Instruction: Generate impression based on findings.

Input: Insidious dementia. There is moderate diffuse cerebral white matter T2 hyperintensity bilaterally, predominantly in a periventricular distribution. There is a subcentimeter area of encephalomalacia in the right cerebellar hemisphere. There is no evidence of intracranial mass or acute infarct. There is no abnormal intracranial enhancement. There is a punctate focus of susceptibility effect in the left pons, which may represent a chronic microhemorrhage. There is prominence of the lateral and third ventricles, perhaps out of proportion to the other cerebrospinal fluid spaces. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. Prominence of the lateral and third ventricles, perhaps out of proportion to the other cerebrospinal fluid spaces, may indicate normal pressure hydrocephalus. 2. Moderate chronic small vessel ischemic white matter disease and a chronic right cerebellar lacunar infarct, but no acute infarct.


Instruction: Generate impression based on findings.

Input: 70 years Female (DOB:11/6/1946)Reason: pain 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 height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is disc desiccation present at this level associated with a diffuse disc bulge marked bilateral facet and ligamentum flavum hypertrophy there is associated narrowing of the neural foramina. Although the neural foraminal are narrowed, within the neural foramina the exiting nerve roots are surrounded by fat. There are some partial effacement of the fat at the lateral recess bilaterally resulting in encroachment of the nerve roots at the lateral recess bilaterally.At L4-5 there is loss of disc space height, disc desiccation and diffuse disc bulge associated marked bilateral facet and ligamentum flavum hypertrophy. There is mild anterior subluxation of L4-5. There is crowding of the nerve roots within the thecal sac. There is narrowing of the neural foramina bilaterally with encroachment of the nerve roots within the neural foramina bilaterally worse on the left side compared to the rightAt L3-4 there is no significant compromise to spinal canal or neural foramina. There is a mild to moderate degree of facet and ligamentum flavum hypertrophy at this level. There is a mild disc bulge at this level.At L2-3 there is no significant compromise to spinal canal. There is mild facet and ligamentum flavum hypertrophy at this level there is a right far lateral disc protrusion at this level encroaching right-sided exiting nerve root within the neural foramen. There are Schmorl's nodes at this levelAt L1-2 there is no significant compromise to spinal canal or neural foramina. There is a disc bulge at this level.

Output: 1.There are multilevel degenerative changes present in the lumbar spine worse at L4-5 where there is moderate degree of spinal stenosis associated with encroachment of the exiting nerve roots within the neural foramina predominantly on the left side.2.There is encroachment of nerve roots at the lateral recess bilaterally at L5-S1 related to degenerative change3.There is a right far lateral disc protrusion present at L2-3 which encroaches the right-sided exiting nerve root


Instruction: Generate impression based on findings.

Input: Right lower extremity numbness Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position.There is minimal disc desiccation and trace disc bulge at the L2-L3 and L4-L5 levels. There is otherwise no significant disc disease at any level. No spinal canal or neural foraminal stenosis at any level. Incidentally seen is a tiny perineural cyst associated with the right L5 and left T12 nerve roots, which are of doubtful clinical significance.Paraspinous soft tissues are within normal limits.

Output: Examination is essentially unremarkable. There are minimal degenerative changes without spinal canal or neural foraminal stenosis at any level.


Instruction: Generate impression based on findings.

Input: 47-year-old female with a new foci mass. Evaluate mass. A vitamin E capsule overlies the medial soft tissues of the left thigh, presumably representing the patient's palpable area of concern. Note is made of a focus of fat signal intensity within the subcutaneous tissue along the medial aspect of the thigh/femoral diaphysis, underlying the aforementioned skin marker, with increased signal abnormality peripherally on fluid sensitive sequences, measuring approximately 17 x 7 x 13 mm (AP by TR by CC). There is thin peripheral enhancement on postcontrast sequences. No additional masses or pathologic enhancement is identified. The imaged musculature is normal in appearance. No bone marrow signal abnormality is identified.

Output: 17 mm mass with fat signal intensity which appears most consistent with a lipoma, although atypical lipoma remains as a differential consideration. Follow-up evaluation by an orthopedic oncologist is recommended.


Instruction: Generate impression based on findings.

Input: 71-year-old male with abdominal pain and prior CT with 1.5 cm enhancing lesion in the liver. Evaluate hepatic lesion. ABDOMEN:LIVER, BILIARY TRACT: There is a T2 hyperintense focus in segment 7 which demonstrates peripheral nodular enhancement with filling in of the lesion on the delayed contrast enhanced phase. No evidence of washout. This lesion measures proximally 1.5 x 0.9 cm (series 7, image 30).SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Kidneys enhance symmetrically without evidence of 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: Segment 7 hepatic lesion most consistent with a hemangioma.


Instruction: Generate impression based on findings.

Input: 16 years, Male, follow-up contusion. Diffuse traumatic brain injury. There are areas of T2 hypointensity with susceptibility involving the right anterior inferior frontal lobes centered on the gyri recti consistent with contusion and similar to recent CT head. There is surrounding edema and minimal local mass effect. There is also minimal extra-axial T2 hyperintensity along the bilateral frontal cerebral convexities without suppression on the FLAIR sequence suggesting minimal subdural fluid.No midline shift or herniation. No hemorrhage is seen elsewhere in the brain. No evidence of ischemia, intracranial mass, midline shift, or herniation. Ventricles remain normal in size. Major flow-voids are preserved. Remainder of the brain is unremarkable. Calvarium and extra cranial soft tissues are grossly unremarkable.

Output: Bilateral frontal lobe contusions with surrounding edema similar to recent CT allowing for differences in technique. Minimal subdural fluid/blood products also suspected along the frontal convexities without mass effect. No evidence of traumatic injury elsewhere in the brain.


Instruction: Generate impression based on findings.

Input: Ms. Jones-Hansbrough submitted outside mammogram dated 6/30/2014, from Regenstein Breast Imaging Center. She was recently diagnosed with right breast IDC in March 2015. Submitted outside study was compared to multiple recent examinations spanning from 02/18/2015 to 03/18/2015. The breast parenchyma is composed of scattered fibroglandular elements. No suspicious masses, microcalcifications or areas of architectural distortion are present on the submitted prior mammogram dated 06/30/2014.  However, there is development of a new ill-defined mass in the right retroareolar breast on mammogram dated 02/18/2015, which was eventually biopsied with pathology of IDC. Patient has since also had an MRI dated 03/18/2015 that demonstrated unifocal malignancy.

Output: Patient has a known unifocal malignancy in the right breast. She is being followed by surgery. No additional imaging is warranted at this time.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: 84-year-old male with ischemic cardiomyopathy, coronary artery disease, DM, HTN and CHF. Because of limited function capacity, patient is referred to rule out ischemia for pre-operative risk assessment prior to hip surgery. MEDICATIONS: Amlodipine, aspirin, carvedilol, ergocalciferol, multivitamin, lovaza, quinapril, simcor, xarelto. First Pass PerfusionDuring hyperemia, a perfusion defect corresponding with the below described myocardial infarction is noted. No ischemic territories are present.Viability/ Myocardial ScarThere is a large, predominantly, transmural myocardial infarction involving the basal and mid inferoseptal, inferior, and inferolateral walls. Additionally, the apical inferior wall is involved. These infarcted myocardial segments are predominantly not viable and are the cause of the above described perfusion defect. The remainder of the myocardium is free of myocardial infarction and likely to be viable. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 62%, the LV end diastolic volume index is 88 ml/m2 (normal range: 74+/-15), the LVEDV is 145 ml (normal range 142+/-34), the LV end systolic volume index is 30 ml/m2 (normal range 25+/-9), the LVESV is 56 ml (normal range 47+/-19), the LV mass index is 76 g/m2, and the LV mass is 125 g. There is subtle hypokinesis of the basal to mid inferior wall and the basal inferolateral wall.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 51%, the RV end diastolic volume index is 85 ml/m2 (normal range 82+/-16), the RVEDV is 140 ml (normal range 142+/-31), the RV end systolic volume index is 41 ml/m2 (normal range 31+/-9), and the RVESV is 68 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsMultiple, large, bilateral renal cyst are noted. Sternal wires are noted. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. There is a large mostly transmural myocardial infarction involving the above described walls. This infarction is predominantly not viable. The remainder of the myocardium is free of myocardial infarction and viable. There are no areas of residual myocardial ischemia.2. Normal LV size and systolic function (LVEF 62%). There is subtle hypokinesis of the basal to mid inferior wall and the basal inferolateral wall.3. Normal RV size and systolic function (RVEF 51%).4. See extracardiac findings.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 67-year-old woman with history of pelvic mass. PELVIS:UTERUS, ADNEXA: In the cul-de-sac posterior to the uterus, there is a 117 x 99 x 94 mm multilobulated, irregularly-shaped mass. This mass is predominantly T2 hypointense, however contains reticular T2 hyperintensity. There is no definite cystic change within this mass. Only a small portion of this mass enhances (10011/273). This lesion is distinct from the uterus and the rectum.A second lesion with similar appearance is seen along the superior right aspect measuring 26 x 19 mm (4/32).Within the left uterine fundus (3/48) there is a 9 mm T2 hypointense intramural lesion, likely a fibroid. The ovaries are not identified.BLADDER: No significant abnormality noted.LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Hemangioma in the L5 vertebral body.OTHER: No significant abnormality noted.

