Instruction: Generate impression based on findings.

Input: History of brain tumors, exact pathology unknown, and a ventriculoperitoneal shunt now presenting with headaches. There are post surgical changes related to a prior right parieto-occipital craniotomy. Immediately subjacent to the craniotomy flap there is a cystic collection in the right occipital lobe measuring 16 x 16 x 20 mm presumably reflecting a surgical resection bed. There is no associated enhancement or solid componentIn addition there is a right frontal approach ventriculostomy catheter with tip approaching midline at the level of the third ventricle. There is a small volume of gliosis along the ventriculostomy catheter tract. The ventricles are decompressed and somewhat slitlike in appearance.No foci of abnormal enhancement or mass lesions are evident. There are scattered periventricular and subcortical white matter foci of increased T2 signal compatible with mild chronic small vessel ischemic disease.No evidence of acute ischemic infarct or acute hemorrhage.The expected intracranial vascular flow voids are present. There is opacification of the right ethmoid air cells as well as mucosal thickening in the bilateral maxillary sinuses. Trace fluid in the mastoid air cells bilaterally. The orbits are unremarkable.

Output: 1. Postsurgical findings from prior right parieto-occipital craniotomy. Immediately subjacent to the craniotomy flap is a cystic collection presumably reflecting the resection cavity. There is no definitive evidence of recurrent or residual tumor, but comparison with prior imaging would be helpful.2. Right frontal ventriculostomy catheter in appropriate position. The ventricles are decompressed and somewhat slitlike in appearance.3. Mild chronic small vessel ischemic changes in the periventricular and subcortical white matter.4. Scattered paranasal sinus opacification; correlate with symptoms of sinusitis.


Instruction: Generate impression based on findings.

Input: 68 year old male with metastatic renal cell cancer and known mets to lung and liver. Rule out biliary tree obstruction. Jaundice, elevated LFTs This examination is limited by absence of IV contrast. CHEST:LUNGS AND PLEURA: Large right and moderate left pleural effusions with associated compressive atelectasis. Mild cardiomegaly. Pulmonary nodules are suspicious for diffuse metastases. MEDIASTINUM AND HILA: Cardiomegaly. CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Questionable hypoechoic lesion in the inferior right hepatic lobe. The lesion measures 7.5 cm in diameter at axial image 103 of series 3. MRI, even an exam without contrast, may be helpful for further evaluation. Hepatomegaly. SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Status post left nephrectomy. Large amount of metal streak artifact in the left perirenal region due to numerous large surgical clips in that area obscures local details. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Small amount of ascites. PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Bilateral pleural effusions. Lung nodules are suspicious for metastases. Ascites. Questionable large lesion in right hepatic lobe, may be further evaluated with MRI/MRCP, if indicated.


Instruction: Generate impression based on findings.

Input: There is normal ventricular size with no evidence of mass effect or edema. There no evidence of bleed. No midline shift. There is normal gray-white white matter differentiation. There is no abnormal signal in the hippocampus bilaterally. On the susceptibility images there is branching linear low signal in the left cerebellar hemisphere, consistent with developmental venous anomaly. There is no restricted diffusion abnormality. The vascular flow voids are normal.There is asymmetric pneumatization of the right petrous apex.

Output: Essentially unremarkable MRI of the brain.


Instruction: Generate impression based on findings.

Input: Reason: eval for tibial tubercle fx vs ocd History: knee pain for 1.5 years worse with sports; intermittent swelling MENISCI: The medial and lateral menisci are normal.ARTICULAR CARTILAGE AND BONE: There is a focal T1 signal hypointensity in the posterior aspect of the medial femoral condyle which measures 6 x 6 x 14 mm, which is compatible with an osteochondral defect. There is no surrounding bone marrow edema, suggesting this injury is likely chronic. The overlying articular cartilage is mildly thinned. The articular cartilage elsewhere in the knee is normal.LIGAMENTS: The anterior and posterior cruciate ligaments are intact. The medial collateral ligament and lateral collateral ligament complex are intact. EXTENSOR MECHANISM: The extensor mechanism is normal.ADDITIONAL

Output: Grade IIB osteochondral defect along the posterior aspect of the medial femoral condyle. There is no associated bone or soft tissue edema, indicating the lesion is chronic.


Instruction: Generate impression based on findings.

Input: Anosmia x 9 months. There is mild mucosal thickening and secretions within the left ethmoid sinuses and left middle meatus. There is slight deviation of the nasal septum towards the right. There is a right concha bullosa. The olfactory bulbs appear to be grossly intact. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is a nonspecific subcentimeter focus of T2 hyperintensity in the left superior frontal gyrus. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. Apparent mild mucosal thickening and secretions within the left ethmoid sinuses and left middle meatus. Further evaluation via a sinus CT may be useful if clinically indicated.2. The olfactory bulbs appear to be grossly intact, without evidence of mass lesions in the anterior cranial fossa.3. Nonspecific subcentimeter focus of signal abnormality in the left superior frontal gyrus.


Instruction: Generate impression based on findings.

Input: 51-year-old female with pain and swelling in the right index finger. Evaluate for tenosynovitis versus chronic fluid collection or osteomyelitis There is nonspecific soft tissue edema involving the index finger with slight thickening of the skin. There is edema and enhancement of the underlying subcutaneous fat. There is also enhancement of the nail bed. There are small foci of low signal intensity within the soft tissues along the radial aspect of the distal phalanx which are nonspecific but could represent small foreign bodies, which were not seen recent radiographs. Mild enhancement of the synovium of the flexor tendon apparatus is suggestive of mild tenosynovitis. There is mild enhancement of the synovium of the PIP joint of the index finger suggestive of mild synovitis, although we see no frank fluid within the joint. We see no frank fluid collection nor do we see bone marrow signal abnormality to suggest osteomyelitis.

Output: Nonspecific inflammatory changes of the finger as described above. Small foci of low signal intensity within the soft tissues adjacent to the phalanx could represent foreign bodies but were not seen on recent radiographs and could also represent small foci of gas or small foci of hemosiderin from prior bleeding. We see no abscess or osteomyelitis.


Instruction: Generate impression based on findings.

Input: Clinical question: Preop planning study. Signs and symptoms: Brain tumor. Preoperative planning study. Pre- and post enhanced Stealth brain MRI:Examination is performed utilizing surgical planning protocol and is not a true complete diagnostic study.Examination redemonstrates a partially solid and cystic enhancing intra-axial in the right anterior and mid temporal lobe. The well-demarcated superficial solid component of the mass demonstrate inhomogeneous enhancement and measuring maximum of 19 x 38 x 44 mm in size. Immediately medial to the solid component of the mass there is a large minimally septated cystic and nonenhancing component measuring at least at 47 x 40 mm in transaxial dimensions. There is resultant significant mass effect on the temporal horn of lateral ventricle. Posteriorly the mass reaches the trigone of right lateral ventricle and with bulge of the cystic component of tumor into the right trigone of the lateral ventricle which is best appreciated on prior noncontrast study. There is also subtle mass effect on the right lateral ventricle however without evaluation of midline and widely patent basal cisternsA punctate focus of enhancement noncontiguous with the tumor in the right temporal lobe (axial post enhanced series 501 image 103 coronal post enhanced series 701 image 20. Images through posterior fossa on post enhanced series demonstrate a multi branch vascular enhancement in the right cerebellum consistent with a developmental venous anomaly

Output: 1.Partially solid and enhancing with a large nonenhancing cystic component mass in the right anterior and mid temporal lobe as detailed above.2.There is bulge of the cystic component of tumor into the trigone of right lateral ventricle as detailed.3.Small developmental venous anomaly in the right cerebellum as detailed.4.A noncontiguous punctate focus of enhancement immediately anterior to the mass in the right anterior temporal lobe as mentioned.


Instruction: Generate impression based on findings.

Input: Male, 76 years old, with subdural hemorrhage. Evaluate for structural lesions. A T1 hyperintense, susceptibility inducing subdural collection is evident along the left parietal lobe with smaller quantities along the left occipital and temporal lobes as well. The collection measures up to 10 mm in thickness which is not significantly changed from prior CT. No new areas of hemorrhage are suspected.Extensive patchy periventricular T2 hyperintensity is seen. No edema or mass effect is detected. The sulci are prominent compatible with underlying parenchymal volume loss. The ventricles are within normal limits. Marrow signal of the calvarium is unremarkable.

Output: Redemonstration of a subacute subdural hematoma predominantly located along the left parietal lobe with smaller quantities present along the left occipital and temporal lobes. No significant interval change in size is seen. No associated or underlying lesions are detected.


Instruction: Generate impression based on findings.

Input: Female, 55 years old, history of compression fracture of T11 of unclear etiology, assess for underlying malignancy. History of sarcoid. The thoracic kyphosis is perhaps mildly exaggerated, but the curvature is smooth and vertebral body alignment is within normal limits. Very slight anterior wedging of the lower thoracic vertebral bodies is seen, including the T11 vertebral body. The degree of wedging is mild and within the limits of normal variation. No evidence of marrow edema is seen to suggest an acute fracture.There are small right paracentral disk protrusions at T6-7 and T7-8. Mild disk bulging with a right foraminal and far lateral protrusion is seen at T11-12 with right-sided foraminal narrowing at this level. No significant spinal canal stenosis is seen.The spinal cord demonstrates normal morphology and signal characteristics throughout.Partially visualized soft tissue structure within the lower mediastinum may represent a hiatal hernia.

