRI:Examination demonstrates a large focus of right anterior frontal hemorrhagic encephalomalacia at the site of previously noted large parenchymal hematoma.There is a thin irregular rim of enhancement surrounding the hemorrhagic cavity which is an expected finding and representing evolving hematoma.There is significant interval decrease in the overall size of this finding and with significant interval resolution of surrounding residual leak edema. Changes results in mild ex vacuo dilatation of right frontal horn and without evidence of mass effect and resolution of previously noted midline shift to the left. Expected postoperative changes of a right frontal craniotomy with subtotal underlying epidural thickening and enhancement.Few tiny foci of FLAIR hyperintensity only in the subcortical white matter of bilateral hemispheres remain similar to prior exam.Normal signal intensity and anatomical morphology of the brain parenchyma otherwise unremarkable MRI sequences. No detectable abnormal parenchymal or leptomeningeal enhancement other than above findings.Unremarkable images through the orbits and including axial fat sat post enhanced series.The signal intensity of the calvarium is bleeding normal and without abnormal enhancement.

Output: 1.Significant interval improvement of a resolving hematoma and postoperative changes in the right frontal lobe as detailed above.2.Resultant mild expansion of right lateral ventricle and resolution of midline shift.3.Negative diffusion weighted series.4.Few punctate nonspecific foci of FLAIR hyperintensity only in the subcortical white matter without change since prior exam.


Instruction: Generate impression based on findings.

Input: History of Hodgkin's lymphoma status post chemotherapy. PET scan shows FDG lesions. ABDOMEN:LIVER, BILIARY TRACT: The liver contour is mildly lobulated. There are several T2 hypointense lesions which do not demonstrate significant restricted diffusion or postcontrast enhancement. Two of these lesions correspond to the new peripheral lesions described on the recent FDG PET which demonstrated FDG uptake. There are signal characteristics are not significantly different from the remaining liver lesions.SPLEEN: No significant abnormality noted.PANCREAS: Pancreas divisum. No evidence of acute pancreatic inflammation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Small mesenteric lymph nodes are noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Multiple liver lesions are identified compatible with history of Hodgkin's lymphoma. There are lesions corresponding to the recently described FDG PET avid lesions whose MR signal characteristics are not different from the other known lesions which were not significantly FDG avid.


Instruction: Generate impression based on findings.

Input: 48-year-old female with medial compartment arthritis and recent new injury with locked left knee. Evaluate left knee for medial meniscus tear. Due to the patient's body habitus, the high resolution coil could not be utilized resulting in slightly suboptimal image quality.MENISCI: There is mild attenuation of the posterior horn of the medial meniscus likely representing chronic attritional tearing. There is also intermediate signal intensity within the posterior horn of the medial meniscus extending to the femoral articular surface likely representing degenerative tearing. There is globular intermediate signal intensity within the body likely representing a combination of intrasubstance degeneration and degenerative tearing. There is slight medial extrusion of the body of the meniscus. We see no fluid-filled meniscal tear or displaced meniscal fragment. The anterior horn appears intact. There is globular increased signal intensity within the posterior horn of the lateral meniscus, at its root, likely representing degeneration, but we see no fluid-filled tear.ARTICULAR CARTILAGE AND BONE: There is severe degeneration of the articular cartilage of the medial compartment with full-thickness cartilage loss along the weightbearing portions of the medial femoral condyle and medial tibial plateau with underlying degenerative signal abnormality within the subchondral bone. The articular cartilage of the lateral compartment is relatively spared, although there is degeneration of the articular cartilage of the lateral femoral condyle anterior to the lateral meniscus. Edema within the anterior aspect of the tibia may represent a direct bone contusion. There is also full-thickness articular cartilage loss along the lateral facet of the patella. There are subchondral cysts in the lateral femoral trochlea with overlying cartilage degeneration. Note is made of tricompartmental osteophytes.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Severe osteoarthritis of the knee with full-thickness cartilage degeneration affecting the medial and patellofemoral compartments.2. Degeneration and degenerative tearing of the medial meniscus, but we see no fluid-filled tear or displaced meniscal tissue.3. Small joint effusion and other findings as described above.


Instruction: Generate impression based on findings.

Input: Other fatigue [R53.83] / Altered mental status, unspecified [R41.82], Reason for Study: ^Reason: eval remote brain injury History: lethargy, facial droop Brain MRIThere is no evidence of acute ischemic or hemorrhagic lesion on the scan. There is suspicious focal nodular enhancement on the left precentral gyrus (Series1101, image 27/36) but the lesion is not conspicuous on other imaging sequences especially 3D SPGR post contrast images. Therefore, this lesion could represent vascular structure such as cortical vein. There is no other unusual enhancement on this 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. The midline structures and cranial-cervical junction are normal. The mastoid air cells are clear. Mucosal thickening on ethmoid sinus and left maxillary sinus were seen.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion on the scan.2. There is a focal nodular enhancing lesion on the left frontal lobe precentral gyrus which likely represent cortical vein as described above. Otherwise no evidence of abnormal enhancement.3. Normal brain MR angiogram.