Output: Large, irregular shaped pelvic mass in the cul-de-sac and smaller, satellite mass with similar imaging characteristics. Imaging and enhancement characteristics are nonspecific but differential considerations include fibrous tumor of the adnexa (such as an ovarian fibrothecoma) or pedunculated, torsed fibroid.


Instruction: Generate impression based on findings.

Input: Male, 67 years old, with right lower extremity weakness. Image quality is significantly degraded by motion artifact. Within this limitation the following observations are made.There is a grade 1 anterolisthesis of L4 relative to L5. The lumber spine is mildly scoliotic. Vertebral body heights are preserved. No evidence of marrow replacement or significant marrow edema is seen.Visualized spinal cord and conus are unremarkable. The nerve roots of the cauda equina are not well assessed due to motion artifact, but no significant abnormalities are suspected.L1-2: Facet hypertrophy and ligamentum flavum thickening. Mild bulging disk. No significant generalized spinal canal stenosis. Moderate right and mild left foraminal narrowing. L2-3: Facet hypertrophy and ligamentum flavum thickening. Bulging disk preferentially towards the neural foramina. No significant generalized spinal canal stenosis. Mild bilateral foraminal narrowing. L3-4: Facet hypertrophy and ligamentum flavum thickening. Bulging disk preferentially towards the neural foramina. No significant generalized spinal canal stenosis. Mild bilateral foraminal narrowing. L4-5: Facet hypertrophy and ligamentum flavum thickening. Bulging disk with effacement of the ventral thecal sac but no significant generalized spinal canal stenosis. Severe right neuroforaminal narrowing with nerve root impingement secondary to posterior element hypertrophy and disk degeneration. Mild left foraminal narrowing. L5-S1: Mild facet hypertrophy. Mild bulging disk. No significant spinal canal stenosis. Mild right neuroforaminal narrowing.

Output: 1. Significantly limited examination due to motion artifact.2. Multilevel degenerative findings, most severely affecting the L4-5 level, where there is a bulging disk and posterior element hypertrophy which result in severe narrowing of the right L4-5 neural foramen with probable nerve impingement.


Instruction: Generate impression based on findings.

Input: 33-year-old female for follow-up thyroid nodules. RIGHT LOBE MEASUREMENTS: 1.8 x 1.9 x 5.9 cmLEFT LOBE MEASUREMENTS: 1.6 x 1.7 x 6.4 cm . There was a typographical error on prior exam with an actual left lobe length of 6.8 cm.ISTHMUS MEASUREMENTS: 0.6 cmRIGHT LOBE: Homogeneous echotexture without mass.LEFT LOBE: There is a complex although predominantly solid mass in the left lobe which abuts in the isthmus mass (see below). When remeasuring the same] as the prior exam this measures 1.9 x 3.7 x 2.4 cm, not significant changed when compared to prior exam. Medial portion of the nodule is difficult to identify due to abutting Isthmus nodule.ISTHMUS: Within the isthmus, there is a predominant solid nodule with cystic components which appears somewhat spongiform measuring 1.9 x 2.9 x 3 cm without change.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Stable isthmus and left lobe thyroid nodules.


Instruction: Generate impression based on findings.

Input: Left knee pain and OCD lesion of tibia. MENISCI: The posterior horn of the lateral meniscus is frayed, similar to the prior study. The medial meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is a heterogeneous lesion with small cysts in the lateral tibial plateau without significant change from the previous study. There is no disruption of the articular cartilage. There may be an old osteochondral defect with subchondral cystic change, but this appears stable from the prior study. There is no evidence of loosening. There is mild adjacent bone marrow edema, similar to the prior study. LIGAMENTS: The ACL, PCL, MCL, and LCL are intact. EXTENSOR MECHANISM: What was previously described as a short segment partial-thickness tear through the distal patellar tendon is most likely a normal variant of the patellar tendon with a cleft, appearing similar to the prior study.ADDITIONAL

Output: 1. OCD lesion of the lateral tibial plateau without disruption of the articular cartilage, similar to prior.2. Fraying of the posterior horn of the lateral meniscus, similar prior.


Instruction: Generate impression based on findings.

Input: There is no evidence of acute infarct. Numerous bilateral supratentorial enhancing lesions have decreased in both size and degree of enhancement although the latter may be secondary to technical factors. For example, a left frontal parafalcine lesion measures up to 13 mm, previously 15 mm, and demonstrates decreased surrounding edema and unchanged susceptibility effect compatible with blood products. As an additional example, a right frontal parafalcine lesion previously measured 6 mm and is not currently visible. There are no new lesions. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull and scalp soft tissues are unremarkable. There is minimal mucosal thickening within the maxillary sinuses and minimal fluid within the mastoid air cells. There is a right lens implant.

Output: Improvement of intracranial metastatic disease when compared with the March 5, 2015 MRI.


Instruction: Generate impression based on findings.

Input: Left shoulder pain. ROTATOR CUFF: There is a full-thickness insertional tear of the anterior fibers of the supraspinatus with less than 1 cm of retraction. The tear is approximately 1cm in AP dimension. Additionally, there is thickening and increased signal intensity of the tendon more proximally suggesting tendinosis. The supraspinatus muscle is unremarkable. The infraspinatus tendon and muscle as well as the teres minor tendon and muscle are within normal limits. Increased signal intensity in the distal fibers of the subscapularis tendon suggesting tendinosis, but no discrete tear is evident. The muscle appears normal.SUPRASPINATUS OUTLET: Moderate osteoarthritis affects the acromioclavicular joint. A small amount of fluid is noted within the subacromial-subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is trace fluid in the glenohumeral joint, without frank effusion. Given the limitations of a non-arthrogram study, the glenoid labrum appears normal.BICEPS TENDON: Given the limitations of a non-arthrogram study, the long head of the biceps appears normal.

Output: 1.Rotator cuff tendinosis with full-thickness insertional tear of the anterior fibers of the supraspinatus, as described above.2.Osteoarthritis affects the acromioclavicular joint.


Instruction: Generate impression based on findings.

Input: Sickle cell disease. Evaluate for stenosis or moyamoya. Brain MRI:There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is fluid in the right mastoid air cells and middle ear cavity which can be congestive or inflammatory. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Head MRA:The right internal carotid artery is slightly larger and more hyperintense compared to the left. The left A1 segment is small but there is a large right A1 segment along with a large anterior communicating artery providing preserved flow in the downstream right anterior cerebral artery and branches. The vertebral arteries codominantly supply the basilar artery. There is no left P1 segment but a large left posterior communicating artery provides the preserved flow in the more downstream left posterior-superior cerebral artery. There is no stenosis or aneurysm.

Output: 1.No evidence of acute intracranial hemorrhage, mass, or acute infarct.2.Fluid in the right mastoid cells can be congestive or inflammatory. 3.There is no vascular occlusion or moyamoya transformation. 4.Normal variations involving the anterior and posterior circulations are described above.


Instruction: Generate impression based on findings.

Input: Reason: r/o tendon History: R pain with limited ROM ROTATOR CUFF: There is partial-thickness tearing of the anterior fibers of the articular surface of the infraspinatus at the level of its insertion on the greater tuberosity measuring approximately 4 mm in AP dimension. The infraspinatus muscle appears intact. There is thickening and intermediate signal intensity within the supraspinatus indicating moderate tendinosis. There is partial thickness tearing of the anterior fibers of the articular surface of the supraspinatus at the level of its insertion on the greater tuberosity measuring approximately 10 mm in the AP dimension and involving less than 50% of the tendon width. There is also interstitial tearing of the supraspinatus more proximally. There is no significant retraction. There is mild fatty infiltration along the myotendinous junction of the supraspinatus and infraspinatus muscles. Evaluation of the subscapularis is limited due to lack of external rotation, however the subscapularis appears grossly intact. The teres minor muscle and tendon appear intact.SUPRASPINATUS OUTLET: There is a trace amount of fluid within the subacromial subdeltoid bursa. Mild osteoarthritis affects the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is anatomic. The glenoid labrum appears intact within the limitations of a non arthrogram study. There is cyst formation within the greater tuberosity.BICEPS TENDON: The tendon of the long head of biceps appears intact. There is circumferential fluid within the tendon sheath which may represent fluid extension of the joint. ADDITIONAL

Output: Partial thickness insertional tearing of the rotator cuff as described above. No evidence of a full-thickness rotator cuff tear or retraction. Rotator cuff tendinosis.


Instruction: Generate impression based on findings.