Output: No evidence of vertebral body compression fracture is seen. Slight anterior wedging of several lower thoracic vertebral bodies, including the T11 vertebral body, is within the limits of normal variation. No marrow edema is detected.


Instruction: Generate impression based on findings.

Input: 24-year-old male with history of tumor resection presents with headache; evaluate for subarachnoid hemorrhage There is a periaqueductal mass, with lymphoplasmacytic histology, that shows interval enlargement from the previous CT on 9/11/2008 now measuring 33 x 30 mm (image 12, series 2) as compared to the previous measurement of 23 x 20 mm. However, there is no significant change compared to the MRI study on 10/12/2009. Again seen is a right ventriculostomy tube that extends to the body of the right lateral ventricle.There is no evidence of intracranial hemorrhage or acute hydrocephalus. The ventricles and basal cisterns are normal in size and configuration.Postsurgical changes from a right frontal craniotomy are again noted. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Periaqueductal mass whose pathology is suggestive of lymphoplasmocytic neoplasmventriculostomy as described above. No acute intracranial hemorrhage or hydrocephalus.


Instruction: Generate impression based on findings.

Input: Headaches. Chiari malformation. Low levels of thyrotropin. BRAIN:The cerebellar tonsils are peg-shaped and extend to 11 mm below the level of foramen magnum, resulting in crowding at this level with near complete obliteration of the CSF space at the level of the cervicomedullary junction. Of note, the odontoid process is mildly retroflexed.There is no dilatation of the ventricles. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is a developmental venous anomaly in the left frontal lobe, which is a common incidental finding. Otherwise, the brain parenchyma is unremarkable and there is no abnormal intracranial enhancement. There is no midline shift. The major cerebral flow voids are intact. There is trace mucosal thickening in the maxillary and anterior ethmoid sinuses.CSF flow study shows preserved anterior but no posterior CSF flow at the level of foramen magnum. Immediately below the level of foramen magnum, there is preserved anterior and posterior CSF flow.PITUITARY:The pituitary gland is normal in size. It shows homogenous contrast enhancement without definite focal lesion. Pituitary infundibulum is normal thickness and midline. The optic chiasm and hypothalamus are unremarkable. The cavernous sinuses are symmetric and unremarkable as well.

Output: 1.Chiari I malformation with attenuated CSF flow dorsally at the level of foramen magnum as described above, but no ventricular dilatation. The odontoid process is mild retroflexed.2.Left frontal developmental venous anomaly, which is a common incidental finding. The brain is otherwise unremarkable.3.Normal pituitary MRI without definite focal lesion.


Instruction: Generate impression based on findings.

Input: Female 26 years old Reason: Crohns disease, evaluate small bowel for stenosis History: - ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The patient is status post colectomy and right lower quadrant end ileostomy.Long segment multifocal bowel wall thickening, mucosal hyperenhancement, engorgement of the vasa recta and luminal narrowing, with associated prestenotic dilatation affecting the distal ileum. The area of wall thickening and luminal narrowing just proximal to the prestenotic dilatation (series 12/62) persists on all phases, raising concern for an underlying stenosis. There is adjacent fibrofatty proliferation suggesting acute on chronic inflammation. The entire length is difficult to determine but is estimated to be on the order of approximately 20 cm.There is an additional short segment of mucosal hyperenhancement and luminal narrowing in a more distal segment of ileum (series 13/65), consistent with active inflammation.Prominent mesenteric lymph nodes are again seen about the areas of active inflammation, which are presumably reactive.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Findings compatible with long segment multifocal acute on chronic inflammation of the ileum as detailed above, as well as an additional more remote short segment of active inflammation in the distal ileum. 2.Focal wall thickening and luminal narrowing resulting in prestenotic dilatation, which may be due to acute inflammation, although raising concern for an underlying stenosis.


Instruction: Generate impression based on findings.

Input: Female 72 years old Reason: eval for possible right meniscus tear History: + McMurray with painful mechanical symptoms MENISCI: There is a complete degenerative tear of the lateral meniscus including the anterior horn, body and posterior horn. There is mild meniscal extrusion.The medial meniscus shows some intrasubstance degeneration in its posterior horn but no discrete tear is evident.ARTICULAR CARTILAGE AND BONE: Full-thickness cartilage loss involving the lateral compartment with subchondral marrow edema involving the lateral femoral condyle and lateral tibial plateau.In the medial compartment, there is diffuse chondral thinning and foci of full-thickness cartilage loss.Foci of cartilage loss involving the medial patellar facet.LIGAMENTS: The anterior and posterior cruciate ligaments are intact. The collateral ligaments and lateral collateral ligamentous complex are intact. EXTENSOR MECHANISM: There is mild prepatellar soft tissue swelling.ADDITIONAL

Output: 1.Degenerative tearing of the lateral meniscus with full-thickness cartilage loss in the lateral compartment.2.Joint effusion and synovitis.


Instruction: Generate impression based on findings.

Input: Neck pain and arm weakness, Spinal stenosis, cervical region [M48.02] Examination is limited by motion artifact.There is accentuated lordosis at the C7 level. The vertebral body heights are maintained. Heterogeneous marrow signal is demonstrated throughout the cervical spine, similar to prior examination. There is a 0.4 cm T2 hyperintense lesion involving the T2 spinous process, new since prior examination. The cervical spinal cord demonstrates normal caliber with normal signal intensity. No significant spinal canal stenosis is appreciated.C2-C3: Shallow disc-osteophyte complex and left more than right uncovertebral joint and facet arthropathy. There is mild left neural foramen narrowing. There is no significant spinal canal or right neural foraminal narrowing. These findings are unchanged.C3-C4: Disc osteophyte complex as well as uncovertebral and facet arthropathy result in moderate left and moderate to severe right progressive neural foraminal narrowing. There is also mild central canal narrowing.C4-C5: Disc osteophyte complex as well as uncovertebral and facet arthropathy result in moderate right and left neural foraminal narrowing. There is also mild central canal narrowing. These findings are unchanged.C5-C6: Disc osteophyte complex as well as uncovertebral and facet arthropathy result in moderate left and mild right neural foraminal narrowing. There is also mild central canal narrowing. These findings are unchanged.C6-C7: Shallow disc osteophyte complex as well as left more than right uncovertebral and facet arthropathy result in moderate-to-severe left and mild right neural foraminal narrowing. There is no significant central canal narrowing. These findings are unchanged.C7-T1: There is no significant disc herniation. There is uncovertebral and facet arthropathy resulting in moderate bilateral neural foraminal narrowing. There is also ligamenta flava thickening. These findings are unchanged.

Output: 1. Multilevel spondylosis of the cervical spine most severe at C3-C4 level where there is moderate left and moderate to severe right neuroforaminal stenosis, progressive since prior examination dated 10/2015.2. A new 0.4 cm lesion involving the T2 spinous process is suspicious for metastatic disease or myelogenous deposit.


Instruction: Generate impression based on findings.

Input: 41-year-old female with history of leiomyoma of the uterus who presents for evaluation. PELVIS:UTERUS, ADNEXA: There are multiple large T2 heterogeneous, avidly enhancing subserosal and pedunculated lesions ranging from 1 cm to approximately 6 cm. The largest on the left measures 5.5 x 5.1 x 5.2 cm; findings compatible with leiomyomas.Bilateral adnexal T2 hyperintense foci are noted most compatible with physiologic cysts.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Multiple enhancing uterine leiomyomas.


Instruction: Generate impression based on findings.

Input: 72 year old with history of coronary artery disease, dyslipidemia and apical hypertrophic cardiomyopathy presenting for evaluation for cardiac function and scar. Left VentricleThe left ventricle is normal in size and ventricular function. LV ejection fraction is 66%, the LV end diastolic volume index is 94 ml/m2 (normal range: 74+/-15), the LVEDV is 173 ml (normal range 142+/-34), the LV end systolic volume index is 32 ml/m2 (normal range 25+/-9), the LVESV is 59 ml (normal range 47+/-19), the LV mass index is 66 g/m2 (normal range 85+/-15), and the LV mass is 121 g (normal range 164+/-36). There is apical hypertrophy which results in obliteration of the apical 1/3 of the ventricle in systole. Associated enhancement of the hypertrophied segments.No intracardiac thrombus.Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 60%, the RV end diastolic volume index is 103 ml/m2 (normal range 82+/-16), the RVEDV is 189 ml (normal range 142+/-31), the RV end systolic volume index is 41 ml/m2 (normal range 31+/-9), and the RVESV is 75 ml (normal range 54+/-17). No right ventricular hypertrophy or enhancement.Right AtriumThe right atrium is mildly dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a three vessel arch. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no pericardial effusion.

Output: 1. Normal left ventricular size and function (LVEF 66%). There is apical hypertrophy with obliteration of the apical cavity at systole. Enhancement of the apical hypertrophic segments consistent with fibrosis. 2. Normal right ventricular size and function (RVEF 60%). No evidence of apical hypertrophy.3. Mild biatrial enlargement.


Instruction: Generate impression based on findings.

