Instruction: Generate impression based on findings.

Input: 2 years, Male, strep pneumonia meningitis. Previous seen areas of nonsuppression of CSF in the cerebral hemispheres on the FLAIR sequences have resolved. Subtle foci of T2/FLAIR hyperintensity are again seen within the bilateral cerebellar hemispheres, which are slightly decreased in prominence on the right and slightly increased on the left. There is subtle associated diffusion hyperintensity. No abnormal parenchymal or meningeal enhancement is appreciated. No intracranial mass or mass effect. No findings to suggest cerebral abscess or evidence of empyema. Ventricles are normal in size without evidence of hydrocephalus. No evidence of acute ischemia or hemorrhage.There is symmetric enhancement of the bilateral cavernous sinuses without evidence of cavernous sinus thrombosis. Pituitary gland appears unremarkable for patient's age. Bilateral orbits appear grossly unremarkable. Interval marked improvement in previously seen opacification of the bilateral maxillary sinuses and ethmoid sinuses is noted. Previously seen opacification of the left mastoid air cells is much improved with mild residual opacification.

Output: 1. No evidence of cavernous sinus thrombosis. No evidence of intraparenchymal abscess or empyema. 2. Previously seen nonsuppression of CSF on the FLAIR sequence related to meningitis is no longer appreciated and is suggestive of overall improvement of meningitis. There are however subtle foci of FLAIR hyperintensity in the bilateral cerebellar hemispheres, which are slightly decreased on the right and slightly increased on the left since 1/1/2016; these findings are likely related to parenchymal involvement of infection.3. Interval improvement in previously seen paranasal sinus opacification as well as improved aeration of the left mastoid air cells.


Instruction: Generate impression based on findings.

Input: 62 year old female with strong family history of breast cancer in mother diagnosed at age 60 and ovarian cancer at 86, breast cancer in maternal grandmother, and breast cancer in paternal aunt diagnosed at age 60. Personal history of skin cancer diagnosed at age of 52. There is scattered fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.Multiple subcentimeter nonenhancing cysts are seen bilaterally. There is no new abnormal enhancement seen in either breast.No abnormal axillary lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Asymptomatic female presents for routine screening mammography. Family history of breast cancer in her mother diagnosed at age 37, and a maternal aunt. Two standard digital views of both breasts were performed with tomosynthesis and reviewed with the aid of R2 CAD. The breast parenchyma is heterogeneously dense, which may obscure small masses (BiRads Density Category C), unchanged in pattern and distribution. Stable scattered benign calcifications. Stable circumscribed masses are again present bilaterally, compatible with cyst seen on MRI.No suspicious masses, microcalcifications or areas of architectural distortion are present.

Output: No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 2 - Benign finding.RECOMMENDATION: NSC - Screening Mammogram.


Instruction: Generate impression based on findings.

Input: Reason: history of right upper quadrant pain, possible cirrhosis?, rule out cbd stone, cholecystitis, pancreatic mass, hepatic mass History: right upper quadrant pain. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic morphology. Geographic areas of T2 hyperintense signal and arterial hyperenhancement involving segments 4, 5, 8, and some of 2, with associated retraction compatible with advanced focal confluent fibrosis. Two foci within segment 5 and 8 within these areas of fibrosis demonstrate delayed washout (1604 images 60 and 71). For future reference, the largest focus measures 3.1 x 3.7 cm (series 1601 and 1604 image 60). Small subcentimeter cyst in the left lobe. The gallbladder is mildly distended. No gallstone, pericholecystic fluid or gallbladder wall thickening. Extrahepatic biliary ductal dilatation. The common bile duct measures up to 1.1 centimeters (series 10 image 98) with gradual tapering to the ampulla. No filling defect identified. Small amount of perihepatic ascites.SPLEEN: No significant abnormality noted.PANCREAS: Pancreatic duct is dilated measuring 0.7 cm (series 10 image 51) with gradual tapering to the ampulla. No pancreatic mass identified.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: 1.Cirrhotic morphology with advanced confluent fibrosis. Within this fibrosis in segments 5 and 8, there are two foci of delayed wash out. While, this is unusual for HCC, recommend short term follow up in 3-4 months to confirm stability. 2.Dilated common bile and pancreatic ducts, which gradually taper to the ampulla without filling defects or obstructing mass. 3.Mildly dilated gallbladder again noted without other evidence of acute cholecystitis.


Instruction: Generate impression based on findings.

Input: Status post left knee injury. Pain medial side swelling, instability. Evaluate for ligamentous tear. MENISCI: The medial and lateral menisci are intact.ARTICULAR CARTILAGE AND BONE: Bone marrow signal is within normal limits. The articular cartilage within all three compartments is intact. LIGAMENTS: The collateral ligaments, cruciate ligaments, and popliteus muscle/tendon are intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: No evidence of ligamentous or meniscal injury.


Instruction: Generate impression based on findings.

Input: Evaluate pancreatic mass. ABDOMEN:LIVER, BILIARY TRACT: Multiple liver hyperintensities likely represent cysts but are incompletely characterized.Mild central biliary ductal dilatation without a discrete lesion, within the limitations of a nonenhanced study.Suggestion of diffuse iron deposition of the liver.Probable focal adenomyomatosis of the normally distended gallbladder.SPLEEN: No significant abnormality noted.PANCREAS: Pancreas divisum. 1.9 x 1.3 cm pancreatic body cystic appearing lesion likely communicates with the main pancreatic duct which is minimally prominent measuring 4 mm. The lesion demonstrates no mural nodularity. Side branch ectasia and additional probable small side branch type IPMNs are noted.ADRENAL GLANDS: Mild adrenal gland thickening.KIDNEYS, URETERS: Multiple bilateral renal hyperintensities are not completely characterized without intravenous contrast. Some of them demonstrate internal complexity/septations.Left renal inferior pole T2 hypointense lesion measures 1.8 x 1.7 cm with proteinaceous/hemorrhagic components, incompletely characterized. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Cystic-appearing pancreatic body 1.9 cm lesion likely communicated with the main pancreatic duct and is likely a side-branch IPMN without mural nodularity. Limited evaluation without contrast.2. Multiple bilateral renal cystic lesions are incompletely characterized. 3. Indeterminate left renal inferior pole 1.8 cm T2 hypointense complex lesion.4. Probable multiple hepatic cysts.


Instruction: Generate impression based on findings.

Input: 50 year-old female with chronic pancreatitis and pancreatic exocrine insufficiency. Status post ERCP on 1/29, which showed pancreatic duct obstruction, unable to be passed endoscopically, assess stricture. ABDOMEN:LIVER, BILIARY TRACT: No intra- or extra-hepatic biliary ductal dilation. No focal mass lesion identified.SPLEEN: No evidence of splenomegaly.PANCREAS: There is atrophy of the pancreas as well as loss of the expected intrinsic T1 signal intensity, consistent with the stated history of chronic pancreatitis. Note is made of irregular contour and non-distensibility of the main pancreatic duct. There is a focal area of narrowing of the main pancreatic duct, approximately 1.7 cm proximal to the level of the ampulla, consistent with the stated history of main pancreatic duct stricture. Additionally, proximal to this area of focal narrowing, is a long segment of relative narrowing of the main pancreatic duct, at the level of the pancreatic body, measuring approximately 2.3 cm in length (as seen on series 1401). There is slight distention of the main pancreatic duct proximal to this region. There is a blunted response to secretin augmentation consistent with the stated history of pancreatic exocrine insufficiency.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Simple cysts are identified within the kidneys bilaterally.RETROPERITONEUM, LYMPH NODES: No evidence of lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1.Findings consistent with the stated history of chronic pancreatitis. There are multiple foci of narrowing affecting the main pancreatic duct, consistent with the stated history of main pancreatic duct stricture, likely related to sequelae of chronic pancreatitis. No obstructing focal mass lesion identified. 2.Blunted response to secretin augmentation, consistent with the stated history of pancreatic exocrine insufficiency which may also be related to the patient's history of chronic pancreatitis.


Instruction: Generate impression based on findings.

Input: 66 years, Male, Reason: met urothelial cancer History: met urothelial cancer; staging. Study limited due to lack of intravenous contrast.ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Multiple scattered subcentimeter T2 hyperintensities. No cysts were seen on prior CTs. Common bile ducts is a prominent without an obstructing lesion present.SPLEEN: No significant abnormality noted.PANCREAS: Prominent pancreatic duct.ADRENAL GLANDS: Right adrenal nodule measuring 1.2 cm (601/27) which does not definitively lose signal on out of phase imaging. Left adrenal nodule measures 0.8 cm (601/23) which does not definitively lose signal on out of phase imaging. Both of these lesions are considered indeterminate and unchanged from prior exams.KIDNEYS, URETERS: Bilateral subcentimeter hemorrhagic cysts. Additional T2 hyperintensities are not well characterized without intravenous contrast. Diffusely increased signal within the kidneys on T2 images likely indicates chronic renal disease.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS: PROSTATE, SEMINAL VESICLES: There is a mass within the perineum at the base of the penis which has increased in size measuring 7.1 x 4.7 x 6.4 cm (1501/7 and 1401/18), previously 3.2 x 4.0 x 2.4 cm. There is invasion superiorly to the right apex of the prostate. The mass abuts the anterior aspect of the rectum. There is increased T2 signal within the central portion of the mass, indicating necrosis.BLADDER: Foley catheter within the bladder.LYMPH NODES: Small pelvic lymph nodes, including a right obturator node measuring 2.2 x 0.6 cm (1501/27) unchanged. Small inguinal lymph nodes are also noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Scattered T2 hyperintensities within the pelvis and spine, incompletely characterized.OTHER: No significant abnormality noted.