Instruction: Generate impression based on findings.

Input: There is restricted diffusion involving the left posterior frontal corona radiata with corresponding flair hyperintensity consistent with acute infarct. Additionally, there are foci of mild hyperintensity on the diffusion sequence with iso-to high ADC values and FLAIR hyperintensity compatible with subacute infarcts. There is moderate degree of flair hyperintensity within the periventricular and subcortical white matter, and to a lesser degree involving the pons,, findings which are nonspecific but most suggestive of chronic small vessel ischemic disease. There two tiny foci of susceptibility in the right posterior frontal lobe which are nonspecific but compatible with chronic microhemorrhages.No intracranial mass or mass-effect is seen. No hydrocephalus. No extra-axial collections. Paranasal sinuses are clear. Partial opacification of the mastoid air cells. Calvarium and extracranial soft tissues are unremarkable.MRA HEAD

Output: 1. Acute infarct involving the left posterior frontal corona radiata with additional subacute infarcts in the left frontoparietal corona radiata and centrum semi-ovale.2. Mild to moderate chronic small vessel ischemic disease.3. No evidence of high-grade stenosis involving the intracranial vasculature.


Instruction: Generate impression based on findings.

Input: Clinical question: Transsphenoidal surgery with persistent subcentimeter lesion within the right pituitary gland. Signs and symptoms: Yearly follow-up. Pre- and post enhanced pituitary MRI:Examination redemonstrates a partially cystic mass in the right side of sella with suggestion of subtle extension into the right cavernous sinus. Compared to prior exam there is no convincing evidence of any change in the signal intensity or size of this lesion.All the measurements of pituitary gland remain nearly identical to prior study. Associated mass effect with this finding evident by leftward deviation of the pituitary stalk remains also identical to prior study. The largest craniocephalad measurement of dictated at 8.8 mm is identical to prior exam.There is no detectable mass within the basal cistern and no evidence of mass effect on the suprasellar visual complex.Pre and post enhanced brain MRI:Negative diffusion weighted images.FLAIR images demonstrate a few punctate nonspecific hyperintensities in the subcortical and periventricular white matter without change since prior exam and without evidence of enhancement. Unremarkable cerebral cortex, cortical sulci, ventricular system and CSF spaces otherwise and stable since prior exam. No detectable abnormal parenchymal or leptomeningeal enhancement.Unremarkable calvarium and orbits without abnormal enhancement.

Output: 1.Pituitary MRI demonstrate stable right-sided pituitary lesion in size, signal intensity and extend since prior study.2.Brain MRI demonstrate no acute intracranial process, stable few nonspecific nonenhancing punctate FLAIR hyperintensity in the subcortical and periventricular white matter and stable unremarkable exam otherwise.


Instruction: Generate impression based on findings.

Input: 43-year-old woman with history of ulcerative colitis status post proctocolectomy with ileal pouch anal anastomosis 23 years ago, left ischiorectal fossa abscess status post drainage and seton placement in December 2015, please evaluate for fistulous tracts. PELVIS:UTERUS, ADNEXA: C-section scar noted. Nabothian cysts present. A simple 3.7 cm right ovarian cyst is noted, physiologic for a menstruating patient.BLADDER: No significant abnormality noted.LYMPH NODES: Mildly prominent inguinal lymph nodes noted, likely reactive.BOWEL, MESENTERY: There is a perianal seton within a transsphincteric fistulous tract extending from the 12:00 position of the rectum to the left gluteal cleft in the left ischioanal fossa. The surrounding soft tissues are indurated with increased T2 signal.Within this region (6/39) there is a questionable T2 hyperintense tract extending from the 1:00 position of the rectum to a 23 x 8 mm collection of fluid in the left labia majora (7/29) which demonstrates minimal peripheral enhancement. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Enhancing fluid collection in the left labia majora which, could represent a small abscess, but likely communicates with the rectum via a suspected (but not clearly visualized) fistulous tract.2.Seton within the left transsphincteric fistulous tract.


Instruction: Generate impression based on findings.

Input: 31 year old male with a history of NF1 and plexiform behind the right knee but extensive tumor beyond. ARTICULAR CARTILAGE AND BONE: No bone marrow signal abnormalities identified.SOFT TISSUES: Note is made of an extensive plexiform appearing masses within the soft tissues about the posterior aspect of the right knee extending inferiorly along the anterior and lateral aspect of the calf as well as along the posterior aspect of the distal femur with associated T2 prolongation peripherally with central low intensity, consistent with the patient's history of neurofibromatosis, although these are incompletely characterized due to the lack of intravenous contrast. The largest lesion along the lateral aspect of the popliteal fossa measures approximately 8.3 x 5.0 cm (image 97; series 1701) and demonstrates heterogeneous internal signal intensity, previously measuring 7.4 x 4.7 cm. Further characterization of these lesions is limited due to the lack of intravenous contrast and dedifferentiation cannot be excluded by this examination. Additional foci of intramuscular fluid signal intensity are identified within the adductors, hamstring, sartorius and quadriceps musculature of the right thigh which appear most consistent with neurofibromas. Additional masses are identified within the left thigh musculature which are also most consistent with neurofibromas. Additional foci of fluid signal intensity are identified within the incompletely imaged pelvis which also may represent neurofibromas, incompletely characterized. There are also multiple foci of increased signal intensity on fluid sensitive sequences within the subcutaneous tissue about the anterior and lateral aspect of the calf and anterior aspect of the thigh which may represent cutaneous neurofibromas.There is mild to moderate muscle atrophy.The severe atrophy of the tibialis posterior, flexor digitorum longus musculature.ADDITIONAL