Input: Diagnosis: Demyelinating disease of central nervous system, unspecifiedClinical question: evaluate for demyelination The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a moderate degree of periventricular white matter lesions and subcortical white matter lesions. Many of the periventricular lesions are perpendicularly oriented to the lateral ventricles. These are stable when compared to the previous exam. No abnormal enhancing lesions are appreciated within the brain parenchyma. There is also lesion redemonstrated in the right middle cerebellar peduncle.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits demonstrate distorted shape of a small size. There is a fluid fluid level in the right eye. The patient is status post ocular surgery.

Output: 1.There is a moderate degree of periventricular white matter lesions and subcortical white matter lesions as well as a right cerebellar lesion all of which were present on the prior exam and have not changed. There is no convincing evidence for acute plaque formation.2.The eyes are distorted in appearance and a small. Please correlate with clinical history.


Instruction: Generate impression based on findings.

Input: Male, 63 years old, with radiating right lower extremity pain and numbness. Spinal alignment is anatomic. Vertebral body heights are preserved. Marrow signal characteristics are heterogeneous. Signal abnormality and enhancement are seen along the L4 superior endplate compatible with a Schmorl's node. Scattered additional nonenhancing Schmorl's nodes are also seen. Small enhancing foci along the superior L2 endplate are nonspecific but likely benign.The visualized distal spinal cord and conus are within normal limits. No epidural abnormalities are suspected. No pathologic intraspinal enhancement is seen.L1-2: Bulging disc. Mild generalized spinal canal narrowing. No significant foraminal narrowing. L2-3: Facet arthropathy and ligamentum flavum thickening. Bulging disc. Moderate generalized spinal canal narrowing with slight crowding of the cauda equina. Mild bilateral foraminal narrowing. L3-4: Facet arthropathy and ligamentum flavum thickening. Bulging disc. Moderate to severe spinal canal narrowing with crowding of the cauda equina. Mild bilateral foraminal narrowing. L4-5: Facet arthropathy and ligamentum flavum thickening. Bulging disc. Severe generalized spinal canal narrowing with crowding and likely impingement of the cauda equina. Moderate bilateral foraminal narrowing. L5-S1: Facet arthropathy left worse than right, and ligamentum flavum thickening. Bulging disc asymmetric to the left. Effacement of the left lateral recess and moderate generalized spinal canal narrowing. Moderate left and mild right foraminal narrowing.

Output: Multilevel disc and posterior element degeneration is seen. This results in a severe spinal canal stenosis at L4-5 and a moderate to severe stenosis at L3-4.


Instruction: Generate impression based on findings.

Input: There are extensive osseous metastases, some with soft tissue components extending into the epidural space and neural foramina, particularly involving the thoracic spine and at L4. There is severe central stenosis with cord compression at T5/6, T6/T7, and T8/9 without convincing evidence of cord edema.Moderate degenerative disease of the lower cervical spine with ventral effacement of the thecal sac and cord deformity. Questionable increased T2 signal in the anterior cord at C5/6 may reflect mild edema versus artifact. It is notable that at this level CSF is maintained posteriorly.Greater than 25% height loss of T8 vertebral body, present on chest x-ray two days prior.

Output: 1.There are extensive osseous metastases, some with soft tissue components extending into the epidural space and neural foramina.2.There is severe central stenosis with cord compression at T5/6, T6/T7, and T8/9 without convincing evidence of cord edema.3.Segment-specific MRI is recommended if symptomology localizes.


Instruction: Generate impression based on findings.

Input: Clinical question: Status post untethering. Signs and symptoms: Status post untethering. Nonenhanced lumbar MRI:Examination was terminated after a severely motion artifact degraded sagittal T1-weighted series was obtained due to patient's severe pain and discomfort.Acquired suboptimal image demonstrate no acute finding when compared with prior.

Output: Aborted exam due to patient's severe pain and discomfort. Only a nearly nondiagnostic sagittal T1-weighted series was obtained.


Instruction: Generate impression based on findings.

Input: Primary CNS lymphoma status post chemotherapy and radiation. There are findings related to right transfrontal biopsy. There is no evidence of abnormal intracranial enhancement. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are unchanged punctate foci of encephalomalacia in the right cerebellar hemisphere, which likely represent chronic infarcts. There are unchanged nonspecific patchy areas of T2 hyperintensity in the cerebral hemisphere white matter. The ventricles are unchanged in size and configuration. There is no midline shift or herniation. There is a persistent left maxillary sinus retention cyst. There is also persistent minimal fluid and mucosal enhancement in the bilateral mastoid air cells.

Output: Stable post-treatment findings without evidence of CNS lymphoma recurrence.


Instruction: Generate impression based on findings.

Input: The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. There are numerous bilateral foci of T2/FLAIR hyperintensity in the subcortical and periventricular white matter as well as in the bilateral basal ganglia and left cerebellum, suggestive of moderate age-indeterminate small vessel ischemic disease, appearing similar to slightly increased compared to prior examination. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain.

Output: 1.No evidence of intracranial metastases.2.Moderate age-indeterminate small vessel ischemic disease appears similar to slightly increased compared to prior examination.


Instruction: Generate impression based on findings.

Input: 20 year-old female with knee pain for one to two years MENISCI: The medial and lateral menisci are within normal limits.ARTICULAR CARTILAGE AND BONE: The articular cartilage appears normal. Bone marrow signal is within normal limits throughout.LIGAMENTS: The cruciate and collateral ligaments are intact. Specifically, the lateral collateral ligament proper and iliotibial band appear normal.EXTENSOR MECHANISM: The quadriceps and patella tendons appear intact.

Output: Normal knee without specific findings to explain the patient's pain.


Instruction: Generate impression based on findings.

Input: Right lower extremity weakness and radiating pain. Evaluate nerve root and for lumbar stenosis. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is mild straightening of the lumbar spinal curvature. Alignment is otherwise within normal limits. Bone marrow signal is heterogeneous which is nonspecific but without discrete suspicious osseous lesions. The conus medullaris is normal in position. No abnormal enhancement. Small sacral perineural cyst incidentally noted at the right S2 level. Individual levels described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: No significant disc disease. No spinal canal or neural foraminal stenosis.L4-L5: Small dorsal annular fissure. Otherwise no significant disc disease. No spinal canal or neural foraminal stenosis.L5-S1: Disc desiccation with small dorsal annular fissure and trace bulge eccentric to the right. There is minimal contact of the right S1 nerve root with the disc without clear evidence of impingement. No central canal or neural foraminal stenosis.Paraspinous soft tissues are within normal limits. Multiple bilateral renal cysts are partially imaged.

Output: Minimal degenerative changes in the lumbar spine as described above. There is minimal contact of the right S1 nerve root related to trace disc bulge at the L5-S1 level without obvious impingement. There is otherwise no significant spinal canal or neural foraminal stenosis at any level. No abnormal enhancement.


Instruction: Generate impression based on findings.

Input: Clinical question: Rule out bleed. Signs and symptoms: History of mass. Non-enhanced CT of brain:Examination demonstrates a high density extra axial mass along the clivus and dorsum sella. This mass abuts the clivus however no definitive bony changes of the clivus. The mass is well-demarcated and measures 26-mm in cranial cephalad axis and 12.4-mm in AP axis on sagittal reformatted image 26. On axial image 9 the largest transaxial dimension of this tumor are 16.8 x 19.2-mm.superior A. the mass projects into the basal cistern and inferiorly in mid section of clivus. There is no evidence of any edema of brain parenchyma associated with this mass. Subtle mass effect on the pons and posterior displacement is noted. The exact etiology of this finding is not clear. The mass is not correctly state of any particular tumor. Differentials could include a hamartoma, mesenchymal type tumor, neuroepithelial cysts, aneurysm as well as less likely possibility of a meningioma. Follow-up with an enhanced MRI examination is recommended. There is normal density and morphology of brain parenchyma and no evidence of hemorrhage, edema, midline shift or hydrocephalus. The gray -- white matter differentiation is well preserved.

Output: 1.Nonspecific extra axial mass in the prepontine cistern extending along the clivus and superiorly terminates and is inseparable from the floor of the third ventricle. Follow-up with an MRI exam is recommended. There is no associated parenchymal edema.2.Unremarkable CT examination of brain otherwise.


Instruction: Generate impression based on findings.

Input: 35-year-old male with history of ulcerative colitis with primary sclerosing cholangitis/cirrhosis. Evaluate for stricture. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic hepatic morphology with areas of T2 hyperintensity and heterogeneous arterial enhancement, which is increased in conspicuity compared to previous examination. This area near the caudate lobe demonstrating the T2 hyperintensity appears to be bulging the capsule mildly. However, the vasculature in this region courses through the abnormal signal and enhancement without attenuation.Again noted is multifocal irregular intra and extra hepatic biliary ductal strictures compatible with the stated history of PSC. The right and left intrahepatic ducts are again poorly seen proximal to the Klatskin point. Common bile duct is patent and noted to be attenuated proximally.SPLEEN: Splenomegaly with the spleen measuring approximately 20 cm, increased from 18 cm. Splenic varices are noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Persistent nonspecific mild periportal lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Stable findings compatible with primary sclerosing cholangitis without significant interval change in the biliary system.2.Heterogeneous T2 signal of the hepatic parenchyma as well as arterial contrast enhancement which is more conspicuous compared to previous examination as detailed. Differential considerations include cirrhotic changes from regenerating liver versus perfusional abnormality.3.Worsening splenomegaly, likely secondary to worsening cirrhosis related changes.