Output: 1.Necrotic mass at the base of the penis is increased in size.2.Multiple subcentimeter T2 hyperintensities within the liver. A benign etiology is favored, such as biliary hamartomas, however these were not seen on prior CTs and are incompletely characterized without intravenous contrast.3.Indeterminate bilateral adrenal nodules are stable.4.Findings of chronic renal disease with bilateral hemorrhagic cysts and indeterminate cysts


Instruction: Generate impression based on findings.

Input: Male, 38 years old, with multiple sclerosis presenting with numbness and weakness. C-spine:Mild prominence of the central canal of the spinal cord is seen from the level of the obex to C2. The caliber of the canal never measures more than 1 mm which is within the limits of normal variation.Since the prior examination, extensive central cord T2 hyperintensity spanning from C2 through C7 has significantly improved. All that remains of this prior abnormality are two longitudinal tracts of T2 hyperintensity within the central gray of the cord bilaterally spanning the C5 and C6 levels. Elsewhere no new areas of pathologic cord signal are seen. No pathologic cord or leptomeningeal enhancement is seen.Straightening of the cervical lordosis is likely positional. Vertebral body height and morphology are normal. No pathologic marrow signal abnormality is seen.No significant spinal canal or neuroforaminal stenosis is evident at any level. Mild posterior disc-osteophyte complex formation is seen at C5-6.Brain:Several punctate foci of T2 hyperintensity are seen within the right frontal subcortical white matter. Accounting for differences in technique, these seem to have been present on the prior examination and have not significantly changed.A small focus of T2 hyperintensity is evident along the left frontal horn, and another along the body of the right lateral ventricle, both of which also seem to have been present previously.No evidence of parenchymal edema, mass effect or midline shift is seen. No restricted diffusion is demonstrated. No pathologic enhancement is seen. A small right frontal developmental venous anomaly is seen.Incidental note is made of ectopia of the right cerebellar tonsil, a stable finding.Extensive ethmoid and maxillary sinus mucosal inflammation is demonstrated, a new finding from the prior exam.

Output: 1.Several scattered punctate lesions are demonstrated in the cerebral hemispheres without significant or convincing interval change. Although two of these are along the ventricular margin, they are ultimately nonspecific in morphology.2.Longitudinally extensive signal abnormality seen previously within the cervical spinal cord has significantly improved. Only two small tracts of T2 hyperintensity persist at the C5-6 level.3.The above described brain and cord findings are not entirely typical for multiple sclerosis. Particularly, the previously seen longitudinally extensive central cord signal abnormality would be an unusual finding in multiple sclerosis. Neuromyelitis optica does remain within the differential based on imaging findings. Likewise, other inflammatory, postinfectious and autoimmune etiologies may also be considered.4.Stable ectopia of the right cerebellar tonsil.5.New paranasal sinus inflammatory disease.


Instruction: Generate impression based on findings.

Input: 14-year-old female with left knee pain with a history of patellar instability. MENISCI: The medial and lateral menisci appear intact.ARTICULAR CARTILAGE AND BONE: There is lateral translation of the patella relative to the femoral trochlea. The femoral trochlea is abnormally shallow, indicating dysplasia. There is a full-thickness articular cartilage defect of the patella along the inferior aspect of the median eminence with edema type signal within the underlying bone marrow. There is also near full-thickness to full-thickness cartilage loss along the medial facet of the patella. There is edema within the lateral aspect of the lateral femoral condyle likely representing a contusion from transient patellar dislocation. The articular cartilage along the anterior lateral aspect of the lateral femoral condyle is slightly increased in signal intensity likely reflecting posttraumatic degeneration. LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The quadriceps and patellar tendons are intact. The tibial tuberosity trochlear groove distance is approximately 15 mm.ADDITIONAL

Output: Findings compatible with the stated history of patellar instability with femoral trochlear dysplasia, lateral displacement of the patella, and articular cartilage defects/degeneration as well as other findings as described above.


Instruction: Generate impression based on findings.

Input: History of multifocal prostate cancer. Patient presents for focal laser ablation of the cancer in the left side of the prostate Patient used prophylactic antibiotics before and after the procedure asprescribed. The patient received antibiotic prophylaxis with oral Ciprofloxacin 500 mg bidstarting the night before the procedure. He took 2 tablets of Ciprofloxacin 500 mg beforethe procedure and will take two tablets after the procedure. Following the discussion ofthe risks, benefits, and alternatives of the procedure, informed consent was obtained forthe research study. The procedure was performed under moderate conscious sedation.MRI focus in the left base, mid-gland and apical peripheral zone suspicious for patient's known cancer waslocalized with T2 weighted MR images. Following sterile preparation, Medtronic's laserablation template was placed in the perineum on the patient and localized on MR images andregistered to the MR images where prostate lesion could be visualized.Following local anesthesia with lidocaine, 14-gauge MR- compatible needles were insertedinto the left side of the prostate to stabilize the prostate. Upon confirmation of thetip of the needle on the left side close to the known lesion, a total of 5 laser ablationswith 30-W, 90 % power was performed within the left mid-gland and apical peripheral zone of theprostate zone. The patient tolerated the procedure well without any immediate complications.Pre-and postcontrast axial MR images are obtained before and after administration of 10 ccMultiHance, upon completion of the procedure. On MR images of ablation defect was notedwithin and around the ablated region. COMPLICATIONS: No immediate complications.BLOOD LOSS: < 10 ml

Output: MR guided laser ablation of the left base mid-gland and base peripheral zone of theprostate.PLAN: Patient was sent to the post-procedural area for observation to ensure voiding. Will follow-up with urology.


Instruction: Generate impression based on findings.

Input: Unspecified tinnitus [388.30], Reason for Study: ^Reason: any structural problems History: tinnitus The brainstem, cerebellum, vermis and tonsils are normal. The inner ear structures, cochlea, vestibule, semicircular labyrinth are normal. The internal auditory canals are normal with delineation of the facial, cochlear and vestibular nerves. No evidence of signal abnormality, mass or abnormal enhancement is noted. The ventricles, cerebral sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast-enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear. No evidence of acute ischemic or hemorrhagic lesion on the scan.There is Thornwald cyst sized about 12.5mm x 9.6mm.

Output: Normal brain and internal auditory canal MRI scans.


Instruction: Generate impression based on findings.

Input: Male, 36 years old. Right hip pain. Several images are limited by patient motion artifact.ACETABULAR LABRUM: There is a large gadolinium/fluid-filled labral tear extending from the 12 o'clock to the 4 o'clock position anteriorly. ARTICULAR CARTILAGE AND BONE: There is a small cyst in the acetabular dome underlying the above-mentioned labral tear anteriorly, with adjacent mild marrow edema. There is prominence of the anterior aspect of the femoral head/neck junction indicating a CAM deformity with an alpha angle of approximately 70 degrees. There are underlying cystic changes anteriorly within the femoral head neck junction.SOFT TISSUES: The soft tissues of the right hip are within normal limits. ADDITIONAL

Output: 1.Cam deformity of the right femoral head/neck junction with a large labral tear as described above.2.Degenerative disc disease of the lower lumbar spine and other findings as described above.


Instruction: Generate impression based on findings.

Input: Diagnosis: Compression of brain. Spinal stenosis in cervical regionClinical question: hx 4th ventriclar flow obstruction with Stenting tube placed eval CINE flow- eval patency of stent and CSF flowSigns and Symptoms: headaches to the base of the skull The CSF spaces are appropriate for the patient's stated age with no midline shift. The patient is status post posterior fossa decompression for Chiari I malformation. There is a ventricular stent present in the fourth ventricle which courses through the foramen of Magendie and behind the upper cervical cord. The appearance of the adjacent cerebellum is stable.The ventricles are non-dilated.CSF flow at the foramen Magnum is biphasic and within normal limits.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Status post Chiari I decompression and 4th ventricular stent without current evidence for ventriculomegaly. The findings are stable compared to the prior exam.2.CSF flow at the foramen Magnum is intact.


Instruction: Generate impression based on findings.

Input: 63 year old woman with GBM. Rule out bleed. There is no evidence of acute intracranial hemorrhage.Patient is status post left temporal craniotomy and left temporoparietal tumor resection. A resection cavity is present in the left temporoparietal region. The temporal horn of the left lateral ventricle is dilated, reflecting volume loss. Left-sided periventricular hypoattenuation and mild dilation of the body of the left lateral ventricle are present -- these findings likely reflect treatment-related gliosis/edema and volume loss. Meningeal thickening is present along the left greater wing of the sphenoid and the left temporal bone -- this is likely postoperative in nature. The study is inadequate to assess for the presence of residual or recurrent tumor -- recommend contrast enhanced MRI for this purpose.The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. No CT evidence of acute intracranial hemorrhage.2. Postoperative findings of left temporoparietal tumor resection as detailed above.


Instruction: Generate impression based on findings.