Output: Findings consistent with the patient's history of neurofibromatosis with associated large plexiform neurofibroma along the posterior aspect of the knee. There is interval increase in size of a 8.3 cm lesion along the lateral aspect of the popliteal fossa, which is incompletely characterized on this noncontrast examination, as described above.


Instruction: Generate impression based on findings.

Input: 42-year-old male with palpable loose body in the left knee MENISCI: The menisci are intact.ARTICULAR CARTILAGE AND BONE: Focal marrow signal abnormality at the posterior aspect of the lateral femoral condyle with focal area of loss of articular cartilage measuring approximately 2.4 cm in AP dimension. Moderate joint space narrowing. LIGAMENTS: The anterior cruciate ligament is intact. The posterior cruciate ligament is intact. The medial collateral ligament is intact. The lateral collateral ligament complex is intact. EXTENSOR MECHANISM: Extensor mechanism is intact.ADDITIONAL

Output: 1.Lesion in the suprapatellar fat pad. This may represent unusual synovitis such as PVNS. Cartilage also be considered although the lesion is unusual signal pattern for cartilage. Examination with intravenous contrast would be helpful.2.Focal loss of articular cartilage of the posterior aspect of the lateral femoral condyle with underlying marrow edema.


Instruction: Generate impression based on findings.

Input: Strong family history of pancreatic cancer. EUS June 2015 was normal. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal morphology, size, and enhancement. Hepatic steatosis. No focal lesion biliary ductal dilatation or vascular abnormality. Partially contracted gallbladder.SPLEEN: Normal splenic size without a focal lesion.PANCREAS: The pancreas is normal in morphology and signal intensity without pancreatic ductal dilatation or focal lesion.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Simple appearing right renal cyst. No hydroureteronephrosis or suspicious lesion.RETROPERITONEUM, LYMPH NODES: Duplicated IVC.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Lobular cystic lesion adjacent to a right mid lumbar facet joint extending into the paraspinal musculature, compatible with a synovial cyst measuring 2.3 x 2.2 cm.OTHER: No significant abnormality noted.

Output: 1.No discrete pancreatic lesion.2.Hepatic steatosis.


Instruction: Generate impression based on findings.

Input: 33-year-old male with a history of testicular carcinoma. Evaluate for recurrance. ABDOMEN: Lack of intravenous contrast limits evaluation for lymphadenopathy and of solid organs.LIVER, BILIARY TRACT: There is decreased T2 signal abnormality with associated loss of signal on in phase sequences throughout the liver and spleen, consistent with hemosiderosis.SPLEEN: There is decreased T2 signal abnormality with associated loss of signal on in phase sequences throughout the liver and spleen, consistent with hemosiderosis.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Atrophic right kidney. Focus of fluid signal intensity with peripheral decreased T1 and T2 signal abnormality likely represents a failed transplanted left iliac fossa kidney.Right iliac fossa transplant kidney in place. There is a small collection along the posterior margin of the superior pole of the transplant measuring 2.4 x 1.0 cm, consistent with the known history of hematoma, appearing decreased in size when compared to the prior study. Note is made of multiple linear and wedge-shaped foci of decreased T2 signal abnormality along the superior and inferior poles of the transplant kidney. Differential considerations include scarring, small infarcts and pyelonephritis. This is incompletely evaluated on this noncontrast examination. The ureter of the transplant kidney is difficult to evaluate secondary to extensive metallic susceptibility artifact from the surgical clips in the surrounding area, however, it appears to insert on the bladder.RETROPERITONEUM, LYMPH NODES: Prominent inguinal lymph nodes are nonspecific, but may be reactive.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Extensive collaterals are identified in the soft tissues overlying the abdomen and pelvis. Heterogeneous bone marrow signal abnormality.OTHER: No significant abnormality.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Prominent inguinal lymph nodes are nonspecific, but may be reactive.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: The left testicle is not visualized and may be surgically absent.OTHER: Right iliac fossa transplant kidney in place. There is a small collection along the posterior margin of the superior pole of the transplant measuring 2.4 x 1.0 cm, consistent with the known history of hematoma, appearing decreased in size when compared to the prior study. Note is made of multiple linear and wedge-shaped foci of decreased T2 signal abnormality along the superior and inferior poles of the transplant kidney. Differential considerations include scarring, small infarcts and pyelonephritis. This is incompletely evaluated on this noncontrast examination. The ureter of the transplant kidney is difficult to evaluate secondary to extensive metallic susceptibility artifact from the surgical clips in the surrounding area, however, it appears to insert on the bladder.