Instruction: Generate impression based on findings.

Input: 55 year old man with paroxysmal atrial fibrillation, non ischemic cardiomyopathy, referred for further evaluation of inducible ischemia and pre atrial fibrillation ablation planning.MEDICATIONS: Lisinopril, Toprol XL, Xarelto, Multaq First Pass PerfusionDuring hyperemia, no perfusion defects were present.Viability/ Myocardial ScarThere is no obvious late gadolinium enhancement to suggest an underlying myocardial fibrosing, infiltrative, or inflammatory process. No evidence of prior myocardial infarction. The myocardial is viable. Left VentricleThe left ventricle is normal in size (when adjusted for body surface area) with moderately reduced systolic function. The overall LV ejection fraction is 34%, the LV end diastolic volume index is 76 ml/m2 (normal range: 74+/-15), the LVEDV is 200 ml (normal range 142+/-34), the LV end systolic volume index is 50 ml/m2 (normal range 25+/-9), the LVESV is 131 ml (normal range 47+/-19), the LV mass index is 32 g/m2, and the LV mass is 85 g. LV dysfunction is global with regional variation.Left AtriumThe left atrium is 131ml (moderately dilated). No obvious left atrial appendage thrombus. Normal pulmonary venous anatomy.Right VentricleThe right ventricle is normal in size with moderately reduced systolic function. The overall RV ejection fraction is 34%, the RV end diastolic volume index is 76 ml/m2 (normal range 82+/-16), the RVEDV is 198 ml (normal range 142+/-31), the RV end systolic volume index is 50 ml/m2 (normal range 31+/-9), and the RVESV is 131 ml (normal range 54+/-17).Right AtriumThe right atrium is moderately dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac 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. No perfusion defects/ "ischemia" present during hyperemia.2. No evidence of myocardial infarction or other forms of myocardial fibrosis, inflammation, or infiltration. The myocardium is viable. 3. Normal LV size (when adjusted for body surface area) and moderately reduced systolic function (LVEF 34%).4. Normal RV size and moderately reduced systolic function (RVEF 34%).5. Moderate biatrial dilation. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Reason: research History: prostate cancer PELVIS:PROSTATE:Prostate Size: 3.8 x 2.4 x 3.8 cm.Peripheral Zone: There is a 4 x 7 mm right apical posterior lesion with restricted diffusion on image #24, series #1303 consistent with prostate cancer. In addition in the mid prostate there are small foci on the right and left side of the peripheral zone close to the midline best seen on image #124, series #1303 consistent with prostate cancer.Central Gland: Benign prostatic hypertrophy.Seminal Vesicles: Unremarkable.Extracapsular Extension: Not present.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.Right apical and bilateral mid peripheral zone cancer without evidence of extracapsular extension or seminal vesicle invasion.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 68-year-old female with history of thyroid nodules, subclinical hyperthyroidism RIGHT LOBE MEASUREMENTS: 5.2 x 2.1 x 2.0 cmLEFT LOBE MEASUREMENTS: 7.0 x 2.1 x 2.4 cmISTHMUS MEASUREMENTS: 1.0 cmRIGHT LOBE: Enlarged thyroid lobe with multiple solid thyroid nodules. A solid, inferior right thyroid lobe nodule without microcalcifications or increased vascularity measures 1.9 x 1.9 x 1.5 cm.LEFT LOBE: Enlarged thyroid lobe with multiple coalescent nodules without discrete measurable nodule.ISTHMUS: Enlarged isthmus with solid, slightly hyperechoic, inferior nodule measuring 2.2 x 2.1 x 1.6 cm. No microcalcifications or increased vascularity is identified.PARATHYROID GLANDS: Not noted.LYMPH NODES: Subcentimeter lymph nodes in bilateral neck. OTHER: No significant abnormality noted.

Output: Enlarged and heterogeneous multinodular thyroid with measurements above. A nuclear medicine thyroid scan may be considered if clinically warranted.


Instruction: Generate impression based on findings.

Input: Spinal alignment is grossly within normal limits without sagittal spondylolisthesis. Vertebral body heights are grossly preserved without compression deformities. The spinal canal remains widely patent without evidence of acute cord compression. The spinal cord is grossly normal in signal and morphology. There are several mild posterior disc osteophyte complexes within the cervical spine most prominent at C4-C5, minimally progressed compared to 2007. At least mild disc bulges are present at L3-L4, L4-L5 and L5-S1 with mild spinal canal stenosis and scattered neuroforaminal narrowing at these levels. Incidental note is made of a small lipoma within the posterior soft tissues of the left back.

Output: No acute cord compression. Mild degenerative changes as described above. Dedicated segment-specific MRI can be considered if clinically warranted.


Instruction: Generate impression based on findings.

Input: The large right intraparenchymal temporoparietal hematoma is not significantly changed along with areas of low and high T2 signal and predominantly low T2 signal and surrounding vasogenic edema. There is no discernible underlying nodule enhancement. There is persistent partial effacement of the right lateral ventricle, right uncal medialization, as well as approximately 5 mm of midline shift to the left. There is minimal right parietal subarachnoid hemorrhage and intraventricular hemorrhage. There are no new areas of intracranial hemorrhage or hydrocephalus. There are periventricular and subcortical T2 hyperintensities, which are nonspecific, but most compatible with chronic microvascular ischemic disease. However, there is no acute territorial infarct. There is mildly prominent leptomeningeal enhancement diffuse in the right cerebral hemisphere diffusely, which may be due to altered hemodynamics. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.MRA HEAD

Output: 1.Redemonstration of large right intraparenchymal temporoparietal hematoma, with adjacent vasogenic edema and effacement of the right lateral ventricle. There is no midline shift or herniation.2.Unchanged minimal right parietal subarachnoid and intraventricular hemorrhage.No evidence of vascular malformation, aneurysm or significant steno-occlusive lesions within the limits of MRA.


Instruction: Generate impression based on findings.

Input: 51-year-old female with back pain status post extensive lumbar fusion. Evaluate for spinal abscess/osteomyelitis. Wound infection per recent neurosurgery notes. Detailed evaluation of the previous surgical site is limited secondary to lack of contrast and distortion from adjacent surgical hardware.New since the previous MRI examination is extensive emphysema throughout the dorsal soft tissues, subcutaneous inflammatory change and adjacent skin thickening within the posterior soft tissues of the back. There is a is a small focal fluid collection posterior to surgical hardware, at approximately the L4 level, within the surgical site which measures approximately 25 x 20 7 mm, (axial T2 series 501, image 11).Inflammatory change, fluid density and foci are extends in craniocaudal dimension by approximately 17cm from the inferior aspect of L4 to the superior aspect of T12. There are multiple foci of air within the subcutaneous tissues at this level. This focal collection is concerning for inflammatory change versus infection. Evaluation of bony structures surrounding hardware is limited secondary to metallic artifact. No definitive evidence of osseous or hardware complication.Redemonstrated is a burst fracture present at L3 grossly unchanged compared with MRI dated 7/13/2011. There is posterior retropulsion of fragments into the central canal which causes crowding of the cauda equina and central stenosis, unchanged. Interval development of trace retrolisthesis of L2 on L4, not significantly changed.Compression deformity is central with compression noted of both the superior and inferior endplates of L3. Posterior retropulsion of cortex also affects both neural foramina causing severe stenosis. The visualized lower thoracic spine demonstrates multilevel degenerative endplate change.L1-2: no central neuroforaminal narrowing.L2-3: Mild disk bulge and mild bilateral neural foraminal stenosis, unchanged. L3-4: Compression deformity as described above. Interval postsurgical change of a posterior stabilization device with bilateral pedicular screws entering the vertebral bodies of L2 and L4, without foraminal involvement. Left L3 laminectomy with bony graft, unchanged. No new fracture or hardware compromise is identified. L4-5: Mild disc bulge without significant compromise to spinal canal or neural foramina, unchanged.L5-S1: Mild disc bulge without significant compromise to spinal canal or neural foramina, unchanged.Lung bases demonstrate multifocal linear areas of opacification which may be secondary to scarring, atelectasis or infection/inflammation, not significantly changed compared to the previous examination.

Output: 1. No evidence of diskitis or osteomyelitis.2. Interval development of subcutaneous stranding, focal fluid and soft tissue emphysema within the posterior soft tissues as described above, concerning for inflammatory change versus infection. 3. Postsurgical changes of a bilateral posterior stabilization device at L2 and L4 without definitive evidence of hardware or osseous complication.4. Unchanged appearance of an L3 compression fracture with posterior retropulsion of fragments into the central canal which causes crowding of the cauda equina, central stenosis and left greater than right bilateral neural foraminal narrowing.


Instruction: Generate impression based on findings.