Input: Female, 10 years old, with history of medulloblastoma, surveillance MRI. Brain:Postoperative findings are redemonstrated in the posterior fossa without significant interval change. The right cerebellar resection cavity is stable in size and morphology. No evidence of pathologic enhancement is seen within or adjacent to the cavity. Scattered foci of susceptibility along the medial margin of the resection cavity are unchanged.No pathologic enhancement is detected intracranially. Nonspecific foci of FLAIR hyperintensity in the right inferior frontal white matter, and the left cerebellum, are unchanged. Likewise, foci of susceptibility within the bilateral temporal lobes are unchanged. No evidence of edema or mass effect is seen. The supratentorial ventricles are normal in size and morphology. Mucosal thickening and secretions are evident in the right maxillary sinus.Spine:A 3 mm focus of susceptibility within the left aspect of the spinal cord at C7-T1 is unchanged. The spinal cord, conus and cauda equina otherwise demonstrate normal signal intensity. No pathologic intrathecal enhancement is seen.Spinal alignment is anatomic. Vertebral body heights are preserved. Fatty marrow replacement throughout the spine is probably related to prior radiotherapy. Otherwise, no pathologic marrow signal abnormality is seen. The intervertebral discs are preserved with no evidence of significant spinal canal or foraminal stenosis.

Output: 1.Stable postoperative findings in the posterior fossa with no evidence of tumor recurrence.2.Stable examination of the spine.


Instruction: Generate impression based on findings.

Input: Reason: is there a medial meniscus tear? History: medial knee pain after twist MENISCI: The medial and lateral menisci appear intact.ARTICULAR CARTILAGE AND BONE: The articular cartilage of the knee appears normal. No bone marrow edema.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The quadriceps and patellar tendons are normal in appearance.ADDITIONAL

Output: No meniscal tear or other specific findings to account for the patient’s pain.


Instruction: Generate impression based on findings.

Input: 53 years Male (DOB:11/12/1962)Reason: lumbar radiculopathy History: painPROVIDER/ATTENDING NAME: RODERICK H. BIRNIE RODERICK H. BIRNIE Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is a large left lateral recess disk extrusion which compresses the nerve roots at the left lateral recess and compresses the thecal sac, effacing CSF surrounding the nerve roots. Disk material extends behind the adjacent endplates. There is associated loss of disk space height and subacute end plate reactive changes (bright on T2 low signal on T1) which is superimpose on a larger area of chronic endplate reactive change (T1 hyperintense and T2 hypointense). The endplates are irregular. There is disk dessication. Overall there is moderate spinal stenosis.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.There is a large L4-5 disk left lateral recess disc extrusion creating moderate spinal stenosis and compression of the nerve roots predominantly at the left lateral recess. It is associated with subacute on chronic endplate reactive change.


Instruction: Generate impression based on findings.

Input: 36 years Male (DOB:9/21/1979)Reason: eval for lumbar disk disease History: left hip pain w/ neuropathyPROVIDER/ATTENDING NAME: SACHIN DILIP SHAH SACHIN DILIP SHAH Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: No compromise to lumbar spinal canal or neural foramina.


Instruction: Generate impression based on findings.

Input: Unspecified esotropia [H50.00], Reason for Study: ^Reason: L ptosis, L esotropia History: above Brain MRINo evidence of acute ischemic or hemorrhagic lesion. No abnormal enhancement.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. The mastoid air cells are clear. Mucosal thickening of bilateral ethmoid sinuses.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion. No abnormal enhancement.2. Normal brain MRA


Instruction: Generate impression based on findings.

Input: History of right lumpectomy in 1999 with radiation therapy for right breast cancer. Also history of benign left breast biopsy in the 1980s. Family history of breast cancer in her mother at 42, and sister at age 60. Patient is enrolled in a screening program for high-risk individuals. There is scattered fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.There are stable postsurgical changes and volume loss from right lumpectomy. No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: 38 year old female status post left lumpectomy for invasive ductal carcinoma in 2012. Patient received chemotherapy, radiation and Herceptin. History of right reduction mammoplasty with keloid formation. History of benign right breast biopsy showing fat necrosis. No current breast complaints. Family history of breast carcinoma in her maternal aunt in her 40s. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region. Stable small high T2 signal lesion in the left lobe of liver most likely a cyst or a hemangioma.

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


Instruction: Generate impression based on findings.

Input: History of medulloblastoma resected in 1994, with recent seizures, for which workup detected a right parietal meningioma. There is an avidly enhancing right superior parietal convexity extra-axial mass that measures up to 22 mm, which is unchanged. There is associated mass effect upon the underlying brain parenchyma, but no evidence of regional vasogenic edema. There are postoperative findings related to left suboccipital craniotomy with encephalomalacia in the left cerebellar hemisphere, but no evidence of a mass in the posterior fossa. There is diffuse dural thickening related to calcifications. There is encephalomalacia in the right lateral temporal lobe. There are scattered punctate foci of susceptibility effect in the bilateral posterior cerebral hemispheres. There is no evidence of acute intracranial hemorrhage or acute infarct. There is a left transparietal ventricular catheter in unchanged position. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is an enhancing mass in the right frontal scalp that measures up to 16 mm. There are bilateral posterior maxillary cystic lesions.

Output: 1. Unchanged right parietal convexity meningioma with associated mass effect upon the underlying brain parenchyma, but no evidence of regional vasogenic edema.2. Postoperative findings related to left suboccipital craniotomy related to medulloblastoma resection with encephalomalacia in the left cerebellar hemisphere, but no evidence recurrent tumor in the posterior fossa. 3. Diffuse dural calcification may be a manifestation of Gorlin syndrome.4. Bilateral posterior maxillary cystic lesions may represent keratocystic odontogenic tumors, which may also be a manifestation of Gorlin syndrome. Dedicated maxillofacial imaging may provide further insights, nevertheless.5. A persistent right frontal scalp lesion may represent a basal cell nevus or carcinoma or other neoplasm.6. Scattered punctate foci of susceptibility effect in the bilateral posterior cerebral hemispheres may represent cavernous malformations or chronic microhemorrhage related to prior radiation. 7. Unchanged appearance of the shunted ventricular system.


Instruction: Generate impression based on findings.

Input: 57-year-old man with elevated alkaline phosphatase and total bilirubin. Evaluate for suspicious lesion or biliary issues. ABDOMEN:LIVER, BILIARY TRACT: The liver measures 20.6 cm in length. No enhancing liver lesion.The gallbladder is normally distended with no cholelithiasis. No intra or extrahepatic biliary ductal dilatation.SPLEEN: The splenic vein is not well seen however small collateral vessels are present consistent with the previously documented splenic vein thrombosis. The spleen measures 14.0 cm in length.PANCREAS: The pancreatic head and uncinate process are normal in appearance and without focal lesion. The body and tail of the pancreas are not well seen secondary to previous necrotizing pancreatitis. The pancreatic duct is not dilated. Inflammatory changes surrounding the pancreas have resolved.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No suspicious renal lesion or hydronephrosis.RETROPERITONEUM, LYMPH NODES: Small peripancreatic and porta hepatis lymph nodes are nonspecific.BOWEL, MESENTERY: Tubular enhancing structures in the gastric fundus may represent varices.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: There is a small amount of pelvic ascites.

Output: 1.No suspicious liver lesion or biliary ductal dilatation.2.Hepatosplenomegaly.3.Chronic splenic vein occlusion with formation of splenic collaterals and possible gastric fundal varices.


Instruction: Generate impression based on findings.

Input: Altered mental status and history of alcoholic cirrhosis of liver with ascites. Many of the images are degraded by patient motion. There is mild cerebral white matter T2 hyperintensity, primarily in a periventricular distribution. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild T1 hyperintensity in the bilateral basal ganglia and pituitary gland. There is also diffuse nonspecific susceptibility effect within the bilateral basal ganglia and midbrain. There is diffuse cerebral and cerebellar volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There are secretions that encompass the entire left maxillary sinus.

Output: 1. No evidence of acute intracranial hemorrhage, mass, or acute infarct.2. Diffuse cerebral and cerebellar volume loss is likely related to alcohol use.3. Findings suggestive of chronic hepatic encephalopathy.


Instruction: Generate impression based on findings.

Input: Reason: r/o hemorrhage History: Headache persistent 8/10 from fell on 04/07/15 The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells demonstrate minimal opacities. The visualized portions of the orbits are intact. There is bony thickening at the level of the lambdoid sutures. This is better evaluated than on the CT of the head and is a little clinical relevance.

Output: MRI of the brain is within normal limits


Instruction: Generate impression based on findings.

Input: Exam is limited by patient motion. There are areas of cortical diffusion restriction along the right superior temporal and right lateral frontal parietal region. Areas of sulcal susceptibility and FLAIR hyperintensity are also identified in these areas, consistent with the subarachnoid blood products seen on recent CT. Other scattered foci of susceptibility are similar to that of the prior exam, including within both thalami. There is a new left superior frontal gyrus oval area of susceptibility consistent with the previously seen small parenchymal hemorrhage, grossly unchanged. There is also slight increased conspicuity of very faint susceptibility in the left frontal deep white matter as compared to the prior MRI, corresponding to an area of subtle hyperdensity on CT. This may represent developing mineralization. There is a punctate focus of diffusion restriction in the right frontal deep white matter as seen on 501/215.Post-contrast images do demonstrate left carotid canal on the fat saturated postcontrast images which may relate to slow flow of contrast within the vessel.Compared to the recent CT, there are stable bilateral well hemispheric subdural effusions, slightly greater on the left side. On the left, the collection measures up to 11 mm in thickness, with long the right measures 8 mm. These are approaching CSF signal intensity on all sequences. There is no pathological enhancement. The ventricles and sulci are prominent, consistent with moderate age-related volume loss. The basal cisterns remain patent. There is no midline shift or significant mass effect. There are scattered punctate foci and confluent areas of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, consistent with mild-moderate chronic small vessel ischemic changes including numerous scattered lacunar infarcts.The midline structures and craniocervical junction are within normal limits. MRA HEAD

Output: 1. Abnormal cortical diffusion restriction along the right superior temporal lobe and just cranially along the right lateral frontal parietal region, with associated areas of subarachnoid as well as parenchymal hemorrhage. Given background of numerous foci of susceptibility, this is felt to be most likely related to amyloid angiopathy, perhaps the rare inflammatory type, which can results in hemorrhagic infarcts.2. Redemonstration of left superior frontal gyrus parenchymal hemorrhage.3. Stable appearance of the thin left greater than right near CSF signal intensity subdural effusions, new since prior MRI.4. Complete occlusion or near occlusion of visualized portion of left internal carotid artery with likely minimal slow flow along the carotid canal on post contrast images, that is most likely chronic. CTA of the head and neck may be obtained for further evaluation.5. Mild stenosis and irregularity of the mid to distal basilar artery and the right P2 segment. Moderate focal narrowing at the left A1 segment origin. Decreased flow related enhancement in the left middle cerebral artery branches. Moderate irregular in narrowing of the cavernous right internal carotid artery.6. Unremarkable MRV head.