Output: 1.No convincing evidence of residual or recurrent disease on this noncontrast examination. Prominent inguinal lymph nodes are nonspecific but may be reactive in etiology.2.Scattered areas of signal abnormality in the right iliac fossa transplanted kidney are incompletely characterized on this noncontrast examination. Differential considerations include scarring and infarct. Pyelonephritis cannot be excluded and clinical correlation is indicated. 3.Small perinephric hematoma along the superior aspect of the right iliac fossa transplant kidney which appears similar to slightly decreased in size when compared to previous examinations.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate growth of secondary GBM. Patient on Avastin. Signs and symptoms: Secondary GBM. Pre and postcontrast enhanced brain MRI:Postoperative changes of a right frontal tumor resection and with resultant ex vacuo dilatation of the adjacent right lateral ventricle remains similar to prior study.Large focus of FLAIR hyperintensity anterior to the surgical cavity and along the right frontal cingulate gyrus measures nearly identical to prior exam and without convincing evidence of abnormal enhancement.Flair and T2 hyperintensity surrounding and within the right frontal horn demonstrate subtle interval increased size and with new evidence of enhancement since prior exam. Finding is highly suggestive of tumor.A second well demarcated masslike lesion with FLAIR hyperintensity along the posterior superior aspect of the resected cavity measures slightly larger in size since prior exam and with evidence of subtle mass effect. The largest AP axis of this lesion measures almost 27 mm compared to prior study measurement of 23. This change however could be secondary to slice positioning. This finding however demonstrate enhancement which is new since prior and best appreciated on axial post enhanced series 11 images 4 and 5. Constellation of findings are suggestive of tumor. Focus of hemorrhagic FLAIR hyperintensity along the interhemispheric aspect of the left hemisphere demonstrate evidence of mineralization and without change since prior exam. It however demonstrate subtle enhancement on post infused images which is more conspicuous on current study however not significantly changed when compared with earlier exams.

Output: 1.FLAIR and T2 hyperintensity surrounding and within the right frontal horn of lateral ventricle demonstrates subtle interval increased size and with evidence of new enhancement as detailed. Finding is suspected of tumor.2.Well-demarcated focus of FLAIR hyperintensity with restricted diffusion along the posterior superior aspect of the surgical cavity in the right frontal demonstrate evidence of new enhancement and suspected for tumor.3.Stable focus of FLAIR hyperintensity with mineralization and subtle enhancement along the interhemispheric aspect of the left frontal parietal lobe as detailed above.


Instruction: Generate impression based on findings.

Input: Clinical question: C2 lesion, colon cancer with metastases to spine. 6 months follow-up. Signs and symptoms: Evaluate for change, six-month follow-up. Pre- and post enhanced cervical MRI:Examination demonstrates uniform T1 hyperintense, T2 hyperintense and T2 STIR hyperintense vertebral bodies and the posterior elements of C1, C2 and C3 representing prior radiation change and without evidence of enhancement or interval change.There is revisualization of multiple foci of intraosseous enhancement in the vertebral bodies of C4, C5, C6, C7, T1, T2 and its posterior elements, posterior elements of T3 and posterior body of T4 on consistent with metastatic lesions. There is no extraosseous spread of tumor. There is minimal interval increase size of metastatic lesion in the vertebral body of C4 since prior exam measuring 11 mm in length compared to 9 mm on prior study (sagittal postcontrast enhanced series). No significant change in the size of the large C5 vertebral body metastatic lesion. There is interval size of metastatic lesion in dorsal aspect of the body of C6 vertebrae measuring approximately 11 mm in height compared to prior study measurement of 5 mm. Minimal increased size of metastatic lesion in the dorsal body of C7 measuring approximately 6 mm on current exam. Previously noted metastatic lesion in the posterior element of T3 also demonstrate interval noticeable increased size measuring at 16.5 mm in cranial cephalad axis compared to prior study measurement of 6 mm.Degenerative changes and resultant moderate central spinal stenosis at C3-C4 and with resultant focal myelomalacia remains stable since prior exam. There is no detectable enhancement of the cord or the leptomeninges.

Output: 1.Stable post radiation changes of C1, C2 and C3 without evidence of metastasis.2.Extensive additional metastatic lesions involving vertebral bodies and posterior elements from C4 through T2 which most demonstrate interval increased size as detailed/measured above.3.No detectable epidural spread of tumor. No abnormal meningeal enhancement.4.Moderate Central spinal stenosis at C3-C4 and associated cord myelopathy without change since prior exam. Degenerative changes at C7-T1 also results in mild central spinal stenosis which has remained stable since prior exam.


Instruction: Generate impression based on findings.