Input: Patient with history of stenosis presenting with severe right-sided lumbar radiculopathy. The axial T1-weighted images are degraded by patient motion. There is multilevel degenerative spondylosis. At L1-L2, there is hypertrophy of ligamentum flavum and degenerative facet joint disease without significant spinal canal or neural foraminal stenosis. There is mild loss of intervertebral disc space at this level. At L2-L3, there is mild facet joint degenerative disease without significant spinal canal or neural foraminal stenosis. At L3-L4, there is thickening of the ligamentum flavum, facet joint hypertrophy, and epidural lipomatosis, resulting in severe spinal canal and mild right neural foraminal narrowing. At L4-L5, there is loss of disc height with mild disc bulging, ligamentum flavum thickening, facet joint hypertrophy, and epidural lipomatosis, resulting in moderate to severe central spinal canal stenosis and moderate bilateral neural foraminal narrowing. At L5-S1, there are mild disc herniations, prominent ligamentum flavum thickening, facet joint hypertrophy, and epidural lipomatosis, resulting in moderate right and severe left neural foraminal narrowing. There are endplate degenerative bone marrow signal alterations and scattered areas of fatty marrow at multiple levels of the lumbar spine. The imaged portions of the spinal cord are unremarkable. The lumbar spine alignment is anatomic and the vertebral body heights are preserved. The paraspinal soft tissues are unremarkable. There is nodularity of the left adrenal gland.

Output: 1. Multilevel degenerative spondylosis and epidural lipomatosis, with marked narrowing of the spinal canal at L3-4 through L5-S1 and variable degrees of neural foraminal narrowing.2. Nonspecific nodularity of the left adrenal gland, which can be further evaluated via dedicated imaging.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Temporary aphasia - concern for TIA. Brain MRI: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild diffuse cerebral white matter T2 hyperintensity, particularly in a periventricular distribution. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Brain MRA: There is no evidence of significant steno-occlusive cerebrovascular lesions or aneurysms. There is a fetal left posterior cerebral artery and a hypoplastic left A1 segment, which are anatomic variants.Neck MRA: The proximal portions of the bilateral vertebral arteries are not well-delineated, likely due to artifact, although stenosis cannot be excluded. Otherwise, there is no evidence of significant steno-occlusive lesions.

Output: 1. No evidence of acute intracranial hemorrhage, mass, or acute infarct. Mild diffuse cerebral white matter T2 hyperintensity, particularly in a periventricular distribution may represent chronic small vessel ischemia.2. No evidence of significant steno-occlusive lesions or aneurysms. 3. The proximal portions of the bilateral vertebral arteries are not well-delineated, likely due to artifact, although stenosis cannot be excluded. Otherwise, no evidence of significant steno-occlusive lesions in the neck arteries. However, a CTA may be useful for further delineation if the status of the vertebral arteries are of clinical concern.


Instruction: Generate impression based on findings.

Input: Malignant neoplasm of unspecified part of unspecified bronchus or lung [C34.90], Reason for Study: ^Reason: lung cancer, evaluate for brain mets History: recent fall and loss of conscious, headaches There is no evidence of acute ischemic or hemorrhagic lesion.There is about 12.5mm (AP) x 11.4mm (CC) x 9.4mm (RL) sized extra-axial enhancing mass attached on the right side of the proximal which shows low signal intensity on T2 weighted images, and isointense signal intensity on T1 weighted image suggest possible meningioma, unchanged since prior scan in terms of size and MR characteristics.There are bihemispheric scattered somewhat patchy T2/flair high signal intensity lesions on periventricular white matter and centrum semiovale indicate nonspecific small vessel ischemic disease, unchanged since prior scan.The ventricles, sulci and cisterns are unremarkable. There is no intra-axial mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. No abnormal enhancement.3. Non specific small vessel ischemic disease.4. Unchanged right parafalcine extra axial enhancing lesion most likely represent a meningioma (about 11mm x 12mm) since prior scan.


Instruction: Generate impression based on findings.

Input: There is no acute infarct, mass effect, or cerebral edema. There is moderate diffuse global volume loss with superimposed diffuse ventriculomegaly which is out of proportion to the degree of sulcal prominence, with the right lateral ventricle larger than the left. There is also volume loss in the brainstem and the cerebellar hemispheres. There are few small foci of susceptibility effect in the brainstem, left anterior temporal lobe, and right frontal and parietal lobes likely representing chronic microhemorrhages, some of which may be subarachnoid in location. There is moderate periventricular and subcortical white matter T2 signal abnormality which is nonspecific, likely representing chronic microvascular ischemic changes, including multiple chronic lacunar infarcts along the thalami and possibly the basal ganglia likely superimposed upon prominent perivascular spaces in the bilateral basal ganglia. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable. There is mild mucosal thickening in the maxillary sinuses.

Output: 1.No acute infarct or mass effect.2.Moderate diffuse global volume loss including the brainstem and bilateral cerebellar hemispheres.3.Ventricular prominence may still be slightly out of proportion to the degree of volume loss, please correlate clinically for superimposed normal pressure hydrocephalus.4.Moderate chronic microvascular ischemic changes. Scattered foci of susceptibility likely representing chronic blood products, some of which may be in the subarachnoid space along the brainstem.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Anoxic brain damage, not elsewhere classified [G93.1] / Extrapyramidal and movement disorder, unspecified [G25.9], Reason for Study: ^Reason: f/u MRI, anoxic brain injury History: 12 yr F with anoxic brain injury secondary to hanging There is no evidence of acute ischemic or hemorrhagic lesion on this scan.Previously seen bilateral basal ganglia restricted diffusion are not demonstrated anymore on today's scan.On T2/FLAIR images, posterior aspect of basal ganglia which showed diffusion restriction on prior scan now shows almost normalized.The most prominent difference of this scan from prior scan is global brain volume loss. Bilateral supra and infra tentorial brain parenchyme show more prominent sulci and slightly increased ventricular system. 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. Mucosal thickening on ethmoid sinuses.Bilateral mastoid air cells show opacifications.

Output: 1. Interval resolution of bilateral posterior basal ganglia restricted diffusion lesions on today's scan.2. No evidence of acute ischemic or hemorrhagic lesion.3. Diffuse volume loss on bilateral supra and infra tentorial brain parenchyme comparing to prior scan.


Instruction: Generate impression based on findings.

Input: History of malignant mesothelioma in the right hemithorax status post pleurectomy and decortication. Epithelioid subtype. Presents for MRI evaluation of new left pleural effusion with nodularity on recent CT. LUNGS AND PLEURA: Postsurgical changes of the right lung base with moderate atelectasis and minimal pleural fluid. There is a small left pleural effusion as seen on the recent CT. There are left sided small pleural plaques. There are several small foci of subtle restricted diffusion and questionable foci of linear enhancement on post-contrast imaging in the left pleural space. No discrete measurable sites of disease are identified in the left hemi-thorax.Left lung base pleural enhancement is present and may be reactive to the pleural effusion. MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Numerous nonspecific right greater than left subcentimeter axillary and anterior abdominal wall lymph nodes.UPPER ABDOMEN: The upper abdomen is partially imaged. A large right renal cyst is partially seen.

Output: Suspicious but not conclusive evidence of tumor involvement of the left hemi-thorax, including several small foci of subtle restricted diffusion and questionable foci of post-contrast enhancement in the left pleural space but no discrete measurable sites of disease are identified in the left hemi-thorax. Stable non-specific small left pleural effusion and pleural enhancement which may be reactive. A follow-up surveillance MRI examination may be of value to assess the evolution of these findings.


Instruction: Generate impression based on findings.

Input: Chiari decompression with syrinx spine, yearly follow up: Back, shoulder, and neck pain, and headache. Brain: There are postoperative findings related to Chiari decompression and right tonsillar reduction. There is now encephalomalacia within the remaining right cerebellar tonsil and right biventral lobule. There is no evidence of pseudomeningocele. There is biphasic cerebrospinal fluid flow anteriorly and posteriorly across the neo-foramen magnum. The cerebellum extends to the level of the superior aspect of the odontoid. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There is no evidence of acute infarction of hemorrhage.Spine: There has been interval decrease in caliber of the cervical and thoracic syringohydromyelia, which measures up to 5 mm in width, previously 7 mm. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis.

Output: 1. Expected postoperative findings in the posterior fossa related to prior Chiari malformation surgery. 2. Interval decrease in caliber of the cervical and thoracic syringohydromyelia.


Instruction: Generate impression based on findings.

Input: Radicular low back pain, lumbosacral spondylosis without myelopathy. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign. There is mild disc desiccation at L2-L3 and L3-L4 levels and moderate desiccation at L5-S1 level. The conus medullaris is normal in position. There is prominent epidural fat at various levels resulting in moderate developmental narrowing of the distal spinal canal. There is mild grade I retrolisthesis of L5 on S1, approximately 3 mm. Minimal retrolisthesis as well as prominent epidural fat was demonstrated on previous CT dated 9/19/2014.Mild to moderate multilevel degenerative changes are seen, as described below:T11-T12: On sagittal imaging there is prominent ligamentum flavum thickening with moderate central spinal canal stenosis.L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: There is mild ligamentum flavum hypertrophy. There is facet arthropathy with joint effusion on the right. No spinal canal or neural foraminal stenosis.L3-L4: There is annular disc bulge with left-sided prominence causing mild left foraminal narrowing. There is mild to moderate spinal canal stenosis.L4-L5: There is diffuse disc bulge causing mild to moderate bilateral neural foraminal narrowing. There is mild hypertrophy of ligamentum flavum and bilateral facet hypertrophy and bilateral joint effusion. There is mild to moderate spinal canal stenosis.L5-S1: There is uncovering of the disc with superimposed mild disc bulge, left more than right, causing causing moderate to severe bilateral neural foraminal narrowing. There is ligamentum flavum hypertrophy and mild to moderate bilateral facet arthropathy. There is mild to moderate spinal canal stenosis. Paraspinous soft tissues are within normal limits.