Instruction: Generate impression based on findings.

Input: Metastatic renal cell carcinoma Evaluation of the postcontrast images limited by motion artifact.There are multiple foci of signal abnormality scattered throughout the pelvis consistent with osseous metastatic disease. The largest lesion is noted within the posterior ilium and demonstrates soft tissue extension into the overlying musculature. The mass demonstrates enhancement following gadolinium administration and measures approximately 7 x 3.9 x 6.4 cm in the greatest transaxial and craniocaudal dimensions. Just inferior to this dominant mass is an additional focus in the left ilium measuring approximately 3.4 x 1.3 x 1.8 cm which may represent a satellite lesion or extension from the more superior mass.Scattered additional foci of enhancement are noted throughout the pelvis and delineated on PACS including within the left iliac wing, the right acetabulum, the sacrum bilaterally, and the right femoral head. Additionally, there is abnormal enhancement and irregularity of the superior endplate of L4 concerning for an additional metastatic lesion with possible pathologic fracture.

Output: Multifocal osseous metastatic disease throughout the pelvis with additional foci noted in the proximal femora and lower lumbar spine. The largest lesion involves the left posterior ilium and measures 7 x 3.5 x 6.4 cm.


Instruction: Generate impression based on findings.

Input: Compared to examination from 5 days prior, there are interval postsurgical changes of decompression of the thoracic spinal canal from T5 to T8 and tumor debulking. Previously seen cord deformity is improved. There remains epidural tumor involving the left ventrolateral aspect of the spinal canal including with minimal cord deformity at the T7 level involving its left lateral aspect. Dorsal thecal sac effacement is much improved. There is subtle T2 hyperintensity within the thoracic cord from T5 to T7 which is suspected and probably present on prior although difficult to appreciate on prior due to the compressed cord.Multifocal osseous metastatic disease is again seen including the T1, T6-T8, and L1 vertebrae. Again noted is extensive involvement of the posterior elements on the left from T6 to T8 and narrowing of the left T6-T7, T7-T8, and T8-T9 neural foramina due to tumor. Enhancing tumor involving the neural foramina at the right C7-T1, right T1-T2, right T2-T3, right T12-L1, and right L1-L2 neural foramina also again seen. Tumor involving the left chest wall from approximately T7-T9, moderate left-sided pleural effusion, and para-aortic lymphadenopathy also again seen.The thoracic spine is in normal alignment, with a normal thoracic kyphosis. Vertebral body heights are maintained. Mild degenerative changes are seen including small central disc protrusion at T6-T7 and T7-T8.There is a fluid collection in the surgical bed which is mostly in the posterior midline paraspinous soft tissues and may represent a seroma or pseudomeningocele. Small amount of the fluid extends into the left lateral epidural space extending from T6 to the T7-T8 levels.

Output: Compared to MRI examination from 5 days prior, interval posterior decompression of the spinal canal from T5 to T8 is seen with laminectomies and tumor debulking. Previously seen cord deformity is improved. Dorsal thecal sac effacement is significantly improved. There however remains rightward displacement of the cord and mild cord deformity at the T7 level related to epidural tumor involving the left ventrolateral aspect of the spinal canal. Paraspinous fluid collection which has mild extension into the left lateral epidural space from the T6 to the T7-T8 levels also mildly contributes to the mass effect. There is subtle T2 hyperintensity within the thoracic cord from T5 to T7 which may have been present on prior study although difficult to appreciate due to the compressed cord.Please see above and recent report from 12/5/2015 regarding additional foci of metastatic disease including involvement of multiple neural foramina.


Instruction: Generate impression based on findings.

Input: Headache 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.Left globe is atrophic and calcified with prosthesis. Single image of the sella turcica demonstrates calcification. There is no CSF density seen in the sella. Correlation with clinical history is recommended. Further evaluation with MRI can be performed. The optic chiasm is normal.

Output: 1. No acute abnormality seen to account for the patient's symptoms of headaches. 2. Calcification noted in the sella turcica. Correlation with clinical history is recommended and further evaluation with MRI can be performed if indicated.


Instruction: Generate impression based on findings.

Input: Evaluate for osteomyelitisIMAGE ACQUISITIONS: CT- right hip, bilateral foot and ankle. Please note that the patient presented with a history of possible osteomyelitis with draining ulcers. An MRI with contrast was suggested to evaluate the right hip and bilateral foot and ankles. However, after conference with the primary service, our request for an MRI was modified and a CT with no enhancement was performed at the service's request.CT of the right hip shows a deep ulcer overlying the greater trochanter extending to the level of the bone with minimal cortical destruction and associated soft tissue gas. These findings are suspicious for osteomyelitis.CT of the right foot and ankle shows what appears to be a shallow soft tissue defect consistent with an ulcer overlying the medial and lateral malleoli. The underlying bony cortex appears intact. Vascular calcifications are noted. Degenerative changes affect the foot and ankle.CT of the left foot shows no ulceration, discrete abscesses or other radiographic findings to suggest osteomyelitis. Slight fat stranding about the foot is consistent with soft tissue edema. The patient is status post mid first metatarsal amputation with the osteotomy edge remaining intact.

Output: 1) Deep ulcer overlying the greater trochanter extending to the level of bone with minimal cortical destruction and associated soft tissue gas suspicious for osteomyelitis. 2) Shallow ulcers overlying the medial and lateral malleoli of the right foot with no evidence of cortical disruption.


Instruction: Generate impression based on findings.

Input: Malignant neoplasm of brain, unspecified site [191.9], Reason for Study: ^Reason: Eval GBM. History: GBM. Redemonstration of the post resection cavity of the right frontal GBM which does not show any interval change in terms of maximum diameter (54mm x 42mm x 63mm) and MR characteristics.There is no evidence of abnormal enhancement except overlying dural enhancement which does not show any interval change since prior exam.Patchy high signal intensity on the peripheral side of the resection cavity on FLAIR/T2 images do not show any interval change since prior scan.No change of retention cyst in the sphenoid sinus.Extra axial fluid collections on craniotomy site has been smaller since prior scan (maximum thickness 4mm from 9mm).The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. No change of post resection cavity since prior scan in terms of size and MR characteristics.2. No evidence of new or residual tumor.


Instruction: Generate impression based on findings.

Input: There are no subependymal nodules or foci of susceptibility effect to suggest parenchymal/subependymal calcifications. There is no hydrocephalus. There is no suspicious enhancement, acute infarct, mass, or cerebral edema. Myelination pattern is normal for patient age. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable.

Output: Unremarkable exam. Specifically, there are no MRI findings of tuberous sclerosis at this time.


Instruction: Generate impression based on findings.

Input: Female, 47 years old, with back pain and numbness in the right leg. Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits allowing for a mild concavity of the superior T11 endplate. No evidence of marrow edema or concerning marrow replacement is seen. The visualized distal spinal cord, conus and cauda equina are unremarkable except as discussed below.T10-11: Small left paracentral/foraminal disc extrusion which mildly narrows the left neural foramen. No significant interval changes.T11-12: Mild facet hypertrophy. Mild loss of disc height with slight disc bulging. No significant spinal canal or foraminal stenosis. No significant interval changes.T12-L1: Unremarkable.L1-2: Unremarkable. L2-3: Unremarkable. L3-4: Progressive moderate facet hypertrophy, particularly on the right with there is a large facet joint effusion and subchondral cystic degeneration. Ligamentum flavum thickening. Mild disc bulging. No significant generalized spinal canal stenosis. No significant neuroforaminal narrowing. L4-5: Progressive advanced facet hypertrophy with large facet joint effusions bilaterally. Significant ligamentum flavum thickening. A new cyst is evident arising from the right ligamentum flavum projecting into and effacing the right dorsal aspect of the spinal canal. A sliver-like area of cystic degeneration also seems to be new within the left ligamentum flavum. Mild disc bulging is seen. These findings contribute to produce a moderately severe generalized spinal canal stenosis, new from prior, with slight crowding of the nerve roots of the cauda equina. The neural foramina are not significantly narrowed. L5-S1: Facet hypertrophy. Mild bulging disc. No significant spinal canal stenosis. Minimal right foraminal narrowing, slightly progressed.

Output: Progressive degenerative findings are seen, primarily affecting the posterior elements at L3-4 and L4-5. For example, there is significant facet degeneration at L3-4 with facet effusion on the right. At L4-5, there is marked bilateral facet degeneration with effusions, and a large new cyst arising from the right ligamentum flavum which projects into the spinal canal and contributes to a moderately severe canal stenosis.