Input: Clinical question: Lesion. Signs and symptoms: Headaches No evidence of hemorrhage, mass effect, midline shift or hydrocephalus. There is subtle low-density surrounding the trigone of right lateral ventricle and extending into the right temporal lobe is again identified as was noted on MRI of brain from 12 -- 16 -- 2008. There is a slight ex vacuo dilatation of the trigone of right lateral ventricle. These findings all remain stable since prior CT examination dated 7 -- 8 -- 2008. Limited view of paranasal sinuses and mastoid air cells are unremarkable. Calvarium is intact.

Output: Stable examination since prior CT and with no acute findings.


Instruction: Generate impression based on findings.

Input: The spinal cord signal appears unremarkable. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. At C7-T1, there is a small left paracentral disc protrusion. There is no significant spinal canal stenosis. There are subcentimeter perineural cysts at the bilateral T8-9, right T9-10, bilateral T10-11, and right T11-12 levels. The largest measures 7 x 9 mm in the T11-12 right neural foramen with possible impingement of the T11 exiting nerve root. The spinal cord displays normal signal and morphology. Bilateral thyroid nodules are partially imaged.

Output: 1. No significant spinal canal stenosis or evidence of spinal cord lesions. 2. Multilevel subcentimeter perineural cysts in the lower thoracic spine, the largest of which is in the right T11-12 neural foramen with possible impingement on the T11 exiting nerve root. 3. Bilateral thyroid nodules. A thyroid ultrasound may be useful for further evaluation.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Disturbance of skin sensation [782.0], Reason for Study: ^Reason: paresthesia to left arm and left face new onset History: see above. Brain MRINo evidence of acute ischemic or hemorrhagic lesion on the scan.The ventricles, sulci and cisterns are symmetric and unremarkable. There is 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.There is about 12.6 mm x 4 mm sized extra-axial well marginated lesion attached on the inner table of the skull on the right hemisphere indicating possible calcified meningioma without showing any evidence of mass effect toward the adjacent brain structure.C-spine MRIThere is evidence of external fixation using plate and screws between C4-C5.Comparing to prior scan performed on March 4, 2015, kyphotic angulation of upper cervical spine from C2 to C6 appears to be slightly lessened.Previously recognized extensive degenerative changes as well as spinal cord syrinx at the level of C5 and C6-7 do not show any significant interval change.Spinal canal narrowing especially at the level of C4-5 appears to use to be lessened than prior scan.Neuroforaminal stenosis especially on the left side C45 appears to be slightly lessened, however, still shows mild to moderate stenosis.Otherwise no significant interval change in terms of degenerative changes of intervertebral discs of cervical spine since prior scan.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. Postoperative status of cervical spine in particular anterior fixation between C4-C5 with interval improvement of 1) upper cervical lordotic angle 2) the degree of spinal stenosis at the level of C45 and 3) the degree of neuroforaminal stenosis at the level of C45 left side.


Instruction: Generate impression based on findings.

Input: Benign neoplasm of brain, unspecified [D33.2], Reason for Study: ^Reason: Inflammatory pseudotumor; f/u progression History: headaches Redemonstration of left frontoparietal craniotomy with parasaggital dural based mass resection status, unchanged since prior scan.Previously seen left cerebral convexity dural thickening and enhancement lesion is again seen, unchanged since prior scan. Associated encephalomalacia with minimal susceptibility lesions indicate postoperative changes also do not show any interval change since prior scan. The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. About 6-7mm downward placement of cerebellar tonsils are again seen, unchanged since prior scan.Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses are clear.Bilateral mastoids show post-mastoidectomy changes with fluid collections on the left side indicating interval left mastoidectomy. No postoperative unusual finding.

Output: 1. Post left fronto parietal craniotomy status. Underlying dural thickening and enhancement on the left cerebral convexity as well as associated left frontoparietal encephalomalacia, unchanged since prior scan.2.No evidence of new abnormal enhancement. No acute ischemic or hemorrhagic lesion.3. Unchanged right mastoidectomy changes since prior scan. 4. Left side postmastoidectomy status, no postoperative unusual finding.5. Unchanged downward herniation of bilateral cerebellar tonsils.


Instruction: Generate impression based on findings.

Input: History of hysterectomy and right hepatectomy. Abdominal mass noted on prior CT. ABDOMEN:LIVER, BILIARY TRACT: Postoperative changes from right hepatectomy of known large hemangioma. There is associated edema and postsurgical changes adjacent to the resection bed without a suspicious lesion or drainable fluid collection. The remaining liver parenchyma has normal signal without a focal lesion.No intrahepatic or extrahepatic biliary ductal dilatation. Status post cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No upper abdominal lymphadenopathy.BOWEL, MESENTERY: Note is made of a duodenal diverticulum. Colonic diverticulosis.BONES, SOFT TISSUES: Postsurgical ventral abdominal wall changes.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: The previously described incompletely imaged soft tissue mass seen on CT 2/9/2016 anterior to the right psoas muscle corresponds to the right ovary with a punctate follicle. The ovary is normal in size and morphology. The patient is status post hysterectomy and left-sided salpingo-oophorectomy. Status post right salpingectomy.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative disc disease affects the lumbar spine most severe at L5-S1.OTHER: No significant abnormality noted.