Output: 1. Moderate degenerative disc disease predominantly involving L5-S1 causing moderate to severe bilateral neural foraminal stenosis.2. There is mild to moderate spinal canal stenosis at various levels predominantly due to prominent epidural fat.3. Unchanged minimal grade I retrolisthesis of L5 on S1.


Instruction: Generate impression based on findings.

Input: Clinical question: Left basal ganglial hemorrhage follow-up. Signs and symptoms: Right-sided weakness. CT of brain without infusion:A well-demarcated hematoma in the left basal ganglia measures 19 mm in transverse axis (axial image 13) and 31.8-mm in AP axis (axial image 14) in comparison with the prior MRI and CT examination there is no evidence of increase in the size of the hematoma. The periphery of hematoma is less defined than prior study which is consistent with breakdown of hemorrhage. There is subtle mass effect on the adjacent left lateral ventricle. This examination is otherwise unremarkable and stable and without any new additional findings.

Output: No evidence of new hemorrhage and essentially stable exam since prior study.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for stroke. Signs and symptoms: Dysarthria and aphasia. Nonenhanced brain MRI:There is no detectable acute intracranial process and diffusion-weighted images are negative.Examination redemonstrates extensive patchy and confluent foci of FLAIR hyperintensity in the periventricular and subcortical white matter of bilateral cerebral hemispheres, minimally in bilateral basal ganglia and moderate the in the pons and minimally in bilateral cerebral hemispheres without detectable change since prior study. Findings are consistent with chronic nonhemorrhagic small vessel ischemic strokes. Similar to prior exam there is a punctate focus of susceptibility in the left paramedian lower pons representing a punctate focus of chronic hemorrhage.Extra-axial dilatation of lateral ventricles similar to prior exam and with maintained midline. Prominence of cortical sulci are stated age similar to prior study.Signal void of major intracranial arterial branches are identified.Calvarium and soft tissues of the scalp as well as the orbits and paranasal sinuses are unremarkable.

Output: 1.No acute intracranial process and no evidence of diffusion weighted abnormalities.2.Stable extensive findings of small vessel ischemic strokes since prior exam as detailed.3.Prominence of cortical sulci and supratentorial ventricular system for patient's stated age similar to prior exam.


Instruction: Generate impression based on findings.

Input: Reason: fell on previous shoulder injury History: fell on right shoulder with pain. Suboptimal evaluation secondary to patient motion artifact.ROTATOR CUFF: There is thickening and intermediate signal intensity within the supraspinatus indicating moderate tendinosis. There is a small interstitial insertional tear of the supraspinatus at the level of its insertion on the greater tuberosity. There is mild fatty atrophy of the supraspinatus. There is mild tendinosis of the infraspinatus tendon. The infraspinatus muscle and tendon appear intact. There is mild fatty infiltration of the infraspinatus at the level of the myotendinous junction. The subscapularis and teres minor muscle and tendon appear intact.SUPRASPINATUS OUTLET: There is a trace amount of fluid within the subacromial subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is anatomic. There is articular cartilage degeneration affecting the anterior inferior glenoid with underlying subchondral cyst formation. The anterior and inferior glenoid labrum is heterogeneous and indistinct indicating degeneration and tearing.BICEPS TENDON: The tendon of long head of the biceps appears intact. There is increased signal abnormality within the intra-articular portion of the tendon the long head of the biceps indicating moderate tendinosis.ADDITIONAL

Output: 1. Minimally displaced fracture of the distal clavicle.2. Tendinosis and small insertional rotator cuff tear without evidence of a full-thickness tear or retraction.3. Osteoarthritis of the right shoulder including full-thickness articular cartilage degeneration along the glenoid and degeneration/tearing of the labrum.


Instruction: Generate impression based on findings.

Input: 65 years Male (DOB:8/13/1951)Reason: orbital tumor left History: collateralsPROVIDER/ATTENDING NAME: SUSAN M. KSIAZEK SUSAN M. KSIAZEK MRI orbits:The eyeballs are intact. No intraconal or extraconal space mass is identified. The extraocular muscles are intact. The lacrimal glands are symmetric and within normal limits in size and configuration. There is no optic nerve enhancement appreciated. The suprasellar cistern is intact . The right eye lens is thinSome mucosal thickening is present in the paranasal sinuses.

Output: There is no evidence for an orbital mass.


Instruction: Generate impression based on findings.

Input: Chemoradiation for left orbital stage 1 rhabdomyosarcoma: light sensitivity in left eye. There are post-treatment findings in the left orbit with mild high signal in the superotemporal region. There is no evidence of left optic nerve abnormality or evidence of gross measurable tumor. The right orbital contents are intact. The imaged portions of the brain appear unremarkable. The skull base appears unchanged. There is scattered paranasal sinus mucosal thickening and secretions. There is bilateral tympanomastoid fluid, left more than right.

Output: 1. Post-treatment findings in the left orbit without evidence of gross locoregional tumor.2. Persistent scattered paranasal sinus inflammation.3. Nonspecific inflammatory changes in the bilateral mastoid air cells, perhaps associated with Eustachian tube dysfunction, particularly on the left side.


Instruction: Generate impression based on findings.

Input: Breast density study, exam for research purposes only. Research scanning of both breasts was performed with the research protocol. The images are stored for research analysis. Formal interpretation was not performed, existing data are not to be used for clinical purposes.

Output: This study was completed for research purposes only. Formal interpretation was not performed, existing data are not to be used for clinical purposes.


Instruction: Generate impression based on findings.

Input: 35 year old male with right hip pain and discomfort. Evaluate for labral tear. ACETABULAR LABRUM: There is linear increased signal abnormality traversing the anterior superior acetabular labrum, best seen on series 801 image 15, consistent with labral tear.ARTICULAR CARTILAGE AND BONE: There is heterogeneous bone marrow signal abnormality affecting the imaged axial and proximal appendicular skeleton, which is nonspecific but may reflect residual islands of red marrow.SOFT TISSUES: The visualized musculature is normal in appearance. ADDITIONAL

Output: Tearing of the acetabular labrum as described above. Other findings as described above.


Instruction: Generate impression based on findings.

Input: 59 year old with diabetes admitted to outside hospital with volume overload and chest pain. Left VentricleThe left ventricle is normal in size with mildly reduced systolic function. The overall LV ejection fraction is 48%, the LV end diastolic volume index is 91 ml/m2 (normal range: 74+/-15), the LVEDV is 231 ml (normal range 142+/-34), the LV end systolic volume index is 47 ml/m2 (normal range 25+/-9), the LVESV is 119 ml (normal range 47+/-19), the LV mass index is 41 g/m2 (normal range 85+/-15), and the LV mass is 104 g (normal range 164+/-36). The left ventricular dysfunction is global and largely related to right ventricular pressure and volume overload. There is non-specific late gadolinium enhancement in a pattern not typical of coronary artery disease to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. The differential for this non-specific pattern includes previous myocarditis, sarcoidosis or other nonischemic cardiomyopathy. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is moderately dilated qualitatively (quantitatively EDV is normal in size indexed for BSA) with moderate-severely reduced systolic function. The overall RV ejection fraction is 30%, the RV end diastolic volume index is 103 ml/m2 (normal range 82+/-16), the RVEDV is 261 ml (normal range 142+/-31), the RV end systolic volume index is 72 ml/m2 (normal range 31+/-9), and the RVESV is 183 ml (normal range 54+/-17).Right AtriumThe right atrium is moderately dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is mild pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild to moderate regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is mildly dilated.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is a small pericardial effusion. The pericardium appears to be thickened (4-6 mm) with some suggestion of adherence to the myocardium in the apical right ventricle. There is increased bowing of the interventricular septum towards the left ventricle during inspiration. These findings are suggestive of constrictive pericarditis. Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. There is pericardial thickening with some suggestion of adherence to the myocardium in the apical right ventricle and supportive findings of interventricular dependence on real time imaging. These findings are highly suggestive of constrictive pericarditis. 2. The left ventricle is normal in size with mildly reduced systolic function. The overall LV ejection fraction is 48%.The left ventricular dysfunction is global and largely related to right ventricular pressure and volume overload. There is a small amount of diffuse, non-specific late gadolinium enhancement in a pattern not typical of coronary artery disease to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. 3. The right ventricle is moderately dilated qualitatively (quantitatively EDV is normal in size indexed for BSA) with moderate-severely reduced systolic function. The overall RV ejection fraction is 30%


Instruction: Generate impression based on findings.

Input: Aphasia and left-sided weakness. Stenosis potentially requiring intervention. Brain MRI: Many of the sequences are degraded by patient motion. There are small areas of restricted diffusion and high T2 signal in the right superior and middle frontal gyri. There is underlying encephalomalacia in the right basal ganglia, middle frontal gyrus, and right corona radiata. There is also diffuse patchy cerebral white matter T2 hyperintensity without corresponding restricted diffusion. There is no evidence of intracranial hemorrhage or mass. The ventricles are unchanged in size and configuration. There is no midline shift or herniation. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Brain MRA: The images are largely degraded by patient motion. There is paucity of flow-related enhancement in the right internal carotid vein. There is tenuous reconstitution of flow-related enhancement in the right middle cerebral artery at the circle of Willis, with a relative paucity of flow-related enhancement in the distal middle cerebral artery branches. There also appears to be asymmetrically less flow-related enhancement in the right anterior cerebral artery. There also appears to be irregular narrowing of the bilateral posterior cerebral arteries. The intradural vertebral arteries and Neck MRA: There is no discernible enhancement of the entire right internal carotid artery. The right common carotid and external carotid arteries appear to be patent. The left internal carotid, common carotid, and external carotid arteries also appear to be patent. However, there appears to be stenosis of the bilateral vertebral artery origins.