Instruction: Generate impression based on findings.

Input: Clinical question answered: 10 month old male with fever x 2 days with swelling behind right ear. Access versus tendinitis. Look for retropharyngeal extension. Signs and symptoms: Fever swelling behind right ear. Examination demonstrates extensive area of soft tissue swelling with stranding of subcutaneous fat and effacement of fascial planes on the right side of neck extending from the right occipital region inferiorly into the right parapharyngeal space and retropharyngeal space with extension into the right submandibular region and inferiorly into the right submental region. At the level of right submandibular region there are multiple loculated necrotic cavities which are believed to represent necrotic lymph nodes. There is significant mass-effect and anterior and medial displacement of right carotid artery. There is complete occlusion of right internal jugular at the level of skull base. There is fixation of edema and swelling into the retropharyngeal space allover no evidence of cavity formation is detected. No evidence of any significant airway compromise is detected. The mastoid air cells and middle ear cavity as well as the external auditory canals remain within normal limits. There is normal enhancement of the right lateral (transverse) sinus and sigmoid sinus as well as the right jugular bulb however as mentioned above the internal jugular vein is occluded exactly at the level of the skull base. Soft tissue swelling with subtle enhancement overlapping the right occipital bone demonstrates suspected minimal lytic changes of the bone. This finding is best appreciated on axial images 62 through 65. This finding is not associated with any abnormality of the lateral or the sigmoid sinus on the right and the inner table of the skull remains intact at this level. This finding may be normal anatomical variation of irregularity of the bone and I believe possibly two of an overlapping infectious process (osteomyelitis) is considered less likely. Entirely exclude possibility of osteomyelitis an MRI examination might be helpful.

Output: 1.Extensive soft tissue thickening extending from the right occipital region into the right parapharyngeal space, right retropharyngeal space, right submandibular region and right submental region as detailed.2.Enhancement of abnormal soft tissue thickening contains areas of internal necrosis in the right submandibular region which are believed to represent the chronic lymph nodes.3.Edema of retropharyngeal space with no evidence of abscess formation or any significant airway compromise.4.Mass effect and anterior displacement of right internal carotid artery by the above findings.5.Complete occlusion of right internal jugular at the level of skull base and inferior.6.Normal enhancement of right lateral and sigmoid sinuses and jugular bulb.7.Minimal irregularity of outer table of the skull in the right occipital region may be anatomical variation and unlikely osteomyelitis. Please see above comments.8.No evidence of spread of infection into the intracranial space or spinal canal.9.Normal pneumatization of right external auditory canal, right middle ear cavity and mastoid air cells.


Instruction: Generate impression based on findings.

Input: Previously demonstrated multiple foci of diffusion signal abnormality have resolved. There are no new foci of restricted diffusion. There is a chronic appearing infarct is present in the subcortical white matter of the inferior frontal gyrus (series 303, image 172). Hemorrhagic products are now evident at a few of these foci of prior restricted diffusion consistent with hemosiderin deposition.There has been interval decrease in size of a right posterior parietal lesion, now measuring 16 x 23 mm in transaxial dimensions (previously 25 x 21 mm. This contains intrinsic T1 hyperintense material without significant associated residual enhancement. Postoperative changes are again noted secondary to a biopsy of this lesion.There is a new small focus of enhancement involving a posterior left insular cortex, in an area of prior stroke, and now associated with susceptibility abnormality.Confluent T2 hyperintense white matter abnormality has increased bilaterally, without associated mass effect, suggestive of treatment change.There is no significant mass effect or midline shift. The cerebellar tonsils are in normal position. The ventricles and sulci are unchanged in size. Flow voids are present within the major vessels indicating patency. Redemonstrated is diffuse sinus disease, with worsening of the frontal sinuses and left sphenoid sinus.

Output: 1.Previously demonstrated multiple foci of diffusion signal abnormality have resolved. There are no new foci of restricted diffusion.2.There has been interval decrease in size of a right posterior parietal lesion, now measuring 16 x 23 mm in transaxial dimensions (previously 25 x 21 mm. This contains intrinsic T1 hyperintense material without significant associated residual enhancement. 3.There is a new small focus of enhancement involving a posterior left insular cortex, in an area of prior stroke, and now associated with susceptibility abnormality. This is of uncertain clinical significance.4.Confluent T2 hyperintense white matter abnormality has increased bilaterally, without associated mass effect, suggestive of treatment change.5.Redemonstrated is diffuse sinus disease, with worsening of the frontal sinuses and left sphenoid sinus.


Instruction: Generate impression based on findings.

Input: Cervical spine:The right cerebellar tonsil lies 7 mm below the level of the foramen magnum and demonstrates a pointed morphology, unchanged. CSF flow analysis demonstrates a flash of biphasic flow at the level of the cerebellar tonsils, unchanged in extent.Straightening of the cervical spine is likely positional. There are no fractures or subluxations. The marrow signal is benign. The cervical cord is normal in signal. The visualized paraspinal contents are unremarkable.C2/3: Unremarkable and unchangedC3/4: Small midline protrusion slightly indents the anterior cord surface without intrinsic or signal abnormality and no resulting stenosis, unchanged.C4/5: Unremarkable and unchangedC5/6: Unremarkable and unchangedC6/7: Unremarkable and unchangedC7/T1: Unremarkable and unchangedThoracic spine:There is a smooth, physiologic thoracic kyphotic curve. The vertebral body heights and disc spaces are maintained. Marrow signal intensity is benign throughout. The spinal cord has a smooth contour and is without focal atrophy, edema, or myelomalacia. There are no masses.T1/2 demonstrates no significant disc bulge or cord encroachment, unchanged.T2/3 demonstrates no significant disc bulge or cord encroachment, unchanged. T3/4 demonstrates no significant disc bulge or cord encroachment, unchanged. T4/5 demonstrates no significant disc bulge or cord encroachment, unchanged. T5/6 demonstrates no significant disc bulge or cord encroachment, unchanged.T6/7 demonstrates no significant disc bulge or cord encroachment, unchanged. T7/8 demonstrates no significant disc bulge or cord encroachment, unchanged. T8/9 demonstrates no significant disc bulge or cord encroachment, unchanged. T9/10 demonstrates no significant disc bulge or cord encroachment. There is right ligamentum flavum and facet hypertrophy without significant resulting stenosis, unchanged. T10/11 demonstrates no significant disc bulge or cord encroachment. Bilateral ligamentum flavum and facet hypertrophy without significant resulting stenosis, unchanged.T11/12 demonstrates no significant disc bulge or cord encroachment. Slight ligamentum flavum thickening and facet hypertrophy without significant resulting stenosis, unchanged.T12/L1 demonstrates no significant disc bulge or cord encroachment, unchanged.

Output: 1.The right cerebellar tonsil lies 7 mm below the level of the foramen magnum and demonstrates a pointed morphology providing MRI evidence of Chiari I formation. CSF flow analysis demonstrates a flash of biphasic flow at the level of the cerebellar tonsils. These findings are stable in appearance.2.There are no MRI findings of syrinx.3.C3/4: Small midline protrusion slightly indents the anterior cord surface without intrinsic or signal abnormality and no resulting stenosis, unchanged.4.Mild degenerative changes of the lower thoracic spine without significant resulting stenosis are stable in appearance.


Instruction: Generate impression based on findings.

Input: Disorder of brain, unspecified [G93.9], Reason for Study: ^Reason: pre op navigation tumor History: rue weakness, transient dysarthria Multiple fiducial markers attached on scalp.Re demonstration of the left parietal operculum irregularly enhancing mass lesion with surrounding edema.The size (38.1mm x 31.3mm), MR characteristics and the extent of surrounding edema appear to be unchanged since prior scan.The left lateral ventricle appears to be slightly deformed.The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: No interval change of the size, MR characteristics and surrounding edema of the left parietal opercular intra axial mass since prior scan.


Instruction: Generate impression based on findings.

Input: There is evidence of interval development of the left fronto-parietal craniotomy for the biopsy of the left parietal intra axial lesion. There is extra dural fluid collections with blood products just underneath of the craniotomy site which is measured about 11.2mm.There is fluid fluid level within the lesion indicating local blood products within the resection cavity.There are irregular enhancement on the site of the lesion especially inferior and peripheral aspect of the original lesion which could represent residual tumor or could represent reactive changes after the surgery.There is no evidence of acute ischemic lesion on this scan.The ventricles, sulci and cisterns are symmetric and unremarkable. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: Postoperative status of the left parietal intra-axial mass lesion as described above.In particular, intra lesional blood products, extra dural blood products and subtle enhancement especially on peripheral aspect of the lesion were demonstrated.


Instruction: Generate impression based on findings.

Input: Male 44 years old Reason: 44M with h/o fistulizing Crohn's disease, c/b EC fistula from terminal ileum to buttock involving sacrum; please eval for residual fluid collection/pelvic fistula tract History: EC fistula PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: The distal right ureter is dilated and demonstrates mural thickening and hyperenhancement suggestive of inflammation. A right ureteric stent is incompletely imaged and terminates in the bladder.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Again seen is a presacral fluid collection which is stable in size and measures 2.6 x 1.5 cm (series 501, image 60), previously 2.6 x 1.3. There are surrounding inflammatory changes. Diffuse inflammatory changes also surround a fluid tract which extends from the collection inferolaterally across the left hemisacrum, through a left lower sacral foramen, and through the gluteus maximus into the subcutaneous tissues of the left posterolateral pelvic wall. There are inflammatory changes posteromedial to the left sciatic nerve. The fluid collection abuts the posteromedial aspect of the right sciatic nerve.BONES, SOFT TISSUES: The aforementioned collection abuts the sacrum and although this study is not optimized for evaluation of the bone there appears to be some abnormal T2 hyperintense and possibly some subtle T1 hyperintense signal within the sacrum. OTHER: No significant abnormality noted.