Input: Reason: r/o tear History: pain. Swelling MENISCI: There is globular increased signal abnormality within the anterior horn of the lateral meniscus indicating intrasubstance degeneration. We see no meniscal tear.ARTICULAR CARTILAGE AND BONE: There is full-thickness loss of the articular cartilage along the medial facet and apex of the patella with underlying subchondral cyst formation. There is also near full-thickness cartilage loss along the femoral trochlea, inferiorly. There is a small partial-thickness defect of the articular cartilage along the posterior aspect of the medial femoral condyle as well as tricompartmental osteophyte formation.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact. There is a septated slightly heterogeneous near fluid signal intensity collection anterior to the patella and patellar tendon with mild edema within the adjacent subcutaneous fat, measuring approximately 4 cm in its greatest dimension. This likely represents a prepatellar bursitis, although this could represent a hematoma, particularly if there is a history of trauma.ADDITIONAL

Output: 1. Septated slightly heterogeneous collection of near fluid signal intensity in the prepatellar soft tissues likely representing a bursitis, but this could conceivably represent a hematoma if there is a history of trauma.2. Osteoarthritis, particularly affecting the patellofemoral joint, and other findings as described above.


Instruction: Generate impression based on findings.

Input: 49-year-old female with right neck mass. Per prior requisition, history of craniopharyngioma status post resection. Head CT: Stable postoperative changes are noted status post resection of craniopharyngioma with surgical clips in the sellar region. If clinical suspicion for the recurrence of craniopharyngioma is high, MRI may be considered. There is a well corticated focal bony deformity located along the inner table of the right parietal convexity. Similar findings were noted on the MRI from 2003 and have not changed since then. These findings likely represent an atypical arachnoid granulation with cortical vasculature extending through it. Recommend routine MRI with SPGR sequence for evaluation of this lesion if clinically indicated.There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration. The calvaria and skull base are otherwise radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.Neck CT: There is diffuse contrast enhancing lymphadenopathy in the neck bilaterally, right greater than left. The largest lymph node measures approximately 2.3 x 2.1 cm and located at the level 2 of the right jugulodigastric chain. No evidence of airway obstruction or midline shift. The oral cavity, oro/nasopharynx, hypopharynx, larynx and subglottic airways are unremarkable/patent. The epiglottis, vallecula, piriform sinuses, and vocal cords are normal. The parotid, submandibular, and thyroid glands are unremarkable. The carotid arteries and jugular veins are patent. Mild degenerative changes are noted in the vertebral bodies of the cervical spine. Otherwise, the osseous structures are unremarkable.

Output: Extensive bilateral, right greater than left, neck lymphadenopathy without a discrete primary lesion. Although an inflammatory process with reactive lymphadenopathy is possible, a neoplastic lesion cannot be excluded.


Instruction: Generate impression based on findings.

Input: 28-year-old male with a history of neurofibromatosis type I presents with lower back pain radiating to the left leg and sciatic distribution. Evaluate for pelvic/sciatic neurofibroma. Note is made of multiple foci of increased signal abnormality on fluid sensitive sequences within the cutaneous, subcutaneous tissue and musculature of the pelvis compatible with the stated history of neurofibromatosis, although these are incompletely characterized on this noncontrast examination. More specifically, the largest lesion in the region of the left gluteus medius muscle measures 2.0 x 1.2 cm (image 15; series 6) which is suggestive of a neurofibroma, although this is again incompletely characterized on this noncontrast examination. The sciatic nerve is normal in appearance, bilaterally. The imaged musculature of the hips is normal in appearance. No bone marrow signal abnormality is identified. Note is made of an apparent disc bulge at the level of L5/S1 with apparent annular fissure, although this is incompletely characterized on this examination.

Output: Multiple foci of signal abnormality within the subcutaneous tissue and musculature of the pelvis consistent with the stated history of neurofibromatosis, although these are incompletely characterized on this noncontrast examination. The left sciatic nerve is normal in appearance. Disc bulge at the level of L5/S1. This could be better characterized with a dedicated lumbar spine MRI if clinically warranted.


Instruction: Generate impression based on findings.

Input: 42-year-old female with pituitary adenoma A previously demonstrated T2 hyperintense, heterogeneously T1 hyperintense lesion in the inferior left aspect of the pituitary gland now measures 5 mm transverse x 2 mm height (previously 5 x 2 mm), as measured on the coronal T2 technique were its greatest conspicuity is visualized.The pituitary gland otherwise demonstrates normal size and signal characteristics. The pituitary stalk sits at midline and enhances normally. The suprasellar cistern is clear and the visualized optic apparatus is normal.

Output: No significant interval change in size of a small lesion within the inferior left pituitary which is presumed to represent an adenoma.


Instruction: Generate impression based on findings.

Input: 76-year-old woman with headache and hypertension. Unresponsive evaluate for ICH. There is a parenchymal hemorrhage in the left parieto-occipital region. The hemorrhage measures 4.8 x 4.3 cm in the axial plane and extends to the cortical surface. No underlying lesion (such as an AVM) is visible on this study. A subdural hematoma measuring approximately 7 mm in thickness is present. The hemorrhage has a surrounding rim of edema and causes mass effect with near total effacement of the left lateral ventricle and approximately 12mm of midline shift at the level of the thalamus. There is partial effacement of the left aspect of the suprasellar cistern, suggesting left uncal herniation. The quadrigeminal cistern is partially effaced. In addition, the brainstem is shifted to the right, causing effacement of the right prepontine cistern. The cortical sulci of both cerebral hemispheres are effaced. Low attenuation with loss of gray-white differentiation is present in the white matter of the right cerebral hemisphere and is most pronounced in the right frontal lobe. This may represent ischemia or edema and could be better evaluated with MRI. Gray-white differentiation is otherwise preserved. The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.Water density fills the posterior nasopharynx -- possibly representing vomitus or secretions.

Output: 1. Left parieto-occipital parenchymal hemorrhage causing mass effect and about 12 mm of midline shift. No underlying lesion such as an AVM is visible on this study. Further evaluation for an underlying lesion is recommended as clinically appropriate.2. Findings of elevated intracranial pressure including effacement of cortical sulci, left uncal herniation, and partial effacement of the quadrigeminal cistern.3. Low attenuation in the white matter of the right cerebral hemisphere with loss of gray-white differentiation concerning for ischemia. This finding could be better evaluated with MRI.This report was discussed by telephone with the Dr. Eric and Dr. Shakur at 4:10 PM.


Instruction: Generate impression based on findings.

Input: Abdominal pain. Evaluate for cholecystitis. ABDOMEN:LIVER, BILIARY TRACT: Giant hemangioma involving the posterior segment of the right hepatic lobe measuring 10.5 x 9.8 cm. Cholelithiasis with a gallstone at the gallbladder neck. Other scattered subcentimeter T2 hyperintesities, likely small cysts, but too small to characterize.The gallbladder is distended, hyperemic and with pericholecystic fluid superiorly compatible with acute cholecystitis. There is mild mass effect on the common hepatic duct resulting in mild intrahepatic ductal dilatation. The common hepatic duct is patent on MRCP images.No filling defect in the common bile duct is evident.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Symmetric mild perinephric fluid is likely chronic.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Mild degenerative endplate changes.OTHER: Mild basilar atelectasis.

Output: 1.Large gallstone impacted in the gallbladder neck resulting in acute cholecystitis with gallbladder wall thickening and pericholecystic fluid. Mass effect from the gallstone results in mild common hepatic and intrahepatic bile duct dilatation (Mirizzi syndrome) - the CBD is patent, however.2.Giant cavernous hemangioma involving the posterior right hepatic segment.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 27 years, Female, Reason: 27 F p/w epigastric pain, hyperbilirubinemia and elevated liver enzymes. RUQ u/s showed mildly dilated bile duct without stone. History: as above. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Intrahepatic biliary ductal dilatation with dilated common bile duct to 8 mm. There is a stone in the distal common bile duct measuring 4 mm. No focal hepatic lesion.SPLEEN: No significant abnormality noted.PANCREAS: Normal appearing pancreatic duct.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: Distal common bile duct stone causing mild intrahepatic and extrahepatic biliary ductal dilatation.


Instruction: Generate impression based on findings.

Input: 55 year-old female with fall, head trauma and possible seizure. BRAIN: There is no evidence of intracranial hemorrhage, mass or edema. Multifocal regions of patchy hypoattenuation are present in a subcortical and periventricular deep white matter distribution, nonspecific; however, most likely represent small vessel ischemic disease, age indeterminate. No acute cortical infarction. If there is clinical concern for acute ischemia, MRI may be considered.Area of hypoattenuation located in the left frontal region, most likely encephalomalacia secondary to prior infarction.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized except for a small retention cyst in the left frontal sinus.CERVICAL SPINE:The cervical spine alignment is anatomic. The vertebral bodies, dens, lateral masses, pedicles, lamina, facets, and posterior elements are intact with no evidence of fracture or subluxation. The pre-vertebral and paraspinal soft tissues are within normal limits. Limited view of the lung apices demonstrate bullous change and emphysema.Multilevel degenerative disk changes are noted as follows:C2-3: Disk osteophyte complex with central protrusion without central or neuroforaminal narrowing.C3-4: Disk osteophyte complex with diffuse disk bulge without central or neuroforaminal narrowing.C4-5: Disk osteophyte complex with right neuroforaminal narrowing. No central canal narrowing.C5-6: Disk osteophyte complex with severe right greater than left mild neuroforaminal narrowing. No central canal narrowing.C6-7: Uncovertebral joint hypertrophy, osteophyte spurring. No central or neuroforaminal narrowing.Within the limits of CT scanning, the thecal sac and spinal cord are preserved with no evidence of significant spinal canal stenosis.