Output: 1. Acute right middle cerebral artery territory infarct superimposed upon chronic small vessel ischemic disease and chronic infarcts, without gross hemorrhagic transformation.2. Critical steno-occlusive disease at the origin of the right internal carotid artery. Further evaluation via Doppler ultrasound may be useful.3. Apparent stenosis of the bilateral vertebral artery origins. Discussed with Physician: AGNIESZKA A ARDELT at 2:40 PM on 10/28/15.


Instruction: Generate impression based on findings.

Input: Ms. Brown is a 66 year old female with newly diagnosed right breast cancer in two locations. She has a family history of breast cancer. Preoperative MRI is requested at this time. There is heterogeneous amount of fibroglandular tissue in both breasts.There are scattered foci of enhancement seen in both breasts, compatible with mild background parenchymal enhancement. However, no one focus is more suspicious than the rest. In the right upper outer breast, there are two areas of mass-like enhancement identified, that correspond to the two biopsy-proven malignancies. - The first area of mass-like enhancement is in the 11:00 location, measuring approximately 1.6 x 0.9 x 1.5 cm. A biopsy marker clip is seen at the peripheral aspect of this enhancement. - The second area of mass-like enhancement is in the 10:00 location, measuring approximately 1.4 x 1.3 x 1.7 cm. This measures slightly larger on the MRI, likely due to related post-biopsy changes. Of note, a 1.2 cm hematoma with increased T1 signal is identified just abutting the inferior aspect of this area of enhancement. A biopsy marker clip is also seen at the peripheral aspect of this area of enhancement. There is no additional site of abnormal enhancement seen in the right breast. There is no abnormal enhancement seen in the left breast. No abnormal axillary lymph nodes are identified in either axillary region.

Output: Biopsy proven multifocal breast cancer in the right breast. No additional MR evidence of malignancy identified. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Male 70 years old with recurrent cirrhosis status post OLT 4/05 for HCC and HCV cirrhosis. Evaluate for lesions, assess hepatic vessel patency. ABDOMEN:LIVER, BILIARY TRACT: The transplanted liver has a nodular contour and heterogeneous signal intensity consistent with chronic liver disease as seen on the previous exam. Perfusion artifact is noted at the periphery of the liver. A serpentine focus of enhancement in hepatic segment 7 is consistent with a portal venous to hepatic venous shunt (series 19/45). No suspicious arterial enhancing liver lesions are identified. The hepatic vasculature is patent.There is mild narrowing of the common bile duct at the expected location of the anastomosis but no intra or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Atrophic native kidneys contain multiple cysts. There is no hydronephrosis within the partially visualized right iliac fossa transplant kidney.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative changes affect the imaged spine.OTHER: No significant abnormality noted.

Output: 1.Allograft liver with findings of chronic liver disease. No suspicious liver lesion.2.Patent hepatic vasculature.3.Mild narrowing at the common duct anastomosis without significant intra or extrahepatic biliary ductal dilatation.


Instruction: Generate impression based on findings.

Input: Clinical question: Thunderclap headache. Signs and symptoms: Transient loss of focus while driving and thunderclap headache. The CSF spaces are appropriate for the patient's stated age of 75 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 to moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate scattered opacities in the ethmoid air cells and some mucosal thickening in the left sphenoid sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.Incidental notes are made of partial empty sella and an 8mm Thornwaldt cyst. These are likely of little clinical significance.

Output: 1.No evidence for acute ischemic cerebral infarction.2.Periventricular and subcortical white matter lesions of a mild to moderate degree are nonspecific. They are associated with increasing age and most likely vascular related.


Instruction: Generate impression based on findings.

Input: 62-year-old BRCA-positive female. Strong family history of breast cancer. There is scattered fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. A few enhancing foci in the lateral inferior left breast are stable. No abnormal lymph nodes are identified in either axillary region. Stable left lobe liver cysts are noted.

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


Instruction: Generate impression based on findings.

Input: Right knee pain MENISCI: The posterior horn of the medial meniscus is small and irregular in contour, compatible with multidirectional tearing. The body of the medial meniscus is partially extruded. The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is bone marrow edema involving the medial tibial plateau and lateral tibial spine. There is a large area of full-thickness cartilage loss involving the medial femoral condyle measuring up to nearly 2 cm in AP dimension and 5 mm in medial-lateral dimension. There is also a large area of full-thickness cartilage loss involving the medial tibial plateau measuring between 1.5 and 2 cm in AP dimension and 8 mm in medial-lateral dimension. There is mild cartilage thinning involving the lateral tibiofemoral articulation, with a small (3-5 mm) focal full-thickness defect in the lateral femoral condyle. There is diffuse cartilage thinning of the patella without focal defects identified.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1.Complex tearing of the medial meniscus as above.2.Large areas of full-thickness cartilage loss involving the medial femoral condyle and medial tibial plateau with less severe cartilage loss involving the lateral compartment and patellofemoral articulation as above.


Instruction: Generate impression based on findings.

Input: 67 year-old female history of RCC. ABDOMEN:LIVER, BILIARY TRACT: Stable bilobar subcentimeter nonenhancing simple cysts. No suspicious hepatic lesions.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Status post left nephrectomy. Subcentimeter nonenhancing right renal cysts.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: Postoperative changes of left nephrectomy with no evidence of recurrent or metastatic disease.


Instruction: Generate impression based on findings.

Input: Numbness and tingling unilaterally. There are several, approximately 10, scattered punctate T2 hyperintense supratentorial lesions in the periventricular and subcortical white matter. Some of the lesions are T1 hypointense. There is no abnormal intracranial enhancement. There is a small nodular convex contour of the right lateral aspect of the medulla. The brainstem and cerebellum otherwise appear to be unremarkable. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. Findings suggestive of demyelinating disease, such as multiple sclerosis.2. A small nodular convex contour of the right lateral aspect of the medulla may represent an accessory cuneate nucleus rather than neoplasm or heterotopion.


Instruction: Generate impression based on findings.

Input: 96 years Female (DOB:6/5/1920) PROVIDER/ATTENDING NAME: SERVICES ANCILLARY SERVICES ANCILLARY The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. There are patchy T2 and FLAIR hyperintense lesions also present in the brainstem.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: Periventricular and subcortical white matter and brainstem lesions of a mild degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: Reason: right elbow pain History: right elbow pain Due to technologist error, the sagittal STIR sequence was not performed.LIGAMENTS: The ulnar collateral ligament appears intact within the limitations of this non arthrogram study. The radial collateral ligament appears intact. The lateral ulnar collateral ligament appears intact.TENDONS: There is increased signal intensity within the common extensor tendon at its origin indicating tendinosis/mucoid degeneration and likely chronic partial thickness tearing. There is additional mild edema within the soft tissues adjacent to the lateral epicondyle. The common flexor tendon appears intact. The biceps and brachialis tendons appear intact. The triceps tendon appears intact.ARTICULAR SURFACES AND BONE: The articular cartilage of the radiocapitellar articulation appears thinned relative to the ulnotrochlear articulation and there are perhaps small cysts within the underlying capitellum suggesting mild osteoarthritis. The bone marrow signal intensity is otherwise normal. SURROUNDING STRUCTURES: The imaged musculature of the right elbow is unremarkable. Nerves appear normal.ADDITIONAL

Output: 1. Common extensor tendinosis/partial thickness tearing with mild adjacent soft tissue swelling.2. Mild osteoarthritis of the radiocapitellar articulation.


Instruction: Generate impression based on findings.

Input: Clinical question: evaluate for bleed. Signs and symptoms: Altered mental status. Status post fall. Nonenhanced head CT:Examination demonstrates no evidence of intracranial hemorrhage.Large area of low-attenuation involving the left posterior temporal and extending into the left occipital lobe and further superiorly into the parietal lobe. There is only suspected subtle mass effect and effacement of adjacent cortical sulci in particular in the parietal component. This finding although has the appearance of an old stroke possibility of a subacute component cannot be ruled out. There is no associated hemorrhage. Recommend further follow-up weighted and MRI exam to exclude acute/subacute stroke. One there is no evidence of hemorrhage midline shift or hydrocephalus.Calvarium is intact. Visualized mastoid air cells and middle ear cavities are pneumatized and unremarkable.Debris within bilateral external auditory canals.CT of cervical spine:Images through the skull base are unremarkable. The articulation of C1 and C2 remains within normal no fracture is detected. Degenerative changes of cervical spine with multilevel neural foramina compromise is identified. There is however no evidence of cervical spinal fracture. The alignment the vertebral column is unremarkable. There is however scoliosis.No detectable soft tissue abnormality of the neck.CT of orbits:Examination demonstrates preseptal periorbital swelling likely result of recent trauma. There is no evidence of fracture. The retro-orbital fat is within normal limits. There is normal morphology and density of globes with intact lenses. The extraocular musculature is unremarkable. Visualized paranasal sinuses are unremarkable.