Output: 1.Presacral space fluid collection consistent with abscess which is unchanged in size compared to prior study.2.Persistent inflammatory changes surrounding the fluid collection with a persistent fistula exiting at the left posterolateral pelvic wall.3.Right hydroureter is incompletely imaged however there is mural thickening and edema suggestive of inflammation. This is nonspecific but may relate to the in situ ureteric stent.4.Signal abnormality within the sacrum immediately subjacent to the aforementioned fluid collection suggestive of chronic osteomyelitis.


Instruction: Generate impression based on findings.

Input: History of liver transplant. Evaluate for biliary stricture. ABDOMEN:LIVER, BILIARY TRACT: Again seen are several hepatic cysts.Mild irregularity of the common hepatic duct with moderate stenosis at the level of Klatskin, stable to slightly increased from the prior study.There is mild irregularity and narrowing at the hepatic duct anastomosis, similar to the prior study.No intrahepatic biliary ductal dilatation.The hepatic artery anastomosis is not visualized but the hepatic artery enhances and appears patent. The portal vein and hepatic veins are patent.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.At least moderate stenosis at the level of Klatskin is stable to slightly increased compared to the prior study.2.Mild irregularity and narrowing at the hepatic duct anastomosis appears similar to the prior.3.Patent vasculature.


Instruction: Generate impression based on findings.

Input: 79 years Female (DOB:5/4/1937)Reason: metastatic FT cancer with new prolonged headaches History: headachePROVIDER/ATTENDING NAME: NITA KARNIK LEE NITA KARNIK LEE The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. This is stable compared to the prior exam.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus. There is a developmental venous anomaly in the left cerebellar hemisphere.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related. 2.There is no evidence for brain metastases.3.Examination is limited as a fusion exam.


Instruction: Generate impression based on findings.

Input: 27 year-old female. History of small bowel and ?duodenal stricture. Evaluate for active disease and stricturing. EPIC history: had ileocecectomy 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: Gastric distention suggestive of partial gastric outlet obstruction due to a stricture at the first and second portions of the duodenum, unchanged. The stricture is approximately 1.5 cm in length and with a 0.7-cm luminal diameter. No associated diffusion restriction or hyperenhancement of the duodenal stricture to suggest active disease.Postsurgical findings of ileocecectomy. No evidence of inflammatory bowel disease in the small bowel or colon. No fistulae or abscesses. Moderate stool burden.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Physiologic follicles in the ovaries with a dominant follicle in the left ovary.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: See above.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Trace free pelvic fluid, likely physiologic.

Output: Short segment likely fibrostenotic disease of the duodenum causing a partial gastric outlet obstruction, unchanged. No new findings.


Instruction: Generate impression based on findings.

Input: Multiple hepatic lesions. History of hepatic steatosis. ABDOMEN:LIVER, BILIARY TRACT: Diffuse decrease in signal intensity on the out of phase images is consistent with hepatic steatosis/fatty infiltration. The liver is enlarged measuring 23 cm in craniocaudal dimension.Demonstrated again are multiple hepatic lesions which are not significantly changed in size or number. The reference largest lesion measures 4.7 x 3.5 cm (series 11 image 15), compared to 4.5 x 3.7 cm previously.The lesions are relatively hyperintense on the T1-weighted fat-suppressed precontrast imaging sequences likely secondary to the background fatty liver and relatively homogeneously hypointense on the nonfat suppressed T2 weighted images. Again, the larger lesions demonstrate some heterogeneity on the fat-suppressed T2-weighted images and peripheral restricted diffusion. On the multi hour delayed images the lesions are iso to slightly hyperintense to the background liver parenchyma.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right renal inferior pole simple cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Stable size and number of the multiple hepatic lesions. Although a few of the lesions demonstrate somewhat atypical characteristics these likely represent multiple focal nodular hyperplasias.2.Hepatomegaly and steatosis.


Instruction: Generate impression based on findings.

Input: Seizure-like activity. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is mild prominence of the temporal horn of the right lateral ventricle, but the ventricles and hippocampi are otherwise normal in size and configuration. There is an incidental focus of subcentimeter dural ossification along the posterior falx cerebri. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No evidence of potential seizure foci.


Instruction: Generate impression based on findings.

Input: 3-month-old female with a history of VACTERL syndrome (cloaca, multicystic dysplastic right kidney, low lying left kidney, and tethered spinal cord on MRI, left thumb hypoplasia, esophageal atresia s/p TEF repair, PFO/PDA) including an imperforate anus with cloaca.EXAMINATION: MR pelvis without and with IV contrast 6/29/2016 The slice thickness and gaps were too large to clearly delineate the anatomy. The lower pole of the solitary left kidney appears to function normally. The T1 fat saturation sequence was not saturated. These technical problems render the exam nondiagnostic.

Output: Nondiagnostic examination. The patient will be recalled for a repeat examination.


Instruction: Generate impression based on findings.

Input: 55-year-old man with history of elevated PSA status post prostatectomy. PELVIS:PROSTATE:The patient is status post prostatectomy. There is a 19 x 8 mm soft tissue nodule in the left prostatectomy bed (series 801, image 26) which has low T2 signal, diffusion restriction, and mild enhancement. This nodule appears to extend to the level of the left anterior rectal wall.BLADDER: There is concentric thickening of the bladder wall.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Enhancing soft tissue focus in the left prostatectomy bed suspicious for local recurrence, less likely residual seminal vesicle. Please correlate with patient's operative history.


Instruction: Generate impression based on findings.

Input: 34-year-old male with bilateral posterior joint line pain and IT band pain and sports/running on and off for 2 years MENISCI: The lateral meniscus appears intact. The medial meniscus appears intact.ARTICULAR CARTILAGE AND BONE: No full-thickness or near full-thickness articular cartilage defects are identified. The patellofemoral compartment cartilage appears relatively spared.LIGAMENTS: The cruciate and collateral ligaments appear intact. Specifically, there is no increased signal abnormality within the lateral synovial recess to suggest IT band syndrome as clinically questioned. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: Marked fatty atrophy of the semimembranosus muscle is nonspecific but may be secondary to denervation, although atrophy due to an old proximal hamstring tear could also be considered. No findings to suggest iliotibial band friction syndrome.


Instruction: Generate impression based on findings.

Input: 47 years, Female, Reason: 47 yr/old female with h/o UC s/p proctocolectomy with IPAA, pouchitis, fissure and now 2 possible fistulae openings on the distal gluteal fold in the tailbone area History: 2 openings with some serosanguiness drainage, small amount in distal gluteal fold area. PELVIS: UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is a small suprasphinteric sinus tract extending from the left lateral aspect of the rectum (3 o'clock position) approximately 1 cm.BONES, SOFT TISSUES: The tip of the coccyx has high signal intensity on T2 and low signal intensity in T1, suggesting osteomyelitis. There is a sinus tract extending from the coccyx to the left gluteal fluid which may represent a draining sinus.There is heterogeneous increased T2 signal within the prevertebral space which may represent phlegmon.Increased T2 signal adjacent to the right sacroiliac joints is likely degenerative.OTHER: Small Tarlov cysts.

Output: 1.Findings compatible with osteomyelitis of the coccyx with a sinus tract draining to the left gluteal fold2.Suprasphincteric sinus tract extending from the left lateral aspect of the rectum.3.Phlegmonous inflammatory changes in the prevertebral space


Instruction: Generate impression based on findings.

Input: Reason: eval for septic joint History: overlying wrist cellulitis, diminished ROM Limited study due to suboptimal coil.There is thickening of the skin of the wrist with subcutaneous edema both volarly and dorsally. There is also edema of the interosseous musculature and scanned portions of the hypothenar musculature with sparing of the thenar musculature. Mild edema of the pronator quadratus and distal flexor musculature. Additionally, there is fatty atrophy of the intraosseous muscles.There is small amount of fluid surrounding the extensor digitorum and extensor carpi ulnaris tendons as they cross the carpus. We see no soft tissue fluid collection to suggest abscess. There is trace fluid in the joints of the wrist, within normal limits. We see no specific features of septic arthritis. There is mild increased signal intensity in the distal ulna, medial margin of the triquetrum, and medial margin of the hamate on fat-suppressed T2-weighted images with relative preservation of signal on T1 images. This finding may represent reactive osteitis, but we see no frank cortical destruction to confirm osteomyelitis. Otherwise bone marrow signal is normal. Please note, this study was not protocoled for or of sufficient quality to assess intrinsic ligaments of the wrist or TFCC; however, no gross abnormalities noted.

Output: Limited evaluation of the wrist due to suboptimal coil as patient's wrist was in a cast (per verbal communication with technologist).Nonspecific soft tissue inflammation as above compatible with cellulitis without evidence of abscess formation. We see no specific findings of septic arthritis. Other findings as above.


Instruction: Generate impression based on findings.