Output: 1.Residual right ovary corresponds to the mass lesion described on the prior CT. The ovary is normal in morphology and size. No hydroureteronephrosis.2.Status post right hepatectomy with postsurgical changes in the hepatectomy bed.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate GBM, patient TMZ, Avestin, NovoTTF. Signs and symptoms: GBM. BMD. Pre and post enhanced brain MRI:Examination demonstrates mild interval decreased size of a large necrotic right hemispheric frontal GBM since prior exam and with decreased surrounding vasogenic edema since prior study. The largest transaxial dimensions of this necrotic tumor with thick irregular rim of enhancement are at 44 x 33 mm compared to prior study the measurements of 56 x 41 mm. Changes results in better visualization of right hemispheric cortical sulci and without evidence of midline shift.Several additional remote foci of FLAIR/T2 hyperintensity and enhancement in the corpus callosum and extensively in the left hemisphere demonstrate varying degrees of interval improvement and progression since prior study. For example a previously noted focus of enhancement in the posterior left occipital lobe which measured at 9 x 10 mm on prior exam has increased to 17 x 18 mm. A smaller additional focus of enhancement in the left occipital lobe which measured at 3.8 mm on prior exam has increased to approximately 9 mm current study. Focus of enhancement in the left anterior temporal lobe which measures 11 x 7 mm on prior exam demonstrates significant interval decreased size and measuring at approximately 8 x 5 mm on current study. Focus of enhancement in the immediate periventricular white matter of the left temporal lobe which measured at 6 mm in thickness has decreased and measuring 2.3 mm on current exam.Few of the additional remote foci of enhancement demonstrate interval improvement since prior study. Multiple transversely oriented rim-enhancing lesions in the corpus callosum demonstrate interval decreased size. The largest lesion in the anterior body of corpus callosum measuring approximately at 34 x 14 mm on prior exam has decreased to 33 x 7 mm in size.The ventricular system remains within normal size and midline is maintained. The CSF spaces/cisterns remain patent.There is no detectable new foci of FLAIR/T2 hyperintensity or new foci of abnormal enhancement since prior exam.

Output: 1.Interval decreased size and surrounding vasogenic edema and regional mass effect of a large right frontal GBM as detailed/measured about.2.Interval progression as well as interval improvement of multiple additional foci of enhancement consistent with multifocal focal GBM as detailed/measured above.


Instruction: Generate impression based on findings.

Input: Reason: posterior reversible encephalopathy syndrome History: seizure MRI of the brainNo diffusion weighted abnormalities are appreciated.There is T2 and flair signal hyperintensity present along the right occipital lobe at the cuneus and along the right parietal lobe at the precuneus and to a much lesser degree scattered along the left precuneus are areas of serpiginous flair signal hyperintensity present within the sulci of the right posterior temporal lobe.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mucosal thickening of the sphenoid sinuses. The visualized portions of the mastoid air cells are opacified. The patient is intubated. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm. There is mild narrowing of the mid basilar artery between the anterior/inferior cerebellar arteries and the superior cerebellar arteries . The right posterior cerebral artery is smaller than the left posterior cerebral artery. There is narrowing and dilations of the basilar artery associated with what appears to be attenuation of the distal posterior cerebral artery branches right more than left To a lesser degree there is suspicion for attenuation of the distal ACA and MCA vasculature. The A2 segment of the anterior cerebral arteries azygos. New right orbitofrontal artery comes off the right A1 segment. The posterior communicating arteries are not readily identified. The left vertebral artery is larger than the right vertebral artery.

Output: 1.Findings are suspicious for cerebral infarction involving the right cuneus and precuneus. 2.There is narrowing and dilations of the basilar artery associated with what appears to be attenuation of the distal posterior cerebral artery branches right more than left. To a lesser degree there is suspicion for attenuation of the distal ACA and MCA vasculature. Vasculitis or vasculopathy cannot be excluded.3.Patchy signal changes in the left precuneus are suggestive of a subacute infarction.


Instruction: Generate impression based on findings.

Input: 38-year-old male with decreased range of motion following direct trauma. Some of the images are limited by patient motion artifact.ROTATOR CUFF: The musculature and tendons the rotator cuff appear normal.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is a linear band of intermediate-to-high signal which traverses the posterosuperior labrum indicating a tear. Lower-intermediate signal intensity extends down the posterior labrum, which may reflect scarring of an old posterior labral tear. The anterior labrum appears intact. There is a mild focal depression of the posterolateral aspect of the humeral head, which may represent an old Hill-Sach deformity. Poorly defined foci of intermediate to low signal intensity within the subscapular recess may reflect focal synovitis.BICEPS TENDON: The tendon of the long head of the biceps appears normal.ADDITIONAL

Output: Findings compatible with a posterosuperior labral tear as described above.