Output: 1.Negative CT of cervical spine for fracture. Degenerative disk disease is noted.2.Head CT demonstrates large area of low-attenuation in the left posterior temporal extending to occipital and left parietal lobe. Although large segment of this finding appears as an old cortical stroke there are suspected areas of effacement of cortical sulci in the parietal region may indicate an overlapping acute/subacute new stroke. Recommend further follow-up with an MRI. There is no evidence of posttraumatic intracranial abnormality.3.CT of orbits demonstrate right sided preseptal periorbital swelling likely result of recent trauma. No evidence of fracture or any abnormality in the retroseptal region.


Instruction: Generate impression based on findings.

Input: Male, 13 years old. Reason: Please evaluate extent of Crohn's involvement History: Newly diagnosed Crohn's disease, abdominal pain, diarrhea, weight lossEXAMINATION: MR enterography without and with IV contrast 3/23/15, 1327 ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesions. No intrahepatic or extrahepatic ductal dilatation. The gallbladder is normal.SPLEEN: Normal size and enhancement.PANCREAS: Normal size and enhancement.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No focal lesions or significant hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: A segment of distal ileum approximately 20 cm in length up to the ileocecal valve shows multiple areas of bowel wall thickening and enhancement alternating with short segments of saccular dilation (series 2101, image 339). These findings suggest active inflammatory process. No evidence of stricture, fistula, or bowel obstruction.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: A segment of distal ileum approximately 20 cm in length up to the ileocecal valve shows multiple areas of bowel wall thickening and enhancement alternating with short segments of saccular dilation (series 2101, image 339). These findings suggest active inflammatory process. No evidence of stricture, fistula, or bowel obstruction.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Areas of bowel wall thickening/enhancement and saccular dilatation involving a 20cm segment of distal ileum up to the ileocecal valve, compatible with a suspected history of Crohn's disease.


Instruction: Generate impression based on findings.

Input: Bilateral renal cysts and right renal cystic lesion inadequately characterize on noncontrast CT 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: Incomplete evaluation given lack of intravenous contrast. There are multiple bilateral renal lesions, some with the appearance of simple cysts with homogeneous T2 signal seen, others are more complex and are T2 hypointense/T1 hyperintense. The largest lesion is in the right mid pole and measures 4.4 x 3.4 cm (series 6 image 22, series 9 image 21), previously measuring 4.1 x 3.4 cm on CT. Thin internal septations (as opposed to multiple cysts next to one another) suggested. There are several foci of T1 hyperintensity and scattered fluid fluid levels within several of the renal lesions, consistent with hemorrhage or proteinaceous material. Overall the lesions appear grossly unchanged in size over the interval.RETROPERITONEUM, LYMPH NODES: No lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: Incompletely evaluated renal lesions given the lack of intravenous contrast. Overall, the lesions are grossly unchanged in size and include simple cysts and complex cysts containing hemorrhage or proteinaceous material. Continued surveillance is recommended in 6-12 months using contrast enhanced MRI as the patient's renal function permits. Special attention should be given to the right mid pole lesion due to its heterogeneity, size and suggestion of thin internal septations.


Instruction: Generate impression based on findings.

Input: 27-year-old female with history of spindle cell sarcoma status post left nephrectomy. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Status post left nephrectomy. No evidence of disease recurrence.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: No evidence of recurrence or metastatic disease.


Instruction: Generate impression based on findings.

Input: Low thoracic and high lumbar back pain with history of neurofibromatosis type I. BRACHIAL PLEXUS: There is dextroconvex scoliosis of the mid cervical spine. The cervical vertebral bodies and a intervertebral disc spaces appear dysplastic. There is severe kyphosis of the cervical spine centered at C3-4 with lordosis centered at C6-7. A grade 1 retrolisthesis of C4 on C5 is seen.There is a 1.8 x 3.1 cm heterogeneously T2 hyperintense soft tissue lesion extending between the anterior arch of C1 and the dens causing expansion of the atlantodens interval up to 6 mm (series 501, image 47). This lesion is new or significantly increased since prior examination. The transverse ligament appears grossly intact but is stretched.There is a 1.6 x 1.4 cm T2 hyperintense lesion, likely a neurofibroma, expanding the left hypoglossal canal (series 701, image 74). In addition, there is a 1.4 x 2.0 cm expansile lesion involving the left C2-C3 neural foramen, also likely a neurofibroma. There appears to be a small amount of epidural fluid located along the posterior right margin of the thecal sac at the C3 level (series 701, image 51), similar to prior examination. There is moderate right neuroforaminal stenosis at C4-5 and C5-C6 secondary to right posterior disc osteophyte complex formation. The spinal cord demonstrates normal caliber and signal intensity.There are numerous ovoid T2 hyperintense lesions along the left jugular chain within the neck. The largest lesion measures 4.3 x 2.4 cm (coronal by transverse) (series 201, image 26). This lesion appears to impinge upon or perhaps arise from the exiting left upper cervical spine nerve roots. There are numerous small lesions along the distal left brachial plexus as well, however these lesions do not appear to significantly impinge upon the nerves. THORACIC SPINE: The thoracic alignment is preserved. The vertebral body heights and intervertebral disc spaces are maintained. There is no significant neuroforaminal or central spinal stenosis. The spinal cord demonstrates normal caliber and signal intensity.LUMBAR SPINE: The lumbar alignment is preserved. The vertebral body heights and intervertebral disc spaces are maintained. No worrisome focal marrow signal is identified. The spinal cord and conus demonstrate normal signal and morphology. The conus terminates at L2. A fatty filum is noted. No neuroforaminal stenosis or central stenosis is noted. Several T2 hyperintense lesions in the periaortic and retroperitoneal space are nonspecific and may be related to lymph nodes versus additional small neurofibromas.

Output: 1. There is a 1.8 x 3.1 cm heterogeneously T2 hyperintense soft tissue lesion extending between the anterior arch of C1 and the dens causing expansion of the atlantodens interval up to 6 mm. This lesion has increased significantly since prior examination. Given the heterogeneity and relatively rapid interval increase in size, malignant degeneration of a nerve sheath tumor should be considered. A CT of the cervical spine with contrast can be obtained to evaluate for bony erosion.2. Expansile lesions in the left hypoglossal canal and left C2-3 neural foramen and likely related to neurofibromas.3. Multiple bilateral jugular chain lesions are consistent with neurofibromas. The largest lesion in the left neck involves the exiting left upper cervical nerve roots and also potentially impinges on these nerve roots. 4. Multiple small probable neurofibromas involving the distal left brachial plexus are demonstrated. No definite right brachial plexus neurofibromas are seen.5. The cervical vertebral bodies are dysplastic with severe kyphosis of the mid cervical spine. 6. A fatty filum terminale is seen. However, the conus terminates at a normal level. The thoracic and lumbar spine appear otherwise unremarkable.


Instruction: Generate impression based on findings.

Input: Male, 75 years old, with low back pain status post L4-5 surgery. The lumbar lordosis is straightened, but sagittal alignment is otherwise unremarkable. Vertebral body height and morphology are within normal limits. No pathologic marrow replacement or marrow edema is seen.The visualized distal spinal cord, conus and cauda equina are unremarkable. No epidural abnormalities are suspected.Postoperative findings are seen at the L4-5 level including partial spinous process resection and probable laminectomy and thickening of the ligamentum flavum.Loss of disc height is evident at L2-3 and L4-5. With the exception of L1-2, all of the lumbar discs demonstrate loss of T2 signal. Additional level specific findings are as follows:L1-2: Unremarkable. L2-3: Mild disc bulging. No significant spinal canal narrowing. Mild bilateral foraminal narrowing. No interval changes.L3-4: Facet hypertrophy and ligamentum flavum thickening. Minimal disc bulging. No significant spinal canal narrowing. Mild bilateral foraminal narrowing. No interval changes. L4-5: Facet arthropathy. Mild disc bulging. No spinal canal stenosis. Severe right and moderate left foraminal narrowing. No interval changes. L5-S1: Facet arthropathy and ligamentum flavum thickening. Disc bulging and left paracentral annular fissuring. No significant spinal canal stenosis. Moderate right and mild left foraminal narrowing. No interval changes.

Output: 1.Relatively mild degenerative findings with no significant interval change. 2.There are no areas of high-grade spinal canal stenosis, though there is a severe narrowing of the right L4-5 neural foramen.3.Postoperative findings at L4-5 appear similar to the prior examination.


Instruction: Generate impression based on findings.

Input: Bilateral sciatica. There is no significant spinal canal or neural foraminal stenosis. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable, aside subcentimeter focal fat or hemangioma in the L4 vertebral body. The caudal spinal cord and conus medullaris display normal signal and morphology. The tip of the conus medullaris is located at the L1-L2 level. The paravertebral soft tissues are unremarkable.

Output: No significant spinal canal or foraminal stenoses in the lumbar spine.


Instruction: Generate impression based on findings.