Input: Clinical question: MS; f/u progression. Signs and Symptoms: Paresthesias. Nonenhanced thoracic MRI:Stable chronic demyelinating plaque in the right posterior aspect of thoracic cord at T3 demonstrate no change since prior study.Demyelinating plaque of thoracic cord at T6 level demonstrate no interval change since prior exam.Demyelinating plaque in the left lateral aspect of the cord at T7 demonstrate no change.Ill-defined demyelinating plaque at T9 level on the right is again identified without change since prior study.Small demyelinating plaque on the right lateral aspect of the cord at T11 is again identified and without change.There is no convincing evidence of any new lesions since prior MRI exam from December 2014.There is normal signal intensity and anatomical alignment of vertebra, without spinal stenosis or neural foraminal compromise.Nonenhanced lumbar MRI:Normal signal intensity and caliber of the lower most visualized thoracic cord and the conus.Normal signal intensity and morphology of cauda equina.Normal signal intensity and alignment of vertebral,. No spinal stenosis or neural foraminal compromise at any level. Examination at L3-L4, L4-L5 and L5-S1 levels demonstrate mild to moderate facet and ligamentum flavum hypertrophy without resultant spinal canal or neural foraminal compromise.

Output: 1.Stable scattered foci of T2/T2 STIR hyperintensity of the thoracic cord consistent with patient's known multiple sclerosis and without convincing evidence of a new finding.2.Unremarkable MRI examination of lumbar spine with the exception of mild to moderate hypertrophic/degenerative changes of posterior elements in the lower lumbar spine as detailed. No spinal stenosis or neural foraminal compromise.


Instruction: Generate impression based on findings.

Input: , trouble speaking. Unspecified chest pain. Non-enhanced CT of brain:There is no evidence of intracranial hemorrhage, edema, mass-effect, midline shift or hydrocephalus.Cortical sulci, ventricular system, CSF cisterns and gray -- white matter differentiation is within normal. Considering provided clinical data follow-up with an MRI is recommended.Calvarium, visualized orbits, paranasal sinuses and mastoid air cells are unremarkable.

Output: Unremarkable nonenhanced CT brain and calvarium.


Instruction: Generate impression based on findings.

Input: Facial paresthesias, bilateral arm paresthesias There are small posterior disc-osteophyte complexes at C5-6 and C6-7 that mildly indent the spinal cord. There is no convincing signal abnormality within the spinal cord, however. There is a minimal disc-osteophyte complex at C4-5 without associated spinal canal or neural foramen stenosis. There vertebral bone marrow signal characteristics appear unremarkable. There is straightening of the vertebral column alignment in the sagittal plane. The vertebral body and disc space heights are preserved. The paravertebral soft tissues are unremarkable.

Output: Degenerative spondylosis of the cervical spine with small posterior disc-osteophyte complexes at C5-6 and C6-7 that mildly indent the spinal cord. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Male 64 years old Reason: Evaluate for HCC History: Cirrhosis with an elevated AFP The arterial phase images are suboptimal, limiting evaluation for hepatocellular carcinoma.ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis. The gallbladder is distended, but not significantly changed compared to prior study. Heterogeneous hepatic parenchyma with prominence of the fissures consistent with cirrhosis. Diffuse signal drop out on in phase images is suggestive of iron deposition. Additional punctate foci of signal drop out are suggestive of siderotic nodules. Arterial phase images are limited due to suboptimal timing. Within this limitation no suspicious lesion is identified.Patent hepatic vasculature.SPLEEN: Mild splenomegaly at 13.6 cm.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Asymmetric renal enhancement in the earlier phases of imaging with normalization on the 3-minute delayed phase of imaging. This is likely perfusional.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Trace ascites. Multiple upper abdomen collateral vessels.

Output: 1.Cirrhotic liver morphology without suspicious focal hepatic lesion. Sequela of portal hypertension with splenomegaly and multiple upper abdominal collateral vessels.2.Cholelithiasis with gallbladder distention, unchanged compared to prior study.


Instruction: Generate impression based on findings.

Input: There is no significant change in size of of the predominantly cystic craniopharyngioma measuring up to 45 mm in the maximal AP dimension and 42 mm in the transverse dimension, similar to prior. There continues to be involvement of the suprasellar, prepontine, cerebellopontine angle, right ambient and right quadrigeminal cisterns, as well as the right middle cranial fossa, with associated mass effect upon the brainstem, right medial temporal lobe, and hypothalamus-optic apparatus complex. Areas of enhancement in the suprasellar cistern are not significantly changed. T1 shortening which may reflect proteinaceous material or blood products in the right ambient cistern also not significantly changed. No enlarging components. Leftward displacement of the pons and contour deformity involving the right lateral aspect of the midbrain is not significantly changed. There is no new mass effect. Again seen are foci of susceptibility effect within the right temporal lobe resection cavity, consistent with hemosiderin deposition, and within portions of the tumor particularly in the suprasellar cistern, which likely represent calcifications.Parenchymal defect/encephalomalacia in the right lateral temporal lobe is unchanged. There is unchanged volume loss of the left cerebellar hemisphere associated with increased T2 signal, which may be attributable to crossed cerebellar diaschisis versus chronic injury. T2/FLAIR signal abnormality in the left medial temporal lobe which may reflect posttreatment change is also unchanged. The basilar artery is tortuous and encased by the tumor. There is stable position of right transfrontal catheter with the tip in the right prepontine cyst. The ventricular system also appears unchanged without hydrocephalus.

Output: Compared to 8/18/2016, there is no significant interval change in size of the treated craniopharyngioma.


Instruction: Generate impression based on findings.

Input: No significant PMH with 2 days of dizziness associated with nausea and leftward horizontal gaze-evoked nystagmus and leftward drifting of fixed gaze. Orbits: The globes and ocular adnexa are intact. Likewise, the optic nerves are unremarkable. There is no evidence of intraorbital mass lesions or abnormal enhancement. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There are small retention cysts in the maxillary sinuses.

Output: 1. The orbits are unremarkable.2. No evidence of acute intracranial hemorrhage, mass, or acute infarction.


Instruction: Generate impression based on findings.

Input: Post-op ACDF There is postsurgical fusion of C4, C5, C6, and C7 with anterior plate and screw device and interposed bone graft. No radiographic evidence of hardware complication is evident. The alignment is anatomic. There is no evidence of superimposed instability.There is fusion of C2 and C3, likely congenital.

Output: Post-operative changes, without evidence of hardware complication or instability.


Instruction: Generate impression based on findings.

Input: Somnolence [R40.0], Reason for Study: ^Reason: anatomic abnormalities? Chiari? History: LOC concerning for seizure No evidence of acute ischemic or hemorrhagic lesion.There is about 22.6mm cerebellar tonsilar herniation through foramen magnum indicating Chiari I malformation.Associated cervical spinal cord syringomyelia from the level of C2 is also seen.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells show fluid signal intensity and mucosal thickenings on bilateral maxillary sinuses, ethmoid sinuses, frontal sinus and sphenoid sinus.

Output: 1. Chiari I malformation with cervical spinal cord syringomyelia.2. No evidence of acute ischemic or hemorrhagic lesion.


Instruction: Generate impression based on findings.

Input: There is normal alignment of the cervical spine with no prevertebral, paravertebral, ligamentous or osseous marrow T2 signal abnormality. The vertebral body and disk heights are preserved. The cord signal is within normal limits. The visualized soft tissues are unremarkable. The flow-voids in the neck are patent. There is no spinal stenosis or disk herniation at any level in the cervical spine. Mild sphenoid sinus disease is partially visualized.

Output: No evidence of acute traumatic injury to the cervical spine.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Patient with non-small cell lung cancer history of epilepsy. Status post craniotomy for brain metastases. No needs disease evaluation prior to therapy In comparison with the prior examination residual blood from the left posterior temporal has been absorbed. Area of edema of right frontal lobe has significantly increased since prior study and is concerning for neoplasm and should be further evaluated with a dedicated MRI examination with infusion. Postsurgical changes of left parietal craniotomy is again identified. No evidence of hemorrhage, midline shift or hydrocephalus.

Output: Significant increase in the amount of vasogenic edema in the right frontal lobe concerning for recurrence of disease and should be further evaluated with an MRI examination.


Instruction: Generate impression based on findings.

Input: 44 year old present for pre-surgical evaluation after receiving neoadjuvant chemotherapy. There is heterogeneous amount of fibroglandular tissue in both breasts. Numerous high T2 signal cysts are seen.Mild parenchymal enhancement is noted bilaterally.The index mass is in one dimension increased in size compared to the most recent prior measurements, today measuring 3.1 x 2.7 x 2.9 cm, previously 3.1 x 2.7 x 2.7 cm. Internal artifact from the biopsy clip is noted. Artifact from the benign biopsy Hydromark clip is also again seen anterior to the known cancer and has no suspicious adjacent enhancement. A few scattered peripherally enhancing cysts are noted on contrast enhanced images of the left breast.No significant change in left axillary lymph nodes, with a reference node again measuring 1.3 x 0.9 cm. No suspicious enhancement is seen in the right breast. There are a few peripherally enhancing cysts in the right breast. No abnormal lymph nodes are identified in the right axillary region.Right chest wall Port-A-Cath is present. Hepatic mass also again noted.

Output: Slight interval increase in measurement of the left breast cancer. No change in reference axillary node.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Ring finger mass There is a lobulated mass within the radial and volar soft tissues of the ring finger. It measures approximately 2 x 1 cm in the craniocaudal and transverse dimensions and extends from the mid diaphysis of the middle phalanx to the base of the distal phalanx with a possible additional small component more distally at the level of the mid shaft of the distal phalanx. The mass abuts the lateral aspect of the flexor digitorum profundus tendon however the underlying tendon is normal. Additionally, the underlying bone is normal in signal without erosion. The mass is isointense to skeletal muscle on T1 sequences and contains tiny foci of increased signal best appreciated on the coronal T1 sequence. The mass is hyperintense to skeletal muscle on fat saturated T2 sequences with small round and curvilinear foci of low signal intensity. Following administration of gadolinium, there is heterogeneous enhancement. No additional masses are identified. The remaining visualized bone marrow signal is normal. A tiny cyst is seen within the head of the third metacarpal.