Output: 1. Diffuse intracranial parenchymal volume loss without acute abnormalities such as hemorrhage or acute cortical stroke.2. White matter disease as described above, nonspecific however most likely represent small vessel ischemic disease.3. Multilevel degenerative disease of the cervical and visualized upper thoracic spine, not significantly changed compared to the previous examination.4. No evidence of cervical spine fracture or subluxation, if spinal cord or ligamentous injury is suspected MRI is recommended.


Instruction: Generate impression based on findings.

Input: 76 year-old female with right renal mass. Status post stroke. Hypertension. Suspected right upper pole renal mass seen on the recent ultrasound examination. This examination is limited by the absence of intravenous contrast.ABDOMEN:LUNG BASES: Mild cardiomegaly. No acute infiltrates or effusions. Dense pleural-based posterior calcification at the right lung base appears benign. Precardiac lymph nodes measure up to 1.5 cm in length.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: The kidneys show moderate atrophy bilaterally. In the right midpole region there is a 3-cm diameter cystic lesion with attenuation measuring approximately 11 Hounsfield units, indeterminate. Additional smaller cystic lesions are present in the right kidney. No associated lymphadenopathy. There is a 1.6-cm exophytic mass at the left lower renal pole with attenuation of 58 Hounsfield units. These lesions could be further characterized with dedicated contrast enhanced CT or MRI, but this may not be possible due to the patient's renal failure.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Contiguous thoracic spine bridging osteophytes compatible with diffuse idiopathic skeletal hyperostosis. Degenerative changes.OTHER: Fat containing umbilical hernia. PELVIS:UTERUS, ADNEXA: Atrophic uterus. BLADDER: Bladder is contracted with apparent mild wall thickening.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Diverticulosis. BONES, SOFT TISSUES: Degenerative changes in the lumbosacral spine and pelvis. Old fracture deformity with callous at a right hip intertrochanteric region.OTHER: No significant abnormality noted

Output: Bilateral renal masses. The right midpole mass appears to be an atypical cyst. The left lower pole mass is indeterminate and may be solid.


Instruction: Generate impression based on findings.

Input: Female, 75 years old. Reason: r.o growth of nodules, adenopathy History: 2 year follow up US for multinodular goiter. left-sided nodules has increased a bit in size on physical examination RIGHT LOBE MEASUREMENTS: 4.6 x 1.2 x 1.6 cmLEFT LOBE MEASUREMENTS: 4.9 x 1.8 x 1.6 cmISTHMUS MEASUREMENTS: 0.4 cmRIGHT LOBE: Heterogeneous echotexture. A hypoechoic nodular focus in the right inferior pole measures 1.4 x 2.5 x 1 .5 cm, nonvascular, unchanged.LEFT LOBE: Heterogeneous echotexture. A heterogeneous hypoechoic mixed cystic and solid nodule in the inferior pole measures 2.5 x 1.4 x 1.5 cm, noncalcified, minimal internal vascularity, unchanged.ISTHMUS: Heterogeneous echotexture. A heterogeneous hypoechoic nodule at the inferior aspect of the Isthmus measures 0.7 x 0.6 x 1 .0 cm, unchanged. An additional heterogeneous hypoechoic nodule at the mid right aspect of the Isthmus measures 0.7 x 0.6 x 0.7 cm, unchanged.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Benign-appearing cervical lymph nodes are identified. A right level 2 lymph node measures 0.7 x 0.3 x 1.3 cm.OTHER: No significant abnormality noted.

Output: Stable thyroid nodules bilaterally.


Instruction: Generate impression based on findings.

Input: History of optic neuritis: visual decline. Orbits: There is diffuse high T2 signal involving the intraorbital, canalicular, and cisternal segments of the left optic nerve. There is also enhancement along the cisternal segment of the left optic nerve. The right optic nerve is intact. There are bilateral lens implants. The bilateral globes and ocular adnexa are otherwise unremarkable. There is no evidence of intraorbital mass lesions.Brain: There is no evidence of intracranial hemorrhage or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is a 10 mm diameter pineal gland cyst. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, mastoid air cells, and scalp soft tissues are grossly unremarkable. There is mild mucosal thickening in the bilateral frontal and ethmoid sinuses.

Output: 1. Findings compatible with left optic neuritis.2. No evidence of acute intracranial hemorrhage or acute infarct.


Instruction: Generate impression based on findings.

Input: Diagnosis: Other specified disorders of muscle Altered mental status, unspecified Other specified disorders of muscle Altered mental status, unspecifiedClinical question: patient w/ clonus of right foot, eval for spinal cord lesionSigns and Symptoms: clonus of foot Lumbar spine:Five lumbar type nonrib-bearing vertebral bodies are presumed to be present which are appropriate in overall height. The L5 vertebra is a transitional vertebra and is partially sacralized. 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 facet hypertrophy present at this level.At L4-5 there is no significant compromise to spinal canal. There is loss of disc space height, disc desiccation and diffuse disc bulge at this level associated with the narrowing of the neural foramina bilaterally and mild encroachment of the exiting nerve roots. Overall there is a mild degree of spinal stenosis at this level with some mild to moderate encroachment of exiting nerve roots. The fat surrounding the exiting nerve roots is mildly effaced.At L3-4 there is loss of disc space height, disc desiccation and a diffuse disc bulge associated with marked bilateral facet and ligamentum flavum hypertrophy and mild anterior subluxation of L3 on L4. There is effacement of spinal fluid surrounding the nerve roots within the thecal sac at this level. Overall there is a moderate to severe degree of spinal stenosis at this level. There is encroachment of the exiting nerve roots within the neural foramina bilaterally at this level. The fat surrounding the exiting nerve roots is effaced.At L2-3 there is loss of disc space height, disc desiccation and diffuse disc bulge associated with the mild to moderate bilateral facet and ligamentum flavum hypertrophy. There is mild crowding of the nerve roots at this level. Overall there is a mild degree of spinal stenosis at this level. There is some narrowing of the neural foramina bilaterally at this level associated with some partial effacement of the fat surrounding the exiting nerve roots. Overall there is a mild to moderate degree of encroachment of the exiting nerve roots at this level.At L1-2 there is no significant compromise to spinal canal or neural foramina.Large osteophytes are present at the left sacroiliac joint.A small amount of fluid in the uterus is a nonspecific finding.

Output: 1.There is a transitional vertebra present which is labeled L5 for the purpose of this exam. Please note that this may affect enumeration of the lumbar vertebrae.2.There is moderate to severe spinal stenosis at L3-4 due to degenerative changes which is associated with encroachment of the exiting nerve roots at this level bilaterally and some mild subluxation.3.There is a mild to moderate degree of encroachment of exiting nerve roots bilaterally at L4-5 and L2-3.4.There is also mild degree of spinal stenosis at L2-3.5.A small amount of fluid in the uterus is a nonspecific finding. It is incompletely evaluated on this exam.


Instruction: Generate impression based on findings.

Input: Female, 52 years old, with history of chronic back pain and SLE, complaining of 3 days bilateral lower extremity weakness, pain, thigh numbness and urinary incontinence. The cervical lordosis is reversed secondary to degenerative disease. A mild thoracolumbar scoliotic curvature is seen along with a grade 1 anterolisthesis of L3 relative to the levels above and below.Vertebral body heights are preserved throughout. No evidence of worrisome marrow replacement is seen. No significant marrow edema is demonstrated apart from scattered degenerative endplate signal change.Disc osteophyte complexes are present at C3-4, C4-5 and C5-6 resulting in mild to moderate spinal canal stenoses at these levels. No significant cord impingement is suspected. Mild disc bulging is also evident in the lumbar spine without significant or high-grade spinal canal stenosis. Mild to moderate foraminal narrowing is evident at L2-3 through L4-5.No significant abnormalities of the spinal cord are suspected. No epidural fluid collections are seen.

Output: 1.No evidence of acute cord compression.2.Cervical spondylosis results in mild spinal canal narrowing at mid cervical levels without significant cord impingement.3.Mild degenerative disc disease is also evident in the lumbar region without significant spinal canal stenosis or impingement of the cauda equina.


Instruction: Generate impression based on findings.

Input: History of seizure, altered mental status Significant motion artifact degrading the exam quality especially for gradient echo and T1 sagittal scans which need to be repeated.There is no evidence of acute ischemic lesion on the scan.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The paranasal sinuses and mastoid air cells are clear.

Output: No evidence of acute ischemic lesion on the scan.Repeat MR exam for T1 sagittal scan, gradient-echo and T1 axial scans.


Instruction: Generate impression based on findings.

Input: Ms. Crawford is a 40-year-old female with recently diagnosed DCIS of the right breast. She presents for MR evaluation. There is scattered fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.In the right lateral breast, far posterior depth, there is an area of irregular enhancement identified measuring 0.9 x 1.4 x 0.8 cm (AP x ML x SI). Susceptibility artifact from biopsy marker clip is seen within the central aspect of this enhancement, compatible with biopsy-proven malignancy.There is no additional abnormal enhancement identified in the right breast. There is no abnormal enhancement identified in the left breast. No abnormal axillary lymph nodes are identified in either axillary region.