Input: Right renal mass. Assess for interval change. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in size, morphology, and signal characteristics. Note is made of several hepatic cysts. No intrahepatic or extrahepatic biliary ductal dilatation. Gallbladder is normal in size without evidence of cholelithiasis. Note is made of focal adenomyosis in the gallbladder fundus. The portal vein and hepatic arteries are patent.SPLEEN: No significant abnormality noted.PANCREAS: The pancreas is normal in size, morphology, and signal characteristic. The main pancreatic duct remains minimally prominent, however it is better visualized today extending all the way into the pancreatic tail. No evidence of stricture as previously questioned.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Redemonstration of a T1 intrinsically hyperintense lesion in the interpolar region of the right kidney. This is not significantly changed in size from prior measuring 1.6 x 1.2 cm in the coronal plane, previously 1.5 x 1.1 cm. There is no appreciable enhancement on the postcontrast images. This is compatible with a benign proteinaceous or hemorrhagic cyst. There are additional simple renal cysts bilaterally. 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.Stable nonenhancing intrinsically T1 bright lesion in the right kidney compatible with a hemorrhagic/proteinaceous cyst.2.No evidence of pancreatic duct stricture as previously questioned.


Instruction: Generate impression based on findings.

Input: There are multiple, at least 10, supratentorial and infratentorial lesions with variable enhancement, many showing susceptibility effect consistent with hemorrhagic products, with variable surrounding confluent T2 hyperintensity. Aside from the calcified right hippocampus lesion, the lesions and associated edema are new from the prior MRI. Most of the larger lesions enhance irregularly along the periphery and are centrally necrotic. For example, a left cerebellar hemisphere lesion measures up to 6 mm, a left medial temporal lobe lesion measures up to 9 mm, a left temporal lobe lesion measures up to 11 mm, a left superior frontal gyrus lesion measures up to 12 mm, a right cuneus lesion measures up to 14 mm, and a right inferior parietal lobule lesion measures up to 19 mm. There is mild mass effect on the posterior horn and atrium of the lateral ventricles, right greater than left. However, there is no significant midline shift. There is a background of punctate T2 hyperintense signal abnormality scattered in the supratentorial periventricular and subcortical white matter which are nonspecific. There is no evidence of acute infarct. The orbits, skull, and scalp soft tissues appear unremarkable.

Output: Multiple supratentorial and infratentorial metastases, many of which are hemorrhagic, but no evidence of acute infarct, midline shift, or herniation.Discussed with Dr. Lukas at 10:30 AM on 4/24/15.


Instruction: Generate impression based on findings.

Input: Note the left sagittal oblique images could not be acquired as the patient requested the study be terminated.Alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign. The cervical and upper thoracic cord are normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. Heterogeneous foci are noted within bilateral thyroid lobes, with a left left focus demonstrating a mixture of both T2 hyperintense and hypointense contents measuring up to 14 mm.C2/3: Mild degenerative changes without stenosisC3/4: Posterior osteophyte disc complex with a central extruded component which causes anterior cord flattening without intrinsic cord signal abnormality. There is also bilateral uncinate hypertrophy and ligamentum flavum thickening. There is mild central, severe left neural foraminal, and moderate right neural foraminal stenosis.C4/5: Posterior osteophyte disc complex, bilateral uncinate hypertrophy, and ligamentum flavum thickening. There is mild central and severe bilateral neural foraminal stenosis.C5/6: Posterior osteophyte disc complex, bilateral uncinate hypertrophy, and ligamentum flavum thickening. There is mild central and severe bilateral neural foraminal stenosis.C6/7: Posterior osteophyte disc complex, bilateral uncinate hypertrophy, and ligamentum flavum thickening. There is severe bilateral neural foraminal stenosis.C7/T1: Bilateral facet hypertrophy without stenosis.T1/2: Bilateral facet hypertrophy and endplate spurring causes mild bilateral neural foraminal stenosis.T2/3: Right facet hypertrophy and endplate spurring causes mild bilateral neural foraminal stenosis.T3/4: Right facet hypertrophy and endplate spurring causes moderate right neural foraminal stenosis.T4/5: Right facet hypertrophy and endplate spurring causes mild right neural foraminal stenosis.

Output: 1.Heterogeneous foci are noted within bilateral thyroid lobes, with a left left focus demonstrating a mixture of both T2 hyperintense and hypointense contents measuring up to 14 mm. A dedicated thyroid ultrasound is recommended for further characterization, especially of the more heterogeneous, greater than 1 cm left thyroid nodule.2.C3/4: Mild central, severe left neural foraminal, and moderate right neural foraminal stenosis.3.C4/5: Mild central and severe bilateral neural foraminal stenosis.4.C5/6: Mild central and severe bilateral neural foraminal stenosis.5.C6/7: Severe bilateral neural foraminal stenosis.6.T1/2: Mild bilateral neural foraminal stenosis.7.T2/3: Mild bilateral neural foraminal stenosis.8.T3/4: Moderate right neural foraminal stenosis.9.T4/5: Mild right neural foraminal stenosis.


Instruction: Generate impression based on findings.

Input: Diagnosis: Disturbance of skin sensationClinical question: please do Dr Javed MS protocol on 3 Tesla MRI, compare to image in PAXSigns and Symptoms: numbness MRI brain: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 punctate T2 and T2 and FLAIR hyperintense lesion present in the right temporal lobe subcortical white matter which is unchanged since the prior exam. Additionally there are several more subcortical white matter lesions in the subcortical white matter of the frontal lobes which also present on the prior exam and are unchanged.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.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal enhancing lesions are identified in the cervical spine. There is straightening of the normal cervical curvature present with mild reversal centered at C5-6. Mild disc bulge present at C5-6.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina. There is a minor disc bulge present at this level.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.There are several subcortical white matter lesions present in the brain which are nonspecific and most likely of little clinical relevance given their number and stability.2.No cervical spinal cord lesions are appreciated to explain the patient's symptoms.3.There is a minor disc bulge present at C5-6 without significant compromise to spinal canal or exiting nerve roots


Instruction: Generate impression based on findings.

Input: 68 year old female with possible right patellar tendon tear on plain film. MENISCI: The medial meniscus appears intact. There is globular increased signal abnormality within the body of the lateral meniscus consistent with intrasubstance degeneration. Some of this signal extends to the femoral articular surface consistent with degenerative tearing/superficial fraying.ARTICULAR CARTILAGE AND BONE: There is a focal full thickness articular cartilage cleft along the medial facet of the patella with underlying degenerative subchondral signal abnormality and cyst formation. There is subjective thinning of the lateral tibiofemoral compartment articular cartilage. There is a focal full-thickness articular cartilage degeneration along the lateral tibial plateau with underlying subchondral signal abnormality. There is full-thickness articular cartilage degeneration along the posterior aspect of the medial femoral condyle with underlying degenerative subchondral signal abnormality.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact. There is increased signal abnormality within the distal fibers of the patellar tendon indicating mild patellar tendinosis.ADDITIONAL

Output: 1. Findings consistent with mild patellar tendinosis. The patellar tendon appears intact.2. Full-thickness articular cartilage cleft and degeneration as described above.3. Intrasubstance degeneration/degenerative tearing of the lateral meniscus.4. Nonspecific subcutaneous edema along the anterior aspect of the patellar tendon.


Instruction: Generate impression based on findings.

Input: Newly diagnosed prostate cancer. Evaluate extent of disease. Pathology dated 7/8/2015 showed 3+3 disease in the right medial and lateral apex PELVIS:PROSTATE:Prostate Size: 2.9 x 4.4 x 4.3 cmPeripheral Zone: Extensive intrinsic T1 weighted hyperintensity throughout the peripheral zone reflecting hemorrhage from biopsy. No discrete measurable lesion.Central Gland: Approximately 8 mm focus in the apex anterior transition zone (series 501/42) demonstrating restricted diffusion and T2 weighted hypointensity abutting the anterior capsule.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: The right apex lesion abuts the anterior capsule.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Extensive post biopsy changes of the peripheral zone without a discrete focus of disease in the peripheral zone. Small focus in the anterior transition zone of the apex may represent site of prostatic carcinoma. The lesion abuts the anterior capsule.


Instruction: Generate impression based on findings.

Input: Hip pain drainage Note that the examination is limited by inability to optimally position the patient, and the patient's body habitus, and by motion artifact.Within the posterior lateral subcutaneous tissues of the left hip is an ill-defined rim-enhancing mixed air and fluid collection measuring approximately 14 x 7.8 x 13 cm in the greatest transaxial and craniocaudal dimensions. This collection extends to the posterior skin surface and abuts the lesser trochanter which demonstrates marrow signal intensity consistent with osteomyelitis. Additional areas of abnormal marrow signal intensity are identified within the left posterior superior acetabulum and left inferior pubic ramus representing additional areas of acute/chronic osteomyelitis.There is a moderate-sized joint effusion. Marked edema of the left pelvic musculature is also present particularly the obturator internus and gluteus medius.

Output: Septic arthritis of the left hip with associated subcutaneous abscess and chronic osteomyelitis.


Instruction: Generate impression based on findings.