Instruction: Generate impression based on findings.

Input: Female 80 years old Reason: 79 yo F with HCC, please evaluate for interval change compared to outside MRI dated 12/2/14. History: none Study is significantly limited due to motion artifact and lack of intravenous contrast.ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis. The liver parenchyma is diffusely heterogeneous and there is a nodular contour, caudate lobe hypertrophy and prominence of the hepatic fissures, consistent with cirrhosis. There is signal dropout on in phase images suggestive of iron deposition. T2 iso-/hypo-intense hepatic lesion measures 4.6 x 3.8 cm (series 8, image 10). The lesion is remeasured on prior study at 5.7 x 4.6 cm. Central T2 hyperintense signal /diffusion signal within the lesion is nonspecific and not significantly changed compared to prior study. Evaluation of this lesion is significantly limited in the absence of contrast.Evaluation for hepatocellular carcinoma is significantly limited in the absence of intravenous contrast however there are no additional areas of T2 signal hyperintensity or diffusion restriction to suggest new lesions.SPLEEN: Splenomegaly measuring 14.6 cm.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple bilateral renal cysts are stable.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Trace abdominal ascites.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Stable position of a cholecystotomy tube. Left upper quadrant collateral vessels are noted.

Output: 1.Limited study due to motion and the absence of intravenous contrast. Comparison with outside images demonstrates decrease in size of treated hepatic lesion. No new lesions are identified given the limitations.2.Cirrhotic liver morphology with splenomegaly and splenic varices.


Instruction: Generate impression based on findings.

Input: Metastatic lung cancer status post treatment. There is interval increase in size of the left inferior frontal gyrus and left lateral orbitofrontal gyrus peripherally enhancing lesions, measuring up to 13 mm and 18 mm, previously 10 and 16 mm, respectively. There is also interval increase in the degree of associated vasogenic edema. Furthermore, there appears to be a new 5 mm diameter lesion in the right posterior middle temporal gyrus. There is no evidence of acute infarct. There is a background of mild scattered cerebral white matter T2 hyperintensity, which may represent chronic small vessel ischemia. 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: Interval increase in size of the left frontal lobe metastases and associated edema. New lesion in the right posterior temporal lobe.


Instruction: Generate impression based on findings.

Input: Thoracic spine:There is mild anterior wedge deformity of T7 due to superior endplate compression, containing material which is hypointense on all sequences, consistent with the provided history of prior kyphoplasty.Marrow edema is noted involving the facet joints at T6/7, T7/8, and T8/9 bilaterally, extending into adjacent pedicles, due to facet degenerative hypertrophy. Facet hypertrophy is also noted more inferiorly, however without associated edematous marrow change.Modic type I discogenic reactive endplate change is noted at T6/7, T9/T10, T10/11, T11/12, and T12/L1.Other than the aforementioned T7 wedge deformity, the remaining vertebral body heights are maintained. The spinal cord is without focal atrophy, edema, or myelomalacia. There are no masses.T1/2 demonstrates no significant disc bulge or cord encroachment.T2/3 demonstrates no significant disc bulge or cord encroachment. T3/4 demonstrates no significant disc bulge or cord encroachment. T4/5 demonstrates no significant disc bulge or cord encroachment. T5/6 demonstrates no significant disc bulge or cord encroachment.T6/7 demonstrates diffuse annular disc bulge encroaching the anterior CSF space however without significant cord abutment or resulting stenosis. T7/8 demonstrates diffuse annular disc bulge with a superimposed small paramedian disc protrusion causing minimal anterior left hemicord flattening without intrinsic cord signal abnormality or resulting stenosis. T8/9 demonstrates diffuse annular disc bulge encroaching the anterior CSF space however without significant cord abutment or resulting stenosis. T9/10 demonstrates no significant disc bulge or cord encroachment.T10/11 demonstrates no significant disc bulge or cord encroachment. T11/12 demonstrates no significant disc bulge or cord encroachment. T12/L1 demonstrates trace retrolisthesis T12 on L1, diffuse annular disc bulge encroaching the anterior CSF space however without significant cord abutment or resulting stenosis. Lumbar spine:Alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign. The conus is normal in signal and morphology and terminates at an appropriate level. The visualized intra-abdominal and paraspinal contents are unremarkable.Disc desiccation is present throughout somewhat sparing the L5/S1 disc level. Mixed Modic discogenic reactive endplate changes are present at L3/4 and L4/5.L1/2: Mild disc bulge without stenosisL2/3: Mild disc bulge and mild bilateral facet hypertrophy without stenosisL3/4: Diffuse annular disc bulge, ligamentum flavum thickening, moderate bilateral facet hypertrophy, and tiny bilateral facet effusions. There is minimal bilateral neural foraminal stenosis.L4/5: Diffuse annular disc bulge, ligamentum flavum thickening, moderate left facet hypertrophy, and moderate to severe right facet hypertrophy. There is mild central, mild left lateral recess, moderate right lateral recess, and moderate bilateral neural foraminal stenosis.L5/S1:Mild disc bulge, mild left facet hypertrophy, and moderate right facet hypertrophy. There are no stenoses.SI Joints: Bridging marginal osteophytes are consistent with mild osteoarthritic degenerative change

Output: 1.There is mild anterior wedge deformity of T7 due to superior endplate compression, containing material which is hypointense on all sequences, consistent with the provided history of prior kyphoplasty.2.L3/4: Minimal bilateral neural foraminal stenosis.3.L4/5: Mild central, mild left lateral recess, moderate right lateral recess, and moderate bilateral neural foraminal stenosis.