Output: Unifocal malignancy of the right breast. No MRI evidence for malignancy of the left breast.If breast conservation therapy is desired, the biopsy marker clip in the right breast can be used as target for preoperative wire localization.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: 31-year-old with severe headache and dizziness. Please evaluate for intracranial hemorrhage. There is no evidence of intracranial hemorrhage, mass, or edema. Subtle periventricular white matter hypoattenuation most prominent in the posterior parietal lobes that is of uncertain significance.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. Small left sphenoid retention cyst, otherwise the visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1.No acute intracranial abnormality.2.Subtle periventricular white matter hypoattenuation most prominent in the posterior parietal lobes. This is of uncertain significance and is still within normal limits, however if patient symptoms persist, MR can be obtained to rule out white matter disease.


Instruction: Generate impression based on findings.

Input: History of urethral cancer status post cystectomy, evaluate for recurrence. 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: Postsurgical changes of right lower quadrant ileal conduit. No abnormally enhancing renal lesions or filling defects within the collecting systems. There is mild hydronephrosis on the right, not significantly changed.RETROPERITONEUM, LYMPH NODES: Small retroperitoneal and mesenteric lymph nodes appear similar to prior.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No specific evidence of tumor recurrence within the abdomen or pelvis.


Instruction: Generate impression based on findings.

Input: A 16 year old male, healthy and asymptomatic who was referred for EKG screening due to familiar history of arrythmia, the EKG showed negative T-wave in inferior leads and borderline criteria for hypertrophy, the echocardiography was normal. Referred to cardiac MRI for further evaluation Left VentricleThe left ventricle size is in the upper normal and the systolic function is low normal. The overall LV ejection fraction is 53%, the LV end diastolic volume index is 106 ml/m2 (normal range: 74+/-15), the LVEDV is 198 ml (normal range 142+/-34), the LV end systolic volume index is 49 ml/m2 (normal range 25+/-9), the LVESV is 93 ml (normal range 47+/-19). 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. Native T1 times were normal. No LVH.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is mildly dilated with normal systolic function. The overall RV ejection fraction is 50%, the RV end diastolic volume index is 123 ml/m2 (normal range 82+/-16), the RVEDV is 229 ml (normal range 142+/-31), the RV end systolic volume index is 61 ml/m2 (normal range 31+/-9), and the RVESV is 114 ml (normal range 54+/-17).Right AtriumThe right atrium is normal.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac Findings This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Low normalLV EF with normal RV EF2. Mild LV and RV enlargement3. No evidence for congenital structural abnormality.4. No evidence for delayed enhancement to suggest an inflammatory or infectious process.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Reason: cervical cancer, radiation brachytherapy planningAdditional history per electronic medical record:Stage IIIB squamous cell carcinoma of cervix, s/p 6 cycles Carbo/Taxol/Avastin, and soon will complete EBRT with concurrent Cisplatin. PELVIS:UTERUS, ADNEXA: The uterine body is small in size, decreased from prior outside examination and which is favored to reflect atrophy in the absence of surgical history of supracervical hysterectomy.The ovaries are normal in size for age. No adnexal masses are identified.There is heterogeneous, abnormal soft tissue signal in the region of the cervix (series 3, image 32) measuring approximately 1.8 x 3.7 cm in the axial plane extending from approximately the level of the left UVJ inferiorly into the uterine body. There is associated heterogeneously increased enhancement. There is also restricted diffusion at the level of the cervix. The area of abnormal signal abuts the posterior wall of the bladder without frank evidence of invasion. The area of abnormal signal also surrounds the distal left ureter at the left ureterovesical junction.BLADDER: The distal tip of a nephroureteral stent is partially visualized in the bladder.LYMPH NODES: No pelvic lymphadenopathy is identified.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Abnormal signal intensity involving the cervix extending into the uterine body compatible with cervical neoplasm as described above. No pelvic lymphadenopathy.


Instruction: Generate impression based on findings.

Input: A 37 year old male with end stage renal disease on dialysis, hypertension, with repeated admission due to chest pain and pulmonary edema. An echocardiography (4/2015) showed hyperdynamic systolic function with severe left ventricular hypertrophy. Now hospitalized and referred to cardiac MRI for further evaluation. Left VentricleThe left ventricle is moderately dilated with hyperdynamic systolic function. The overall LV ejection fraction is 72%, the LV end diastolic volume index is 116 ml/m2 (normal range: 74+/-15), the LVEDV is 208 ml (normal range 142+/-34), the LV end systolic volume index is 33 ml/m2 (normal range 25+/-9), the LVESV is 58 ml (normal range 47+/-19), the LV mass index is 161 g/m2 (normal range 85+/-15), and the LV mass is 290 g (normal range 164+/-36). There are no regional wall motion abnormalities present. Diffuse concentric left ventricular hypertrophy, maximal at basal septum up to 23mm. T1 time was above 1100ms at base, between 1050-1000ms at middle segments and between 1000-1050ms at the apex. These T1 time values represent most likely abnormal values at base, borderline at middle segments and probably normal at the apex. No myocardial iron overload is noted.No intracavitary thrombus is noted.In the context of this patient, these findings support the diagnosis of cardiac amyloid.Left AtriumThe left atrium is mild to moderately dilated. Right VentricleThe right ventricle is mildly dilated with normal systolic function. The overall RV ejection fraction is 62%, the RV end diastolic volume index is 118 ml/m2 (normal range 82+/-16), the RVEDV is 212 ml (normal range 142+/-31), the RV end systolic volume index is 44 ml/m2 (normal range 31+/-9), and the RVESV is 80 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThere is dense calcification along the inferolateral mitral annulus with low density within the central portion of calcification which is demonstrated on recent CT. This is shown on MRI with low signal on the steady-state free precession sequences. This low density in the central calcification is suggestive of caseous necrosis. This contributes to slight decreased excursion of the basal posterior leaflet of the mitral valve. No significant mitral stenosis is visualized.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no pericardial effusion.Extracardiac FindingsIron overload is noted in the liver. Previous mediastinal lymphadenopathy from CT 7/15 does not appear as prominent on the current examination.

Output: 1. The left ventricle is moderately dilated with hyperdynamic systolic function, the LVEF is 72%. There are no regional wall motion abnormalities present. Diffuse concentric left ventricular hypertrophy, maximal at basal septum up to 23mm. T1 time was above 1100ms at base, between 1050-1000ms at middle segments and between 1000-1050ms at the apex. These T1 time values represent most likely abnormal values at base, borderline at middle segments and probably normal at the apex. In the context of this patient, these findings support the diagnosis of cardiac amyloid.2. The left and right atrium are dilated. 3. The right ventricle is mildly dilated with normal systolic function, the RVEF is 62%.4. Evidence of iron deposition in the liver and possibly in the spleen.


Instruction: Generate impression based on findings.

Input: 53 year old female status post left lumpectomy for IDC in October 2013 , followed by radiation therapy presents today for routine follow up. Patient is currently on anastrozole. No current breast complaints. Three standard views of both breasts and 2 spot magnification views of left breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. Scar marker overlies area of lumpectomy in the left upper inner quadrant with architectural distortion/scarring and surgical clips at that site. No suspicious calcifications seen on spot magnification views. 3 clips from prior benign biopsies identified in the right breast and 2 clips from prior benign biopsies identified in the left upper outer quadrant and a third clip identified in the left retroareolar region. Scattered benign calcifications seen in both breast. Few subcentimeter benign morphology masses in the right upper-outer quadrant are mostly unchanged from prior study and most likely correspond to cysts as seen on prior MRI dated 5/23/2013No dominant mass, suspicious microcalcifications or new areas of architectural distortion in either breast. Surgical clips identified in the left axillary region.

Output: No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: Diagnosis: Malignant neoplasm of brain, unspecifiedClinical question: Metastatic urothelial cancer with brain meets, s/p resectionSigns and Symptoms: intermittent HA There is redemonstration of status post left frontal craniotomy. Since the prior exam a hemorrhagic lesion in left frontal lobe has regressed. There is significantly less perilesional signal change compared to the prior exam and less mass effect. There is some nodular enhancement present along the anterior and inferior aspect of the surgical bed. There is some susceptibility effect along the inferior aspect of the lesion.There is a 10 mm enhancing lesion in the left temporal lobe at the superior temporal gyrus adjacent to the superior temporal sulcus which previously measured 7 mm.The visualized portions of the paranasal sinuses demonstrate minor opacities. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Since the previous exam the left temporal lobe mass has increased in size. This is compatible with metastatic disease.2.The patient status post left frontal craniotomy. Vasogenic edema associated with a left frontal lobe resection site for mass has regressed. The possibility of some residual or recurrent tumor cannot be excluded.


Instruction: Generate impression based on findings.