Input: 48-year-old female presents for MR directed ultrasound of the left breast. The patient has known right breast DCIS. MRI (11/21/2016) demonstrated a small benign-appearing mass in the left 3:00 position. MR directed ultrasound was performed. Detected was a circumscribed oval mass without blood flow measuring 5 x 4 x 6 mm at 3:00 position, 2 cm from nipple in the left breast. This mass corresponds to the enhancing lesion on the MRI.

Output: Benign mass in the left breast at 3:00 position, corresponding to the MR findings. Because this is benign, no further assessment is needed. BIRADS: 2 - Benign finding.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: 21-year-old female with C2 -- C3 neurofibroma. Preplanning for surgical resection. Images through the skull base including cavernous sinuses are unremarkable. Calcific and atrophic right globe is noted. Paranasal sinuses and mastoid air cells are unremarkable.Images through the soft tissues of the neck demonstrate a very large non-enhancing mass on the right side of the neck measuring approximately 37 mm in transverse axials and 26-mm in AP axis (axial image 49). This mass extends into the right C3 -- C4 neural foramina with significant expansion and remodeling of the bone. There is also extension of mass into the vertebral body of C4 as well as C4 -- C5 neural foramina which also demonstrates significant expansion. There is suggestion of significant extension of mass into the spinal canal at C3 -- C4 and C4 there C5 the findings are consistent the patient's known neurofibroma. Multiple additional small nonenhancing masses consistent with patient's known neurofibromatosis is also noted. None of these lesions demonstrate any significant enhancement.These findings are better visualized on MRI examination of soft tissues of the neck.

Output: Findings consistent with neurofibromatosis as detailed above.


Instruction: Generate impression based on findings.

Input: 35-year-old female with left lower quadrant and abdominal pain. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: There is gallbladder sludge versus cholelithiasis. No definite evidence of cholecystitis.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXAE: The uterus is enlarged and there is a central fundal mass which measures 5.6 x 6.4 cm, most likely due to a fibroid, at axial image 114/157. There is a larger anterior and superior central pelvic mass extending from the uterus which appears circumscribed with a thickened wall that measures 8.2 x 10 x 14.3 cm on axial image 91/157 of series 3 and coronal image 67/100. This mass contains fluid and central fat density. There are peripheral calcifications best seen at axial images 86 - 87/157 and coronal image 57/100. These findings suggest the presence of a mature cystic teratoma. Further evaluation with transvaginal ultrasound and/or MRI may be helpful, if indicated.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: A small amount of pelvic free fluid is present.

Output: Central pelvic mass(es) as probably consisting of a fibroadenoma and teratoma, as described above. Further evaluation with transvaginal ultrasound and/or MRI may be helpful, if indicated.Cholelithiasis without cholecystitis.


Instruction: Generate impression based on findings.

Input: 53 years, Male, Reason: history of RALP for prostate cancer, now with biochemical recurrence. Evaluate for any nodules, nodes, or signs of recurrence History: biochemical recurrence of prostate cancer. PELVIS:PROSTATE:Prostate Size: Status post prostatectomy.Peripheral Zone: Status post prostatectomy.Central Gland: Status post prostatectomy. A small tubular focus with enhancement but no abnormal ADC/T2 signal in the surgical bed (1001/14 and 1901/1468) most likely represents a vessel. No definite evidence of recurrence.Seminal Vesicles: Status post removal of seminal vesicles.Extracapsular Extension: Status post prostatectomy.BLADDER: No significant abnormality noted.LYMPH NODES: Small inguinal lymph nodes.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No evidence of local recurrence.


Instruction: Generate impression based on findings.

Input: Finger mass Just deep to the flexor tendons of the index finger and slightly distal to the A2 pulley is a well-circumscribed mass measuring approximately 5 x 2 mm. The mass appears intimately associated with the flexor tendon sheath and flattens the underlying flexor tendon. The underlying bone is normal in signal with no evidence of erosive change. This mass demonstrates isointense signal on T1 and is slightly hyperintense on T2 sequences. Following contrast administration, there is suggestion of some enhancement on the coronal postcontrast sequence although there is no significant difference in signal between the axial pre and post images. Probable cyst noted in the head of the third metacarpal.

Output: Well-circumscribed mass appearing intimately associated with the flexor tendon sheath of the index finger. The location and signal characteristics is most suggestive of a giant cell tumor of tendon sheath.


Instruction: Generate impression based on findings.

Input: Reason: Rule out posterior circulation stroke. Evaluate centrum semiovale CT hyperintensity for hemorrhage or tumor. History: Sudden onset unsteadiness, vomiting, vertical nystagmus. There is no evidence of acute infarct. There is a lesion with substantial susceptibility effect and central T1 hyperintensity in the right posterior centrum semiovale that measures up to 10 mm. There is no surrounding edema or abnormal enhancement. There are a few scattered punctate foci of nonspecific cerebral white matter T2 hyperintensity. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: A lesion in the right posterior centrum semiovale that measures up to 10 mm likely represents a cavernous malformation. No evidence of developmental venous anomaly, acute hemorrhage, or acute posterior circulation infarction.


Instruction: Generate impression based on findings.

Input: Clinical question: Postop. Signs and symptoms: Seizures. Pre and post enhanced brain MRI:Examination demonstrates a surgical cavity in the right posterior parietal and extending inferiorly into the right posterior temporal lobe abutting the trigone of right lateral ventricle. Surgical cavity demonstrates expected serosanguineous fluid content. Its irregular shape makes precise measurements difficult however it measures maximum of 29 mm in transverse, 20 mm in AP and 44 mm in craniocaudad dimensions. There is surrounding vasogenic edema and with resultant mass effect and including trace deviation of midline to the left.T1 hyperintensity within the surgical cavity representing blood products precludes precise assessment for presence of enhancement or detection of tumor. Within this limitation however subtle patchy thin linear enhancement along the surgical cavity wall is detected which is within expected postoperative change. Further follow-up is needed to exclude residual tumor.Unremarkable exam otherwise and without detectable abnormal focus of enhancement or signal abnormality.There is a small epidural collection under the craniotomy flap measuring approximately 9 mm in thickness with subtle mass effect on the adjacent parenchyma. Subgaleal serosanguineous fluid and air overlapping the calvarium in the surgical region is also noted. Expected postoperative pneumocephalus in the right frontal subarachnoid space is noted.

Output: 1.Surgical cavity measuring 29 x 20 x 44 mm extending from right posterior parietal inferiorly abutting the right trigone of the lateral ventricle. No convincing evidence of residual tumor on this initial study. Follow-up is needed.2.Vasogenic edema surrounding the surgical cavity and postoperative changes results in regional mass effect as well as trace deviation of midline to the left.3.Expected postoperative changes of 9 mm thick epidural collection under the flap and subgaleal fluid/air as well as right frontal subarachnoid pneumocephalus as detailed.


Instruction: Generate impression based on findings.

Input: Female with history of ovarian tumor. ABDOMEN:LIVER, BILIARY TRACT: Several images are degraded by artifact. The liver is normal in morphology, signal intensity and enhancement. No biliary ductal dilatation. No vascular abnormality.There are at least 3 lesions identified demonstrating mild T2 weighted hyperintensity and peripheral rim enhancement on postcontrast imaging, suspicious for metastatic disease. The segment 7/8 lesion measures 1.1 cm (series 12 image 11). The segment 5 peripheral lesion measures approximately 8 mm (series 12 image 30). The segment 2 peripheral lesion measures approximately 9 mm (series 12/28). Additional very small peripheral segment 7/8 T2-weighted hyperintensity. These lesions are decreased in size when compared to the 4/9/2015 CT.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: Outside exam read:Several enhancing lesions in the liver are compatible with metastatic disease and are decreased in size compared to the 4/9/2015 outside hospital CT.


Instruction: Generate impression based on findings.

Input: 16 year old status post patellar dislocation. MENISCI: The menisci are intact.ARTICULAR CARTILAGE AND BONE: No bone marrow edema. The articular cartilage is intact.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: No evidence of an acute injury. However, there is an abnormally shallow trochlear groove which places the patient at risk for recurrent patellofemoral dislocations.


Instruction: Generate impression based on findings.

Input: History of prolactinoma. There is an unchanged 5 x 7 mm nodular lesion along the right anterior aspect of the pituitary gland with slight protrusion into the right cavernous sinus. The infundibulum is situated in the midline and not thickened. The optic apparatus is intact.

Output: Unchanged subcentimeter lesion along the right anterior aspect of the pituitary gland, which may represent a prolactinoma.


Instruction: Generate impression based on findings.

Input: Headache. CVA. Cerebral infarction.IMAGE ACQUISITIONS: 4.5-mm contiguous axial CT sections of the brain without contrast infusion. No acute intracranial hemorrhage, mass effect or shift of midline structures. Small low attenuation lesions in the cerebellum consistent with chronic infarcts are again noted. A low-attenuation lesion in the genu of the right corpus callosum, consistent with chronic lacunar infarction is unchanged. Multiple small foci of periventricular low-attenuation have not significantly changed. There is abnormal low attenuation in the genu of the corpus callosum, corresponding with high signal intensity on MRI. Low-attenuation is also present in bilateral periatrial white matter. Small juxtacortical foci of low-attenuation are again noted. A chronic left occipital infarct is unchanged.

Output: Stable CT findings. No CT evidence of new infarction. No acute intracranial hemorrhage.