Instruction: Generate impression based on findings.

Input: Elevated PSA. PELVIS:PROSTATE:Prostate Size: 4.7 x 5.5 x 4.4 cmPeripheral Zone: In the left mid gland to apex there is a wedge-shaped region of T2 weighted hypointensity measuring 1.4 x 1.2 cm (series 901/12) which is associated with restricted diffusion (series 704/184) and arterial enhancement.Central Gland: 5 mm well-defined focus of restricted diffusion (series 704/284) with associated T2-weighted hypointensity in the left mid-gland transition zone may represent a BPH nodule and less likely a small focus of prostatic adenocarcinoma. Benign prostatic hyperplasia.Seminal Vesicles: No evidence of seminal vesicle invasion. Left seminal vesicle T2-weighted hypointensity may be post-treatment related.Extracapsular Extension: No evidence of extraprostatic extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.4 cm lesion in the left mid gland to apex may reflect a site of prostatic adenocarcinoma. Additional non-specific left mid-gland 5 mm focus may represent a small focus of carcinoma verus a BPH nodule.No evidence of seminal vesicle invasion, extraprostatic extension or pelvic lymphadenopathy.


Instruction: Generate impression based on findings.

Input: Reason: Outside Request: anterior instability left shoulder spastic quadriplegia; labral tear Evaluation is limited by metallic susceptibility artifact due to orthopedic hardware overlying the posterior aspect of the glenoid.ROTATOR CUFF: The supraspinatus and infraspinatus tendons appear intact. The teres minor and subscapularis tendons appear intact.SUPRASPINATUS OUTLET: There is trace fluid within the subacromial/subdeltoid bursa of doubtful clinical significance. The acromioclavicular joint is normal in appearance.GLENOHUMERAL JOINT AND GLENOID LABRUM: Evaluation of the glenoid and glenoid labrum is limited as described above. The anterior third of the glenoid appears deformed with slight angular depression of the articular surface, however, we are not certain to what degree this represents a true anatomic deformity or deformity related to the aforementioned metallic susceptibility artifact. The anterior inferior labrum appears enlarged which may represent a compensatory phenomenon. Although no gadolinium is seen separating the labrum from the underlying glenoid, the margins of the hypertrophied labrum are slightly irregular perhaps reflecting chronic degeneration. Furthermore, the articular cartilage of the anterior inferior glenoid is abnormally thickened and irregular with low signal intensity which also may represent a combination of degeneration and labral overgrowth. The posterior inferior labrum is difficult to evaluate due to metallic susceptibility artifact. The superior labrum appears intact. The glenohumeral joint capsule is patulous.BICEPS TENDON: The tendon of the long head of the biceps appears intact.

Output: 1. Limited study due to metallic susceptibility artifact from the patient's orthopedic hardware as described above.2. Deformity of the anterior inferior glenoid as described above which may reflect a peculiar dysplasia or the sequela of prior trauma/surgery. Although we see no fluid-filled tear of the labrum, the anterior inferior labrum appears thickened and irregular which may reflect a combination of chronic degeneration and scarring. Other findings as described above.


Instruction: Generate impression based on findings.

Input: 37 years Female (DOB:12/14/1978)Reason: Evaluate for lumbar epidural steroid injection, eval for herniated disc/ osseus mets History: lumbar painPROVIDER/ATTENDING NAME: MAGDALENA ANITESCU BENJAMIN DOMB Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment. There is some loss of vertebral body height present at L1 and L2 associated with some T2 signal hyperintensity within the L1 and L2 vertebral bodies.. The conus medullaris on sagittal imaging is grossly intact. There is diffuse marrow replacement presentAt L5-S1 there is loss of disc space height, disc desiccation and diffuse disc bulge associated with endplate reactive changes which are bright on T2 and dark on T1. Although the neural foraminal are narrowed, within the neural foramina the exiting nerve roots are surrounded by fat.At L4-5 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.There is diffuse marrow replacement present which could be related to patient's known lymphoma.2.There are compression fractures present at L1 and L2 which appear to be subacute.3.There are degenerative changes present in the lumbar spine worse at L5-S1 where there is some narrowing of the neural foramina. There is no significant compromise to the spinal canal or exiting nerve roots as a result of degenerative changes.4.The examination is incomplete due to patient's inability to complete the exam as a result of anxiety. This may result in a lower detection rate of underlying abnormalities within the lumbar spine.