Input: Diagnosis: Encephalopathy, unspecifiedClinical question: Encephalopathy The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of generalized brain atrophy present.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There is redemonstration of a small cystic lesion just below the left cerebellar hemisphere measuring 16 x 6 mm in coronal dimensions which is stable when compared to the prior exam and most likely represents a small arachnoid cyst.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.There is no evidence for any significant microhemorrhages in the brain parenchyma. There is no evidence for foci of diffusion restriction within the brain parenchyma.The visualized portions of the paranasal sinuses demonstrate opacification of the frontal sinuses, ethmoid air cells and sphenoids sinuses with an air-fluid level in the right maxillary sinus and mucosal thickening in the right maxillary sinus. There is a polypoid appearing lesion which extends into the right ostiomeatal complex unit from the right nasal cavity. This could also be identified on the prior exam from 7/12/2014. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.There is opacification of the paranasal sinuses with a polypoid type lesion in the right nasal cavity extending into the right maxillary sinus. Please correlate with clinical evaluation for nasal polyposis and/or possible antrochoanal polyp.2.An air-fluid level in the right maxillary sinus could potentially represent acute sinusitis. Please correlate with clinical symptoms3.Findings suggest a mild degree of generalized brain atrophy but not significantly different than the prior exam.4.Small arachnoid cyst adjacent to the left cerebellar hemisphere. This is stable.


Instruction: Generate impression based on findings.

Input: 36 week old infant with apnea; evaluate for bleed. There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.Subtle areas of questionable low attenuation within the subcortical white matter and bilateral frontal lobes that could represent prior hypoxic injury; recommend follow up MRI if clinically indicated.

Output: Subtle areas of questionable low attenuation within the subcortical white matter in bilateral frontal lobes that could represent prior hypoxic injury; recommend follow up MRI if clinically indicated.


Instruction: Generate impression based on findings.

Input: 11 month old female with a cerebellar vermis lesion. Expected postoperative changes are again seen from the previous vermian mass biopsy through a small right paramedian occipital burr hole with resolution of the previous pneumocephalus and trace subdural blood products. Redemonstrated is a polypoid non-enhancing right cerebellar vermian lesion with normal T2/Flair signal intensity, which extends into the fourth ventricle and which is not significantly changed. The small hypothalamic lesion and subtle thickening of the tectal plate which narrows the cerebral aqueduct are also not significantly changed.Unchanged small focus of enhancement just above the tectal plate which is suspected to represent normal enhancing pineal tissue.There is a stable right frontal approach ventriculostomy catheter with tip in the midline on the anterior aspect of the septum pellucidum. The ventricles and sulci are within normal limits and there is no midline shift or mass effect. The major cerebral flow voids are intact. There is a fluid in the right greater than left mastoid air cells. There is patchy opacification of the ethmoid air cells bilaterally. The orbits, skull, and scalp soft tissues are grossly unremarkable.

Output: No significant change in the hypothalamic lesion, polypoid cerebellar vermis lesion extending into the fourth ventricle, or the thickening of the tectal plate which narrows the cerebral aqueduct. These lesions may be hamartomatous/developmental especially given their absence of associated signal abnormality or enhancement but recommended continued follow-up.


Instruction: Generate impression based on findings.

Input: 53 year old female with a history of left breast mastectomy and sentinel node biopsy in March 2009 for DCIS with immediate reconstruction (DIEP flap). No current breast complaints. Status post left mastectomy and autologous reconstruction.There is heterogeneous amount of fibroglandular tissue in the right breast.Mild parenchymal enhancement is noted in the right breast.Two susceptibility artifacts from biopsy clip in the right breast are again seen.A few enhancing foci in the right breast are unchanged.No abnormal enhancement is seen in right breast or reconstructed left breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: 30-year-old male with history of anterior shoulder pain status post fall. Evaluate for labral or other soft tissue pathology. ROTATOR CUFF: Intermediate signal intensity is noted of the supraspinatus tendon near the insertion site compatible with tendinopathy. Otherwise there is no evidence of full-thickness tear or other abnormality.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: No significant abnormality noted. Specifically no evidence of labral tear is noted.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: Findings compatible with tendinopathy of the supraspinatus tendon near the insertion site.


Instruction: Generate impression based on findings.

Input: Male, 83 years old. Back and leg pain. Exam is severely limited due to continued patient motion.Marked abnormal signal within both sacral wings is compatible with a known history of insufficiency fracture. Both iliac bones show additional areas of abnormal signal which may represent additional fractures. There is nonspecific edema/inflammation in subcutaneous soft tissues posterior to the sacrum.

Output: Extremely limited study showing sacral insufficiency fractures and other findings as above.


Instruction: Generate impression based on findings.

Input: There is left temporooccipital restricted diffusion with matching ADC hypointensity which is T1 hypointense centrally with gyral T1 hyperintensity, T2 hyperintensity, and enhancement.Elsewhere there are small foci of T2 hyperintensity within the white matter, splenium, and pons without restricted diffusion, susceptibility abnormality, mass effect, or enhancement.The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage. Flow voids are present within the major vessels indicating patency. Scattered foci mucosal thickening is present throughout the paranasal sinuses with a superimposed air-fluid level in the right sphenoid sinus. There is also fluid in bilateral mastoid air cells.

Output: 1.Subacute left temporooccipital infarct.2.Scattered foci mucosal thickening is present throughout the paranasal sinuses with a superimposed air-fluid level in the right sphenoid sinus. There is also fluid in bilateral mastoid air cells.


Instruction: Generate impression based on findings.

Input: Male, 15 years old, with new numbness and tingling in the bilateral legs, status post cervical spinal cord injury in June 2016 after wrestling. Cervical:Evidence of anterior and posterior instrumented fusion is seen at C5-6. Artifact from the instruments causes local image distortion. At the C5-6 level, a band of abnormal hyperintense T2 signal appears to traverse the spinal cord. Above this level, an inverted-V shaped column of abnormal T2 signal is seen involving the midline dorsal spinal cord. This abnormality extends superiorly to the cervico-medullary junction. Below the C5-6 level, abnormal spinal cord signal is seen more diffusely, but in particular, the lateral columns appear to be affected. This abnormality extends down to the level of the conus.Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. No areas of pathologic marrow replacement or edema are seen. Intervertebral discs are preserved. No significant compromise of the spinal canal or neural foramina is seen.Spinal alignment is grossly anatomic. Vertebral body heights are preserved. No areas of pathologic marrow replacement or edema are seen.

Output: Evidence of severe spinal cord injury is seen at the C5-6 level where there is a band of T2 hyperintensity spanning the cervical cord. This may represent partial transection or sequelae of prior contusion.Above the level of spinal cord injury, abnormal T2 signal is seen affecting the dorsal columns. Below the level of the spinal cord injury, abnormal T2 signal is seen more diffusely within the cord but particularly affecting the lateral columns. This pattern of findings is characteristic of Wallerian degeneration following spinal cord injury.No additional pathologic or unexpected findings are seen in the context of prior trauma.


Instruction: Generate impression based on findings.

Input: Evaluate for OCD versus interval resolution of Panner's disease There is bony edema involving the lateral epicondyle of the distal humerus but improved when compared to the prior study. There is a small elbow joint effusion. There is osteochondral defect at the articular surface of the lateral epicondyle measuring approximately 6 x 6 mm in size. No definite evidence of loose bodies within the joint space. There is minimal edema to the olecranon but improved from prior study. The flexor and extensor tendons and ligaments are normal.

Output: Bony edema at the lateral epicondyle of the distal humerus but improved from prior study. There is a osteochondral defect at the articular surface of the lateral epicondyle as described above.


Instruction: Generate impression based on findings.

Input: High protein in CSF with headaches rated at 10/10. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are unremarkable, aside from asymmetry of the occipital horns of the lateral ventricle, which can be a normal variant. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable. There are probable secretions in the left petrous apex. There are secretions in the right frontal sinus.

Output: 1. No evidence of demyelinating lesions, mass, or acute infarct.2. Probable secretions in the left petrous apex. Assessment for petrous apicitis is otherwise limited without contrast.


Instruction: Generate impression based on findings.

Input: Left sensorineural hearing loss. The bilateral cranial nerve 7 and 8 complexes are intact. There is no evidence of mass lesions. The inner ear structures, including the cochlea, vestibule, endolymphatic duct, and semicircular canals, appear unremarkable. The bilateral mastoid air cells and middle ears also appear unremarkable. There is a cystic pineal gland that measures up to approximately 15 mm. There is diffuse volume loss of the imaged portions of the brain parenchyma.

Output: 1. No evidence of retrocochlear or inner ear lesions.2. A cystic pineal gland that measures up to approximately 15 mm likely represents benign cystic degeneration.


Instruction: Generate impression based on findings.

Input: Female, 18 years old, with exertional headaches. The cerebral and cerebellar hemispheres and brainstem show normal signal intensity and morphology. No restricted diffusion is seen.No evidence of parenchymal edema, mass, or mass effect is seen. There is no evidence of intracranial hemorrhage or abnormal extra-axial fluid. The ventricular system is normal in caliber and morphology. An incidental developmental venous anomaly is present in the right temporal lobe. No pathologic parenchymal or extra-axial enhancement is detected.Signal intensity of the bone marrow is unremarkable. No significant abnormalities of the paranasal sinuses are detected.

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


Instruction: Generate impression based on findings.

Input: Ms. Marshall is a 49-year-old female with a personal history left breast skin sparing mastectomy in 2011 for DCIS. Family history of breast cancer in paternal grandmother, paternal great aunt, and paternal cousins. She has no current breast related complaints. Patient is status post left breast mastectomy with DIEP flap reconstruction. There is heterogeneous amount of fibroglandular tissue in the right breast.No abnormal enhancement is seen in the right breast or the reconstructed left breast. No abnormal axillary lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: ND - Routine Diagnostic Mammogram.