Output: Subcutaneous mass of the ring finger as detailed above. The enhancement pattern is not consistent with that of a ganglion and the lobulated margin and signal characteristics may be reflective of a vascular anomaly such as a venous malformation. A tenosynovial giant cell tumor is also considered as a less likely option.


Instruction: Generate impression based on findings.

Input: Female 12 years old; Reason: Left hip pain x 6months, CAM and pincer lesion on previous MRI, need arthrogram to diagnose labral tear, no improvement with PT. Evaluation is slightly limited by the presence of an air bubble within the joint. BONES / CARTILAGE: The bone marrow signal is normal. The cartilage appears normal. There are prominent supra-acetabular fossae bilaterally at the 12:00 position on both sagittal and coronal planes, a normal variant. HIP JOINT / LABRUM: There is a very small tear of the anterior superior labrum, best seen on the radial images (series 1201, image 5). SOFT TISSUES: No significant abnormality noted. OTHER

Output: 1. Small anterior superior labral tear.2. Prominent supra-acetabular fossae bilaterally, a normal variant.


Instruction: Generate impression based on findings.

Input: Lesion in pituitary and possible Chiari malformation: yearly follow up. Pituitary: There is an unchanged hypoenhancing lesion in the left lobe of the pituitary gland, measuring up to approximately 4 mm. The posterior pituitary bright spot and infundibulum are intact. The optic apparatus and cavernous sinuses are unremarkable. Brain: The cerebellar tonsils are minimally low-lying, but conserve rounded morphologies. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. No appreciable change in the left pituitary lesion, which likely represents a microadenoma.2. The cerebellar tonsils are minimally low-lying, but conserve rounded morphologies.


Instruction: Generate impression based on findings.

Input: Right sided weakness and sensory change. There are punctate foci of restricted diffusion and high T2 signal in the upper left precentral gyrus and paracentral lobule. There is a background of diffuse patchy cerebral, brainstem, and cerebellar white matter T2 hyperintensity. There are punctate foci of encephalomalacia in the bilateral basal ganglia and corona radiata. There is also encephalomalacia and susceptibility effect in the right posterosuperior temporal lobe and inferior parietal lobule. There is a pineal cyst that measures 9 mm in diameter. There is diffuse mild cerebral volume loss. There is no midline shift or herniation. There is a 9 mm diameter basilar tip aneurysm. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. Punctate recent infarcts in the left upper left precentral gyrus and paracentral lobule.2. Chronic lacunar infarcts in the bilateral basal ganglia and corona radiata. 3. Area of chronic hemorrhagic infarction in the right posterosuperior temporal lobe and inferior parietal lobule. 4. A background of diffuse patchy cerebral, brainstem, and cerebellar white matter T2 hyperintensity may represent chronic small vessel disease. 5. A 9 mm diameter basilar tip aneurysm appears to have gradually increased in size.


Instruction: Generate impression based on findings.

Input: Reason: last MRI abnormal with finding of possible gliosis, previous hematoma, or a developmental anomaly: 6 month follow up There is a persistent somewhat ill-defined T2 hyperintense intra-axial mass involving the right mesial temporal lobe, which appears to be unchanged. There is thin smooth, sheet-like enhancement overlying the anteromedial aspect of the tumor, which is also unchanged. The right temporal horn is posteriorly displaced due to mass effect. There is no evidence of acute intracranial hemorrhage or acute infarct. There is nonspecific thickening of scattered ethmoid air cells and right sphenoid sinus. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Persistent right mesial temporal lobe mass, which may represent a low-grade neoplasm. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Female 62 years old Reason: 62F with colon CA. Suspicious lesions in liver on CT History: see above ABDOMEN:LIVER, BILIARY TRACT: There are 2 hypoenhancing lesions within the liver, one within segment 4A and the second within segment 8. These are difficult to identify on the axial T2 and diffusion-weighted images however on postcontrast images these demonstrate rim enhancement (series 1003, image 35). The largest lesion measures 0.6 x 0.5 cm (series 1003, image 35). The lesions do not meet criteria for hepatic cyst/hemangioma and are suspicious for hepatic metastases.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: Multiple enhancing, diffusion restricting retroperitoneal lymph nodes are suspicious for malignant involvement.BOWEL, MESENTERY: Circumferential thickening of an approximately 6.8 cm segment of distal transverse and proximal descending colon about the splenic flexure. There is abnormality of the adjacent mesentery likely due to a combination of direct extension from the colonic mass into the mesentery and an aggregate of matted regional lymph nodes. This confluent abnormality measures approximately 4.3 x 5.8 cm (series 1004, image 76). There is delayed enhancement of a peripheral thick rind of tissue surrounding the aforementioned colonic mass and mesenteric abnormality suggestive of a fibrous component of tumor which extends into the retroperitoneum to the left psoas muscle posteriorly (series 1004, image 74) and extends to proximal jejunal loops anteromedially (series 1004, image 71).BONES, SOFT TISSUES: No significant abnormality noted.

Output: Circumferential colonic tumor at the splenic flexure with direct extension into the adjacent mesentery, mesenteric and retroperitoneal lymphadenopathy, and suspicion for hepatic metastases.


Instruction: Generate impression based on findings.

Input: 66-year-old male with rising PSA after prostatectomy. PSA 0.21 PELVIS:PROSTATE:Prostate Size: Status post prostatectomy.Peripheral Zone: Status post prostatectomy.Central Gland: Status post prostatectomy.Seminal Vesicles: Surgically absent.Extracapsular Extension: Status post prostatectomy.BLADDER: No significant abnormality noted. Asymmetric soft tissue along the left aspect of the cystourethral anastomosis with corresponding mild early asymmetric enhancement (series 1501, image 42). LYMPH NODES: Prominent bilateral inguinal lymph nodes are nonspecific.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Asymmetric soft tissue demonstrating early enhancement along the left aspect of the cystourethral anastomosis is equivocal for a focus of residual/recurrent disease.


Instruction: Generate impression based on findings.

Input: Redemonstrated are enhancing lesions in the left medial temporal lobe and superior right cerebellar vermis. The enhancing lesion involving the left medial temporal lobe abutting the left cerebral peduncle and left optic tract is smaller measuring 5 x 10 mm (series 12, image 54) compared to 9 x 10 mm previously on the OSH MRI from 6/8/2016 and 10 x 13 on the brain MRI from 12/8/2015. The second enhancing lesion involving the right superior cerebellar vermis measures 10 x 11 mm, previously 10 x 12 mm on the OSH MRI from 6/8/2016 and 8 x 6 on the brain MRI from 12/8/2015 (when utilizing axial T1 postcontrast images, as this allows for more comparable measurements). The corresponding FLAIR signal abnormality in these regions is unchanged.There are several scattered foci of susceptibility compatible with hemosiderin staining and are unchanged. There are scattered periventricular and subcortical cerebral white matter T2/FLAIR hyperintensities which are nonspecific and stable. There is no diffusion abnormality. There is diffuse volume loss. The cisterns remain patent. There is no midline shift or mass effect. Normal flow-voids are demonstrated in the major intracranial vascular structures. There are changes related to right-sided parotidectomy which is only partially visualized. There is persistent asymmetric thickening of the post-geniculate segment of the right facial nerve on the delayed postcontrast images which is somewhat more continuous compared to the previous exam. There is fatty marrow replacement in the visualized marrow of the clivus and upper cervical spine, which is likely related to posttreatment changes.

Output: 1.Stable to decreased size of the left medial temporal lobe metastatic lesion.2.Right cerebellar vermian lesion stable since outside prior exam, but is remains slightly larger than more remote 12/2015 exam.3.Post surgical changes of parotidectomy which is incompletely evaluated with persistent more continuous enhancement of the post-geniculate portion of the right 7th nerve.4.Mild degree of unchanged chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: Right tonsil p16+squamous cell carcinoma T4N? treated with CRT 2011 at OSH with multiple recurrences, status post salvage oropharyngectomy with flap and right neck dissection 2/2014 at OSH no PNI or LVSI, followed by second local recurrence to right neck and salvage surgery right oral cavity with negative margins but dysplasia 12/10/14 at OSH, referred here with right nasopharynx recurrence, which was treated with induction chemotherapy, followed by chemo/re-irradiation to a total dose of 75Gy completed on 0/30/15. There are postoperative findings related to resection of the posterior right hemimandible with hardware fixation and flap reconstruction of the right-sided pharyngeal soft tissues. There are also postoperative findings related to right neck dissection. There is no measurable residual tumor within the right nasopharynx. There are denervation changes in the right tongue. There is no evidence of significant cervical lymphadenopathy. The thyroid and remaining salivary glands appear unchanged. There is newly apparent patchy T2 hyperintensity and enhancement in the left C1 and C2 vertebrae. There is scattered fluid within the right mastoid air cells. The right internal jugular vein is absent. The imaged intracranial structures are unremarkable.

Output: 1. Post-treatment findings in the right nasopharyngeal region without measurable residual tumor.2. Newly apparent patchy T2 hyperintensity and enhancement in the left C1 and C2 vertebrae is of uncertain significance and may be treatment related or inflammatory versus less likely neoplastic. Perhaps follow up via PET may be useful.